Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.
Incredible Years: Agencies and Administrators
Abstract: To evaluate the 12-month efficacy of a parentbased intervention programme on children?s and mothers? outcomes in a sample of Portuguese preschoolers displaying early hyperactive and inattentive behaviours (AD/HD behaviours), 52 preschool children whose mothers had received the Incredible Years basic parent training (IY) were followed from baseline to 12 months of follow-up. Reported and observational measures were used. Effects were found in the children?s reported AD/HD behaviours at home and at school after 12 months. Large effect sizes were also found in mothers? variables: a decrease in selfreported dysfunctional parenting practices and an improved sense of competence and observed positive parenting. However, the improvements in coaching skills that have been observed after 6 months of follow-up decreased over time. No other significant differences were found between 6 and 12 months follow-up, with small effect sizes indicating that the significant post-intervention changes in child and parenting measures were maintained. After 12 months of follow-up, there was a clinically important reduction of over 30 % in reported AD/HD behaviours in 59 % of children. The sustained effects observed both for children and their mothers suggest long-term benefits of IY. Therefore, efforts should be made by Portuguese policy makers and professionals to deliver IY as an early preventive intervention for children displaying early AD/HD behaviours.
This study, one of the first within a European context, focused on a high-risk sample recruited from real-world urban settings and showed significantly improved child and parent outcomes following a parenting intervention delivered by regular, communitybased service staff. The findings reported here support the importance of early childhood intervention and the utility of evidencebased parenting programs in community-based services in different cultural contexts and in settings characterized by high levels of social disadvantage. This work is an important step in the development, evaluation, and delivery of empirically validated interventions for vulnerable young children with conduct problems and their families. These findings should serve to guide future policy and practice decisions for governments and practitioners who are considering investing in and/or delivering the Incredible Years BASIC Parenting program for children with behavioral problems in disadvantaged communities across different geographical and cultural contexts.
There is strong evidence for the effectiveness of IY with diverse parenting populations but this is the first known study of the programme with bereaved families. The findings support its use with such families where child behaviour is a concern.
Parents own grief reactions, coupled with the multitude of practical stressors, may impact their ability to provide emotional care and stability for remaining children (Worden, 1996). Pfeffer et al. (2000) stressed that parents can become so overwhelmed and consumed by their own loss that they become less aware of their children?s emotional state. Alternatively, a parent?s own grief may prevent them from being able to cope with their child?s emotional and psychological needs. A parent?s level of physical and emotional exhaustion following the death of a spouse or significant family member may leave them with few internal resources to handle the new challenges of parenting
There is lack of research on the importance of including fathers in parent training programs. This study?s? main purpose is to examine the short-term effects of fathers attending an Incredible Years Parent Training (IY) for Portuguese preschoolers with oppositional/defiant symptoms. Thirty-six children (whose fathers were willing to attend a parenting group with their wives or partners) were randomly assigned either to receive the IY Program or to a waiting-list control group. Outcomes for the study included self-reported parenting-related variables and parents? ratings of their children?s behaviors. Data were collected before the intervention and six months after it. Results showed significant effects on fathers? positive parenting practices and ratings of children?s prosocial behaviors, as well as a reduction of the impact of symptoms on family functioning. Findings provided support for the short-term effectiveness of the IY intervention in Portuguese fathers of preschoolers with oppositional symptoms.
This study reports on analysis of official record data gathered on 237 primary teachers enrolled in the Incredible Years Teacher (IYT) programme during 2010-2011. IYT is a group based programme that provides teachers with training in skills to manage disruptive classroom behaviours. Before and after comparisons showed that after the provision of IYT teachers reported significant (p < 0.001) increases in the frequency of use and usefulness of positive behaviour management strategies. In addition there were generally high levels of teacher satisfaction with various aspects of the programme including: the overall programme; teaching strategies used in the course; specific teaching techniques; and workshop leaders. These findings provide preliminary evidence of the efficacy of IYT and teacher satisfaction with the programme. It is suggested that further evaluations of the programme are conducted using a randomised wait list design.
There is a growing evidence base showing the efficacy of school-based interventions to prevent conduct problems but few evaluations have addressed teachers? perceptions of these programmes.
In this study teachers reported benefits to their own teaching skills and professional development, to their relationships with children and to the behaviour, social-emotional competence and school readiness skills of the children in their class. Teachers also reported benefits to teacher?parent relationships and to children?s behaviour at home.
In the UK between three and seven percent of children aged five to 15 years meet diagnostic criteria for conduct disorder (CD; National Institute for Health and Clinical Excellence [NICE], 2006); boys are three times more likely than girls to have such problems (Hutchings, Williams, Martin, & Pritchard, 2011; Office for National Statistics, 2007). Children with early onset behavioral problems likely to develop into CD are at high risk for social and emotional problems, poor school attendance, school dropout, academic failure and delinquency (Webster-Stratton, Reid, & Stoolmiller, 2008). Over the last decade, teachers have reported increasing levels of behavioral problems within the classroom (Hutchings et al., 2011). These children are often taught by teachers who are ill prepared to cope with disruptive behavior (Webster-Stratton et al., 2008). They are also likely to receive less support and positive feedback from their teachers and their peers (Arnold et al., 1999). Exposure to a supportive teacher and a positive classroom environment improves the academic achievement of high-risk children (Werner, 1999). High levels of praise for appropriate behavior improve children?s behavioral, social, and emotional adjustment as does the use of proactive teaching and positive discipline strategies (Webster-Stratton et al., 2008). These studies demonstrate that there is a need for effective, evidence-based classroom intervention programs to support teachers.
Children of incarcerated mothers are considered at risk for disruptive behavior problems and later delinquency. Parenting may play a key role in this intergenerational transmission of delinquency. The present study aimed to evaluate the effectiveness of the Incredible Years parent training, enhanced with home visits, for (formerly) incarcerated mothers to prevent disruptive behavior problems in their 2- to 10-year-old children, by means of a nationwide randomized controlled trial. Mothers of 133 children
(M age?76.91 months; 48.9% boys) were assigned to an intervention, consisting of group sessions and individual home visits, or a no-intervention control group. The intervention yielded significant effects on parenting and child behavior for maternal report. Marginally significant effects on child behavior were found for teacher report. The
results show short-term effectiveness of parent training for the high-risk and hard-toreach population of (formerly) incarcerated mothers and their children.
Although co-morbid diagnoses often are not the presenting problem for a child with ODD, they convey additional risk in short- and long-term treatment outcomes and may be directly or indirectly contributing to the externalizing behavior problems (C. Webster-Stratton, 1985, 1990). Thus, treatments that target children?s oppositional and aggressive behaviors, such as the Incredible Years (IY) Child Dinosaur Curriculum must be flexible enough to meet the needs of children with complicated profiles. Since young children cannot easily communicate their feelings or worries and the reasons for their misbehavior, it is important for therapists to look beyond the aggressive symptoms to the underlying reasons for the misbehavior.
Children with intellectual or developmental disabilities (ID/DD) are more likely than typically developing children to experience behaviour problems. Parent training, such as the IncredibleYears Parent Training (IYPT) series, has been a widely used intervention to support families with children with or at-risk for behaviour problems; yet to date, this programme has not been used with parents with young children with developmental delay or disabilities.
Over the past thirty years, hundreds of carefully controlled studies have demonstrated that there exist today a number of effective therapies and services for children and families which can reduce behaviour problems and delinquency, improve mental health, assist abusive parents to improve their child-rearing, and increase family functioning (Weisz and Weiss, 1993). Yet in spite of this evidence, few empirically supported interventions have been widely adopted in applied settings (Kazdin, Bass, Ayers, and Rodgers, 1991). In the paper, we describe an empirically supported parenting intervention developed and evaluated by the first author, including the strategies used to make it easy for clinicians in the field to implement with integrity.
While cultural adaptations have been made for specific cultural groups, the appeal of the more ?generic? but culturally sensitive EBP is that it is cost effective and allows for more flexibility in program delivery because it can be used with heterogeneous cultural groups rather than single culture groups. Multicultural groups can also foster greater understanding among parents of differing cultural backgrounds and experiences leading to more tolerant and respectful communities. The challenge of this approach is to train therapists to provide the EBPs using culturally sensitive principles that are generalizeable across cultures. The Incredible Years (IY) Parenting program has shown promising effects in many random control group studies with diverse cultures in United States as well as in numerous other countries. This paper reviews the ?principles? embedded deeply in the IY program, which are designed to provide a culturally sensitive structure to the delivery of the program.
Childhood aggression is escalating and at younger ages. The developmental progression of aggression in children suggests that the propensity for physical aggression and oppositional behaviour is at its highest at age two. Typically, as children develop, aggression begins to subside in each subsequent year and reaches a relatively low level prior to entering school (ages five to six). However, for some young children, levels of aggressive behaviour remain high and eventually result in the diagnosis of Oppositional Defiant Disorder (ODD) or early onset Conduct Disorder (CD). These labels refer to an aggregate of disruptive and antisocial behaviours that include high rates of oppositionality, defiance, and aggression. Studies indicate that between 7% and 20% of children meet the diagnostic criteria for ODD and/or CD and that these rates may be as high as 35% for children from low-income welfare-dependent families.
Subject Research on the prevention and treatment of aggression is vitally important because the emergence of early onset ODD/CD in preschool children is stable over time and appears to be the single most important behavioural risk factor predictive of antisocial behaviour for boys and girls in adolescence.4,5 In particular, physically aggressive behaviour in children as young as age three has repeatedly been found to predict the development of violent juvenile delinquency and drug abuse in adolescence,6 as well as depression and school dropout rates.7 There is some suggestion that, in the absence of intervention, early starter aggressive tendencies in children may crystallize around age eight.8 At this point in life, learning and behavioural problems may become less amenable to intervention and more likely to develop into a chronic disorder.9 Since treatment of aggression becomes increasingly difficult and more costly as children grow older, it seems both pragmatic and cost effective to offer treatment and prevention efforts during the toddler and preschool years. Unfortunately, recent projections suggest that less than 10% of school-aged children (and even fewer preschool-aged children) who need services for aggressive behaviour actually receive them;10 and less than half of this group receive empirically validated interventions.
Read the article (French version) (PDF)
Agressivité chez les jeunes enfants : services ayant fait leurs preuves dans la r?duction de l?agressivit?
Background: Parenting practices predict early childhood physical aggression. Preventive interventions that alter parenting practices and aggression during early childhood provide the opportunity to test causal models of early childhood psychopathology. Although there have been several informative preventive intervention studies that test mediation models in older children, no such studies have been conducted with younger children at high risk for psychopathology.
Method: Within the context of a randomized controlled trial, we examined whether changes in parenting practices mediate the effects of a family intervention on observed physical aggression among African American and Latino younger siblings of adjudicated youths.
Results: Improved parenting practices partially mediated the intervention effect on physical aggression. Improvements in harsh parenting, responsive parenting, and stimulating parenting explained a significant amount of the intervention effect on child physical aggression observed in the context of parent?child interactions. Parenting practices accounted for 38% of the intervention effect on physical aggression.
Conclusions: There was support for the hypothesized model of the prevention of physical aggression during early childhood. Intervention benefits on parenting practices partially accounted for intervention effects on physical aggression in young high-risk
Low-income children often develop in environments that undermine adjustment and academic success. One key challenge facing schools serving children in poverty is that teachers lack the training and ongoing support needed to manage challenges these children present. The Incredible Years Classroom Management Teacher Training Program (IYS-TP) is one program that improves classroom atmosphere and teacher practices, encourages social-emotional development in the classroom, and ultimately reduces behavior problems and enhances school readiness skills among high risk, low-income children.
Background: This study examined the effectiveness of an evidence-based parent training program in a real-world Scandinavian setting.
Method: Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self-referred to participate in the Incredible Years? Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self-report data with data from a recent efficacy study.
Results: Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months.
Conclusions: The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence-based U.S. protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy-access early intervention to families of children with or at risk of ADHD.
Summary: Parenting programmes that are delivered in group settings have the potential to help parents develop parenting skills that improve the behaviour of their young children. This review provides evidence that group-based parenting programmes improve childhood behaviour problems and the development of positive parenting skills in the short-term, whilst also reducing parental anxiety, stress and depression. Evidence for the longer-term effects of these programmes is unavailable. These group-based parenting programmes achieve good results at a cost of approximately $2500 (?1712 or ?2217) per family. These costs are modest when compared with the long-term social, educational and legal costs associated with childhood conduct problems.
Background: Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.
Objectives: To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.
We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.
We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.
Data collection and analysis:
Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.
This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.
Authors’ conclusions: Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
Article is available for purchase: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008225.pub2/abstract
Incredible Years Training for Parents. The Incredible Years parenting series includes three programs targeting parents of high-risk children and/or those displaying behavior problems. The BASIC program emphasizes parenting skills known to promote children’s social competence and reduce behavior problems such as: how to play with children, helping children learn, effective praise and use of incentives, effective limit-setting and strategies to handle misbehavior. The ADVANCE program emphasizes parent interpersonal skills such as: effective communication skills, anger management, problem-solving between adults, and ways to give and get support. The SUPPORTING YOUR CHILD’S EDUCATION program (known as SCHOOL) emphasizes parenting approaches designed to promote children’s academic skills such as: reading skills, parental involvement in setting up predictable homework routines, and building collaborative relationships with teachers.
We have learned that IY can be disseminated with high fidelity and sustained over time. Some of the critical factors include selecting optimal clinicians to deliver the program; providing them with quality training workshops coupled with ongoing supportive mentoring and consultation, on-site peer and administrative support; facilitative supports; and ongoing program evaluation and monitoring of program dissemination fidelity. Certainly it requires a collaborative team to bring about innovative change. Although it may be tempting for convenience sake and short-term resources to ignore the growing dissemination literature, doing so almost certainly will result in weak and unsustainable programs. Given that there are considerable time and costs involved in delivering even ineffective programs, a much wiser choice would be to invest resources in programs known to sustain high quality evidencebased practices.
Casey Family Programs conducted an evaluation that provides some preliminary evidence of effectiveness for a child welfare population of an existing evidence-based program?The Incredible Years Parent Training Program. Information on effective models for this population is lacking.
Evaluating the implementation and outcomes of an evidence-based program in child welfare settings is an initial step toward addressing the gap between research and practice for improving the well-being of children and families involved with child welfare.
This study evaluated the use of classroom-level behavior management strategies that align with School-Wide Positive Behavioral Interventions and Supports (SW-PBIS). Direct observations of universal classroom management strategies were conducted across 33 elementary classrooms in elementary schools implementing SW-PBIS with high fidelity. Findings indicate that classrooms had posted positively stated classroom rules at high rates, whereas teacher use of specific praise and the ratio of positive to negative interactions were less than optimal. Furthermore, classroom teachers with higher rates of general praise were found to report being more efficacious with regard to classroom management. In turn, teachers in classrooms with higher rates of disruptive behavior reported feeling less efficacious. In addition, teachers with lower rates of positive to negative interaction, who used higher rates of harsh reprimands and had higher rates of disruptions, reported higher levels of emotional exhaustion. Implications for developing supports to assist teachers struggling with universal classroom management strategies are described.
One effective means of preventing early-onset conduct disorder (CD) may be to target preschool children with ADHD before more serious conduct problems have escalated. Unfortunately, one limitation of the ADHD treatment-outcome literature is that comparatively little research has been conducted with samples of children under age seven.
Although research indicates that methylphenidate and other psychostimulants are effective in reducing core ADHD symptoms such as inattention and distractibility among preschoolers (see e.g., Connor, 2002), there is little evidence to suggest that these medications prevent the escalation of ADHD to ODD and CD in later childhood or adolescence
Raising children is one of the hardest jobs facing adults in our society and one for which there is least preparation. Moreover, several aspects of the job of parenting have become more difficult in recent years. Much has been learned about the risk and protective factors associated with different developmental outcomes for children and the important role parents can play in promoting children’s social, emotional and academic capacity and competence. Our current understanding is that many parents are not well prepared to do their best for their children.
In this chapter we consider factors that can make parenting more challenging and describe the growing number of interventions, in statutory and voluntary services, that have been developed to support parents and children within their own communities.
Servicestyrelsen har i perioden 2008-2010 i samarbejde med 13 kommuner afpr?vet to evidensbaserede familiebehandlingsprogrammer, hhv. b?rneprogrammet Dinosaurusskolen (DINO) og for?ldreprogrammet BASIC. Der har v?ret iv?rksat parallelle evalueringer af hvert af de to programmer, som dog afrapporteres samlet, da der er tale om to programmer og to evalueringer med st?rk synergi i form?l og design, som bl.a. giver mulighed for at anvende de forskellige programmer og kombinationer som interne sammenligningsgrupper.
DINO og BASIC er en del af den evidensbaserede programserie ?De Utrolige ?r? (DU?). DINO har til form?l at hj?lpe b?rn med adf?rdsvanskeligheder i alderen 4-8 ?r ved at tr?ne deres sociale f?rdigheder gennem gruppesamlinger. BASIC henvender sig til for?ldre til b?rn i alderen 3-6 ?r og giver dem r?d og vejledning i forhold til deres b?rn i grupper med op til 12 for?ldre.
Der er tidligere i evalueringen udarbejdet to delrapporter: Delrapport 1 indeholder en analyse af kommunernes udgangspunkt for implementeringen af programmerne, heriblandt m?lgruppen og den praktiske implementering. Rapporten beskriver de forskellige m?der, kommunerne organiserede og fortolkede de to DU?-programmer p?. Delrapport 2 har fokus p? effekten af de to DU?-programmer ved efterm?lingen, og med hvilken fidelitet programmet er implementeret. Denne rapport udg?r den afsluttende rapport i evalueringen af DU?. Rapporten belyser den umiddelbare effekt af deltagelsen i programmet samt den mere langsigtede effekt ved opf?lgningen 6-8 m?neder efter afslutningen og belyser s?ledes ogs? effekternes holdbarhed. Ligeledes belyser rapporten forskelle i kommunernes implementeringsmilj?, samt hvordan disse forhold p?virker fideliteten i programmet. Man kan l?se f?lgende i rapportens kapitler.
A key principle of this programme is modelling, a primary way of learning for both children and adults. The importance of nurturing parents and offering appropriate venues, refreshments and cr?che facilities cannot be underestimated. The overall atmosphere is one of support, not judgment. Parents are encouraged and challenged too. They are given the opportunity to think through solutions for themselves and consider the impact of their behaviours. Parents begin to model a similar style with their children, starting to understand how their child may be feeling. This is often the catalyst for an improved relationship and a decrease in undesirable behaviour usually follows.
A substantial body of research has clearly shown that young children with early-onset behavioral problems are at significantly greater risk of having severe antisocial difficulties, academic underachievement, school drop out, violence, and drug abuse in adolescence and adulthood. More than two decades of research has also identified a number of high-quality programs for parents and teachers which have been shown to reduce childhood conduct problems and strengthen social competence and in trun prevent secondary outcomes involving crime and violence. Rather the greatest challenge for schools is to select, implement, and sustain these programs for parents and teachers.
This article is about the successful implementation of the Incredible Years program and sustaining the program with high fidelity.
Two long-term follow-up studies of randomized trials show that relative to controls, youth at risk for behavior problems who received family intervention at age 4 had lower BMI and improved health behaviors as they approached adolescence. Efforts to promote effective parenting and prevent behavior problems early in life may contribute to the reduction of obesity and health disparities.
This study provides preliminary data about a parenting intervention for families of preschoolers with early attention deficit hyperactivity disorder/oppositional defiant disorder symptoms carried out in two diverse primary care pediatric offices. Mothers reported improvements in parenting skills and a decrease in stress. Mothers and providers reported high levels of satisfaction. Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.
Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking.
The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13.
In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group.
Determining evidence-based interventions for use in practice can be challenging. Efficacy research, which employs strict standardization of a manual or protocol, randomized control trials, and comparisons to other treatments or placebos, reveals how strongly an intervention creates change or improves functioning. However, one criticism of efficacy research is its inability to predict how or if an intervention will work within real-world, less-controlled settings. Many issues surround effective implementation of evidence-based treatments into practice (Chorpita, 2003). Much of existing intervention research in psychology is limited to Stage I: Treatment Efficacy (Chorpita). This project addresses Stage III: Effectiveness: Dissemination by employing an evidence-to-practice
model of research applied to the treatment of attention deficit hyperactivity disorder (ADHD) under highly naturalistic conditions.
We examined effectiveness of the IYPT as treatment and preventive intervention.
Results of 50 studies showed that the IYPT is effective regarding child behavior.
Effects with regard to distinct outcomes and distinct informants were found.
Initial severity of child behavior was the strongest predictor of effects.
The IYPT meets criteria for a well-established intervention.
The present meta-analytic review examined effectiveness of the Incredible Years parent training (IYPT) regarding disruptive and prosocial child behavior, and aimed to explain variability in intervention outcomes. Fifty studies, in which an intervention group receiving the IYPT was compared to a comparison group immediately after intervention, were included in the analyses. Results showed that the IYPT is an effective intervention. Positive effects for distinct outcomes and distinct informants were found, including a mean effect size of d = .27 concerning disruptive child behavior across informants. For parental report, treatment studies were associated with larger effects (d = .50) than indicated (d = .20) and selective (d = .13) prevention studies. Furthermore, initial severity of child behavior revealed to be the strongest predictor of intervention effects, with larger effects for studies including more severe cases. Findings indicate that the IYPT is successful in improving child behavior in a diverse range of families, and that the parent program may be considered well-established.
Families with socioeconomically disadvantaged and ethnic minority backgrounds are often hard to reach for the prevention and treatment of disruptive child behavior problems. We
examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority backgrounds in the Netherlands.
Parent engagement (i.e. enrolment, ongoing attendance, participation quality) remains ia major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check-Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific programme, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that support our approach.
Parent engagement (i.e. enrolment, ongoing attendance, participation quality) remains ia major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check-Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific programme, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that support our approach.
The Early Child Longitudinal Survey, a nationally representative sample of more than 22,000 kindergarten children, suggests that exposure to multiple poverty-related risks increases the odds that children will demonstrate less social and emotional competence and more behavior problems than more economically advantaged children (West, Denton, & Reaney, 2001).
Background Early risk factors for poor child outcomes are well established,.
Using Paired T-Tests, analysis of the 5 subcategories of Negative Parenting revealed that the Intervention group showed changes in the right direction in all five subcategories, 3 of these were significant changes; Critical Statements, Physical Negatives and Negative Commands.
Highlights of this evalutation are in poster format.
This study set out to evaluate the use of a video based parent training programme (The Webster?Stratton Programme) in the management of children referred to child mental health services for treatment of behaviour problems. Following diagnostic assessment children were assigned to one of two groups: parents of both groups completed the parenting programme and, in addition, in the second group the child received an intervention appropriate to his/her clinical presentation. The waiting list control group waited 3 months prior to allocation to either treatment group. Standardised rating scales were administered pre-treatment, post-treatment and at 6-month follow-up to both treatment groups, and at an interval of 3 months to the control group. Improvement was significantly greater in both the treatment groups than in the control group. Parenting training programmes are an effective intervention in the management of clinic-referred children with behaviour disorders.
Children with disruptive behavior problems (DBPs) constitute a large group among those cared for by child and adolescent social and psychiatric services. Serious anti-social behaviours, such as truancy,stealing, robbery and drug abuse, are very costly for society. Therefore, from a societal point of view, it is important to identify DBPs and introduce interventions already during the preschool years, aiming to prevent pathways leading from oppositional defiant disorder (ODD) to severe conduct problems in middle childhood and adolescence.
The programme is effective in improving child behaviour and parenting competencies with parents of 8+ aged children.
These data provide convincing evidence of the effectiveness of the IY programme with parents of high risk youngsters aged 8 and above. Staff in regular service settings, even when relatively inexperienced, can achieve good outcomes when supported with training, supervision and adequate time and resources.
Management of behavior problems in an inpatient child and adolescent psychiatric unit is largely the responsibility of nurses, yet few evidence-based programs exist that prepare nurses for this role. A pilot study examined the effects of a 3-day standardized parent/teacher training program adapted for inpatient child and adolescent psychiatric unit nurses. Findings indicated that the standardized parent/teacher training program resulted in significant increases in self-reported use of child praise/incentives and working with parents, with accompanying desired changes in observed nurse behaviors during nurse?child play sessions. Participants rated the program positively and highlighted gains of greater empathy and fewer judgments of parents. Findings support evidence-based training programs for nursing staff and suggest further research.
Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021 children. Four separate meta-analyses were conducted, concerning overall EF, working memory, inhibition and cognitive flexibility. A medium correlation effect size was obtained for overall EF (ESzr00.22) and for inhibition (0.24), whereas a small effect size was found for working memory (0.17) and for cognitive flexibility (0.13). Moderator analyses revealed a stronger effect for older preschoolers compared to younger preschoolers, and for children from referred samples compared to community samples. These results show that EF, especially inhibition, is related to externalizing behavior problems already in preschool years.
The current paper reports on the feasibility of implementing an existing empirically-based program, The Incredible Years, tailored to parents of young children with Autism Spectrum Disorder (ASD). Parents raising preschool-age children (ages 3 to 6) with ASD (N=17) participated in a 15-week pilot trial of the intervention. Quantitative assessments of the program revealed fidelity was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, play-based child behavior skills, parent stress management, social support, and visual resources. More work is needed to further refine the program to address parent self-care, partner relationships, and the diverse behavioral and communication challenges of children across the autism spectrum. Furthermore, parent access and retention could potentially be increased by providing in-home childcare vouchers and a range of times and locations in which to offer the program. The findings suggest The Incredible Years is a feasible intervention for parents seeking additional support for child- and family-related challenges, and offers guidance to those communities currently using The Incredible Years or other related parenting programs with families of children with ASD.
Few direct studies have looked at the economic costs of conduct disorder or its consequences. Related studies suggest that costs are high. In the United States the cost for crimes committed by a typical juvenile delinquent (under 18) was estimated at $80,000? $325,000 (?56,000??232,000). Between ages 19 and 24 a typical adult criminal costs a further $1.2m. Victim costs were by the far the greatest part of this total. Dropping out early from school added $243,000?$388,000 to age 24, heavy drug use a further $150,000?$360,000. Rescuing a high risk youth from this typical life path was estimated to save $1.7m?$2.3m.
Children in foster care have social and emotional problems at rates three to ten times higher than those found in the general population. During the elementary school years (i.e. 5?12 years), research indicates that disruptive behavior in children in care can negatively impact social, emotional and academic development, as well as placement stability. Evidenced-based interventions to improve children’s behavior and reduce parenting stress are necessary. This pilot study augmented an existing evidenced-based intervention (i.e. the Incredible Years) developed for birth families for use with foster caregivers. Results from 18 families indicate that foster caregiver-reported conduct symptoms were significantly lower for children whose families participated in the treatment group. A similar trend was found for the overall externalizing behavior. No significant changes were identified in parenting attitudes and stress. Participants reported high levels of satisfaction and acceptability with the program and outcomes. These findings indicate that foster caregiver training should be examined in larger, randomized control trials.
Parent training (PT) is an evidence-based treatment for reducing and preventing child conduct problems and abusive parenting. However, questions have been raised about the dissemination of PT to culturally diverse families who hold different views on childrearing. Group PT was applied in two Chinese immigrant families illustrating strategies for addressing potential cultural barriers. The Incredible Years program builds in therapeutic process elements to address cultural concerns to enhance engagement. In addition, augmenting basic PT with additional skills training can help parents manage stressors common in immigrant families to facilitate uptake of new parenting skills. This implementation experience suggested that high-risk immigrant Chinese parents can be effectively engaged in group PT, even when they are not in treatment voluntarily.
Reference only for this article.
Mary and John, well-educated parents, were describing the problems they were having with their three-year-old-son. “He is unable to accept discipline, disobeys, has temper tantrums, demands attention, can’t get along with other children, and acts irritable and unhappy.” They had come to the Parenting Clinic at the University of Washington and were seeking help.
Many school-based interventions to promote student mental health rely on teachers as implementers. Thus, understanding the interplay between the multiple domains of fidelity to the intervention and intervention support systems such as coaching and teacher implementation of new skills is an important aspect of implementation science. This study describes a systematic process for assessingmultiple domains of fidelity. Data from a larger efficacy trial of the Incredible Years Teacher Classroom Management (IY TCM) program are utilized. Data on fidelity to the IY TCMworkshop training sessions and onsite weekly coaching indicate that workshop leaders and the IY TCM coach implemented the training and coaching model with adequate adherence. Further, workshop leaders? ratings of engagement were associated with teacher implementation of specific praise, following training on this content. Lastly, the IY TCM coach differentiation of teacher exposure to coaching was evaluated and found to be associated with teacher implementation of classroom management practices and student disruptive behavior.
This study investigated the influence of therapist skill on the effectiveness of a manualized parenting program for child antisocial behavior. A reliable instrument with 10 scales was developed to measure skill. 15 parenting groups were observed, from a controlled trial involving 90 clinically referred, disadvantaged children aged 3-8 with severe antisocial behavior. Child outcome was assessed by interview. The skill level of therapists running the groups was found to be a significant predictor of effectiveness.
Over the past decade, the science related to developing and identifying “evidence-based practices and programs” has improved-however the science related to implementing these programs with fidelity and good outcomes for consumers lags far behind. As a field, we have discovered that all the paper in file cabinets plus all the manuals on the shelves do not equal real world transformation of human service systems through innovative practice. While paperwork and manuals do represent what is known about effective interventions, these tools are not being used effectively to achieve behavioral health outcomes for children, families, and adults nationally. Clearly, state and national policies aimed at improving human services require more effective and efficient methods to translate policy mandates for effective programs into the actions that will realize them.
To this end, our intent is to describe the current state of the science of implementation, and identify what it will take to transmit innovative programs and practices to mental health, social services, juvenile justice, education, early childhood education, employment services, and substance abuse prevention and treatment. The content is distilled from a far-reaching review of existing implementation literature that looks beyond the world of human services to organize and synthesize critical lessons from agriculture, business, engineering, medicine, manufacturing, and marketing. As you will find, authors from around the globe share the rigors of attempting to implement practices and programs and agree that the challenges and complexities of implementation far outweigh the efforts of developing the practices and programs themselves.
This study examined group leaders? adherence to The Incredible Years Parenting Program?s components and collaborative process during a yearlong dissemination in a large multicultural city and universal prevention context. Mixed methods were used to evaluate adherence and develop an understanding of the barriers and facilitators of therapist fidelity. Results suggest that the protocol and collaborative group processes were implemented with a high degree of adherence with the three exceptions of role plays, videotape modeling dosage, and ?buddy calls.? A number of interconnected barriers with implications for future implementation were identified. Key contributors to adherence included the training and structure of the program, emphasis on accountability and ongoing session monitoring, and important aspects of supervision and group leader qualities.
Multi-component interventions for conduct disorder target several contexts of a child?s life (e.g., both home and school environments) and are generally more effective than single-component behavioral interventions. Whether the multi-component approach is cost-effective remains an unanswered question. This article analyzes two decades of data from the Incredible Years (IY) Series to examine the costeffectiveness of delivering multiple, stacked intervention components versus a single-component delivery approach. Cost-effectiveness analysis (CEA) provides decision makers with important economic information that can be used to aid in the selection of a program delivery format from one of several competing approaches. CEA concepts, including explicit budget constraints and strict dominance, are demonstrated using IY data; guidelines for interpreting CEA results are provided. Our analyses suggest that combining intervention components is a cost-effective approach to treating behavioral problems in a clinic-based youth population.
In most cases, implementation strategies have been limited to paper-based manuals that focus on describing interventions without providing complementary information on necessary implementation resources and activities. Because of this, they do not facilitate the real-world application of innovative, research-based practice.
Recently, researchers have begun to study implementation in an effort to understand the key ingredients for successful program implementation. This brief will define implementation, highlight why the effective implementation of evidence-based practices is critical to achieving outcomes, and outline six core components that drive successful program implementation, referred to as “drivers.”
Background: Conduct problems in children are common and have attracted considerable interest, not least because of their negative psychological, social and economic consequences. Controlled trials demonstrate that parenting programmes can be effective in reducing childhood behavioural problems, but much less is known about the processes of change or contextual factors that influence trial outcomes.
Objective: This study involved a process evaluation which was nested within a randomised controlled trial (RCT) of the Incredible Years Parenting Programme (IYPP) in Ireland. The study was designed to: (1) identify and examine the key facilitative and inhibitive factors associated with the implementation of the programme in disadvantaged settings; and (2) to assess the level of implementation fidelity (IF) achieved within the RCT evaluation.
Method: The process evaluation employed a longitudinal, mixed-methods approach, and consisted of two separate but related stages. In Stage One, the experiences of stakeholders (parents, practitioners and organisational managers) were assessed and explored using semi-structured interviews and focus groups. A series of in-depth interviews (N=81) was conducted with parents at pre-intervention (n=20), and at three follow-up time points, including 6- (n=33), 12- (n=20), and 18-months later (n=8). A further 16 interviews were conducted with group facilitators (n=11) and service managers (n=5) following delivery of the IYPP. Interview data were analysed using constructivist grounded theory. Stage Two was based on a mix of parent reports (N=103) and facilitator reports (N=11) designed to investigate aspects of fidelity within the RCT. Data were examined using a series of ANOVAs and correlational analyses.
Results: Three overarching themes were identified from Stage One, including: (1) ?Experiences of learned helplessness? (e.g. the association between child conduct problems and family conflict and social isolation); (2) ?Perceived benefits and mechanisms of change? (e.g. the links between positive outcomes and a number of factors, including key parenting skills, social support, longer-term resilience and commitment, and facilitative organisational practices); and (3) ‘Challenges in programme implementation’ (e.g. cultural discomfort with praise and positive attention,conflict with partners; and organisational difficulties with fidelity, attrition and sustainability). The findings from Stage Two indicated that IF was high in relation to therapist adherence (M=90%, SD=4%) and parental satisfaction (M=6.69, SD=0.14), but lower with regard to the retention of parents (M=8.23 sessions, SD=4.79). There were no statistically significant relationships between IF and the primary child behaviour outcome.
Conclusion: This process evaluation is one of the first studies to investigate the key short- and long-term factors associated with implementing the IYPP within disadvantaged settings. The findings underline the many benefits gained from participating in the IYPP whilst also indicating that extra supports may be required to enhance outcomes for the most vulnerable families, particularly in the longer term. Overall, the study highlights the feasibility of implementing the IYPP within the existing infrastructure of mainstream health and social service settings in Ireland. These findings represent a valuable addition to current evidence on the effectiveness of the programme, whilst also informing its routine implementation both within Ireland and elsewhere.
Depression is a common and debilitating illness and there is a strong association between maternal depression and childhood Conduct Disorder (CD). This paper examines the impact of maternal depression on the outcome of treatment for the prevention of CD. Data from the Hutchings et al. (2007) Randomised Controlled Trial (RCT) of a parenting programme for parents of high-risk three and four year olds are used to explore the potential role of change in maternal depression as a mediator of child behaviour outcome. The role of positive parenting as an additional mediator was also examined due to previous research findings. Improvement in maternal depression was found to be a significant partial mediator of improvement in child behaviour. Maternal depression continued to be a partial mediator when positive parenting was included in the mediation model. Parenting interventions for the prevention of CD are more likely to result in improved child behaviour when they also address the skill deficits known to be associated
with maternal depression.
Disruptive behavior disorders such as Attention Deficient/Hyperactivity Disorder and Oppositional Defiant Disorder are common and stable throughout childhood. These disorders cause long-term morbidity but benefit from early intervention. While symptoms are often evident before preschool, few children receive appropriate treatment during this period. Group parent training such as the Incredible Years has been shown to be effective in improving parenting strategies and reducing children?s disruptive behaviors. Because they already monitor young children?s behavior and development, primary care pediatricians are in a good position to intervene early when indicated.
Objective: The aim of the study was to extend research on the potential benefits of adding ongoing feedback, coaching, and consultation to initial therapist training workshops to ensure fidelity of delivery of evidencebased practices, specifically for the Incredible Years parenting program.
Methods: A randomized controlled trial compared two models for training therapists to deliver the parenting program for children at high risk of developing conduct problems. Therapists (N=56) from ten communitybased mental health service organizations in California were trained in either a three-day workshop model (N=25), based on active, experiential, self-reflective, principle-based learning, videomodeling, and manuals, or an enhanced training model (N=31) that included all elements of the workshop model plus ongoing expert coaching, video review of and feedback on group sessions, and consultation for therapists and agency supervisors.
Results: Overall fidelity across both conditions was rated >3 on a 5-point scale in seven of eight domains measured. Therapists in the condition that received ongoing coaching and consultation were significantly stronger in four of the domains: practical support, collaboration, knowledge, and skill at mediating vignettes. Conclusions: Consultation and expert coaching for training therapists beyond the standard three-day training enhanced skills and therapists? adherence to the model. (Psychiatric Services 65:789?795, 2014; doi: 10.1176/ appi.ps.201200177)
ps.psychiatryonline.org June 2014 Vol. 65 No. 6. Written permission to reuse or distribute material published in the journals of the American Psychiatric Association must be secured from American Psychiatric Publishing https://store.appi.org/requestform/
As part of the Drivers of Crime work programme the Ministries of Education, Health and Social Development established a pilot study of the Incredible Years Parent (IYP) programme to assess its effectiveness in reducing conduct problems in a New Zealand context. ?? The New Zealand Incredible Years Pilot Study provided evidence to suggest that IYP, a programme developed overseas, can be successfully implemented in New Zealand and retain its general level of effectiveness for both M?ori and non-M?ori families. The Follow-up Study investigated the longterm outcomes for 136 (82%) of the 166 children and parents who were in the original sample. The key finding of the Follow-up Study is that the IYP programme outcomes were maintained over the 30-month follow-up with no diminution in the size of effects for almost all of the outcome measures.
Several aspects of the evidence-based IY BASIC parenting series make it particularly effective for families involved with child welfare due to maltreatment. The programs make extensive use of video modeling methods, showing a vignettes of families from different cultural and socioeconomic backgrounds with a variety of parenting styles and child temperament and development. The observational modeling and practice training approach is more effective learning for some of these families than the more cognitive, verbal training approaches.
Analyses showed a significant reduction in child problem behaviour and improvement in carers? depression levels for intervention families at follow-up, compared with control. Unexpectedly, there was a significant improvement in control carers’ self-reported ‘parenting’ strategies.Initial foster carer training could incorporate the IY programme to support carers in establishing positive relationships and managing difficult child behaviour. Programme participation may lead to reduced service use and improved placement stability.
The strategies used to manage children?s behaviour contribute significantly to the development, establishment and maintenance of conduct problems, and there is substantial evidence in the literature suggesting that parenting programmes are the most effective interventions for preventing or treating conduct problems, in the short
and long term, especially if delivered early, before the child encounters secondary risk factors following the transition to school. There is strong evidence for the effectiveness of the IY
Basic Parenting Programme in enhancing parenting skills and reducing child conduct problems, as well as improving parent child relationships with children aged three to eight years old.
Increasing numbers of high-risk children now spend time in out-of-home care during their pre-school years. Government, at national and local level, is increasingly recognising the importance of delivering evidence-based parenting programmes, to parents of children living in disadvantaged areas at risk of developing CD, but this has not been reflected in similar support to childcare staff working in nurseries in these areas.
A growing body of research provides evidence of the prevalence of childhood conduct problems and the long-term negative consequences that result. It also identifies parent management training such as the Incredible Years Parenting (IYP) programme as an effective evidence-based treatment. ?? As part of the Drivers of Crime work programme the Ministries of Education, Health and Social Development established a pilot study of the IYP programme to assess the effectiveness of this programme in reducing conduct problems in a New Zealand context. ?? The project was influenced by the recommendations of the Government Advisory Group on Conduct Problems, the Ministry of Education Positive Behaviour for Learning strategy and the desire to develop a new collaborative model to evaluate government-funded programmes. The benefits of the IYP training were broadly similar for M?ori and non-M?ori families. Both M?ori and non-M?ori parents expressed high to moderate satisfaction with the programme. These results suggest the IYP programme can be successfully implemented in New Zealand and retain its general level of effectiveness.
[spacer]The use of Time Out as a self-regulation calm down strategy for children between the ages of 3 and 9 years old is part of a.
The current investigation puts forth the authors? conceptualization of a cultural approach to implementing evidence-based practices with American Indian (AI) families. Their approach involves two phases, the motivational phase, which sets an historical context for current difficulties; and the intervention phase, which links evidence-based skills with cultural traditions, beliefs, and values. Herein, they present preliminary evidence for the efficacy of the intervention phase, overlaid onto the Incredible Years parenting program.
Which programme to choose? How to deliver it so as to achieve comparable outcomes to those reported in the research trials? These two issues, choice of programme and how to take interventions to scale and deliver them effectively in service settings, are the subject of the growing field of “implementation science” that has been informed by the Society for Prevention Research and set out in their guidance to service providers on how to ensure that evidence based programmes work in service settings (Flay et al. 2004) and by the work at the University of Colorado Center for Violence Prevention in identifying strongly evidence- based ?blueprint? programmes (Mihalic et al. 2002).
This paper provides a case study in the implementation and dissemination of the strongly evidence-based Incredible Years parent, child and teacher programmes across Wales. It describes the author?s work in delivering, researching and supporting the dissemination of the parent programme, and subsequently the child and teacher programmes, with the support of the Welsh government. It sets out the reasons for choosing the programmes, the steps taken to test their effectiveness in service settings across Wales, the dissemination process and lessons learned.
This study takes an in-depth look at parental acceptability (i.e., the ability to meet parent needs) of an intervention that has shown strong empirical support for treating and preventing childhood conduct disorder. The authors obtained acceptability data from 30 parents of children ages 5 to 12 years presenting externalizing behavior problems through completion of the Treatment Evaluation Questionnaire-Parent Form and the Incredible Years Parent Program Video Evaluation Form. The Incredible Years Self-Administered Parent Training Program was implemented over 8 weeks with the majority of participants showing improvement. Study results indicated that the Incredible Years Self-Administered Parent Training Program was found to be acceptable with a significant difference in level of acceptability between Video Series 2 and 3. Given the ease of dissemination and acceptable nature of this parent training program, future research on this evidence-based intervention is warranted within a school-based mental health service delivery model.
Children who are looked after experience significantly higher levels of social, emotional and behavioural difficulties than children who live with their family of origin. Such difficulties tend to be pervasive and can have detrimental consequences for placement stability, and ultimately for the child?s ability to reach their potential. Government documents such as Care matters highlight the importance of providing ongoing training and support to foster carers to equip them with the necessary skills to manage the complex needs presented by children who are looked after. The nature of this training and support is often debated. With this in mind, Barnardo?s Professional Fostering Service piloted the Incredible Years Basic Parenting Programme with 13 foster carers. The 12-week programme was evaluated using the Eyberg Child Behaviour Inventory pre and post intervention. Results provide a promising insight into the potential of the Incredible Years Basic Parenting Programme as a method of training and supporting foster carers.
Research demonstrates that interventions targeting multiple settings within a child’s life are more effective in treating or preventing conduct disorder. One such program is the Incredible Years Series, which comprises three treatment components, each focused on a different context and type of daily social interaction that a child encounters. This article
explores the cost-effectiveness of stacking multiple intervention components versus delivering single intervention components.
Economic data may be used to compare competing intervention formats. In the case of this program, providing multiple intervention components was cost-effective.
Most of the parenting programs in the U.S. are originally developed for Americans who understand American culture and common parenting practices. Therefore, when pilot-testing these programs with minority populations, it is important to examine not only the effectiveness of the program but also the cultural and linguistic appropriateness and usefulness of program content and delivery.
The goal of this study was to evaluate the delivery of a parenting program to 17 Korean immigrants for cultural and linguistic appropriateness and usefulness regarding recruitment, retention, program content, and delivery methods. Focus group interview data were audiotaped, transcribed, and analyzed. Themes identified included fit between the parents? desire and what the program offered, effective recruitment and retention strategies, program content and videotapes: based on western cultural background but useful, helpful role-play and homework, and recommendations (Korean language videotapes, longer classes, extended learning). The findings can be used in adopting the program to increase cultural and linguistic
When families are more involved there are positive outcomes for families, teachers and schools. Schools with high levels of parental involvement have better reputations in the community, higher teacher morale, higher parental ratings of teacher performance, and increased support from families (Henderson & Mapp, 2002; Heymann & Earle, 2000). These interrelated benefits are likely the result of involvement patterns that occur when parents are in contact with schools at levels they are comfortable with and the contacts are associated with increased comfort and endorsement of school. Overall parental involvement in school and in supporting children?s learning at home have received extensive attention in the literature. Less research has been conducted on patterns and teacher perceptions that can serve as a barrier to greater parent involvement. This study documented that teachers may feel less comfortable with parents of children who need the most support
The LEAP to Achieve Project trained teachers in effective classroom management practices using the Incredible Years (IY) Teacher Training program. The project aims to determine if classrooms who receive the training have a reduction in aggressive/disruptive and off-task behavior and an increase in academic performance. In order to better determine the effects of the training, some teachers received the intervention while others did not.
“I love project LEAP. It is a very good program for teachers. It gives so many examples on how to be positive with behavior in your classroom.”
This long-term study has demonstrated the stability of positive intervention outcome for families within this disadvantaged, at-risk, population, using both self-report and objective observational data. The relatively low drop-out rate and high mean attendance reflects the effectiveness of the intervention in engaging typically hard-to-reach-families. Positive effects of the Incredible Years programme are maintained over time for many children and families who are in greatest need. Up to 40% of untreated children diagnosed with conduct disorders develop later problem behaviours including drug misuse, criminal and violent behaviour.
Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multi-agency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children?s conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multi-agency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial set-up costs were ?3305.73; recurrent delivery costs for the program based on eight parents attending a group were ?752.63 per child, falling to ?633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were ?1509.28 per child based on eight parents, falling to ?1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively.
Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children’s externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.
Pre-intervention, post-intervention, and follow-up measures of teacher strategies, teacher efficacy, and pre-intervention and post-intervention measures of child behavioural strengths and difficulties were combined with written structured teacher feedback to evaluate the effectiveness of an Incredible Years Classroom Management Training Programme (Webster-Stratton & Reid, 2002) delivered to 15 teachers from multiple schools in a single Irish Education Centre setting over a period of 5 months. Participation in the programme was followed by significant positive change in emotional and behavioural difficulties in key children on whom the teachers focused as part of their training and by significant positive changes post intervention and at follow-up in teachers’ sense of efficacy with regard to student engagement and classroom management. Limitations such as lack of control group and limited generalisability of findings are addressed.
New IY programmes for parents of toddlers and babies were recently developed in Seattle by Carolyn Webster-Stratton, Ph.D. The 12-week toddler parenting programme has been the subject of a Welsh Government funded separate evaluation. The eight-week programme discusses appropriate stimulation and aims to increase parental sensitivity to their babies’ cues, encourage the development of parent support networks and highlight safety issues. Parents and their babies meet weekly with two trained leaders for twohour sessions. Updates on their infants’ activities and development are shared in a safe and supportive environment. Parents are encouraged to implement the programme strategies in their daily activities at home.
A randomized controlled trial was used to evaluate a parent training intervention for caregivers with preschool-age children with developmental disabilities. Results suggest that this parent training intervention was superior to usual care for young children with developmental delays or disabilities in reducing negative parent?child interactions and child behavior problems. Participants in the experimental group indicated high satisfaction with treatment.
Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empiricallyvalidated parent training curriculum. CM provided incentives for daily monitoring of parenting and child behavior, completion of home practice assignments, and session attendance.
Parents of young children often seek the support of professionals when experiencing difficulties in managing their child?s behaviour. Parents of children with complex neurodevelopmental disorders, including autism spectrum disorder (ASD), are no exception.
Following the Wanless Report, a new service was set up across the county of Conwy in North Wales to promote the psychological wellbeing of children and young people. This followed the Wanless principles of managing demand and remodelling services in order to provide an accessible and equitable non-stigmatising service for children and families, and the post of specialist behaviour practitioner was created. The aim was to support the parents of children aged five to 11 years who had mild to moderate behavioural difficulties, and also the staff working with these families.
Incredible Years equally benefitted children with CD with and without family psychiatric histories of externalizing behavior. Family psychiatric history of externalizing behavior and parental depressive symptomatology predicted greater severity of CD symptomatology at baseline.
Conduct disorder (CD) is estimated to affect 5-10% of children aged 5-15 years in the United Kingdom and the United States. For those children with early onset in pre-school years, CD frequently persists into adulthood, and predicts poor employment prospects, marriage breakdown and self-harming and/or anti-social criminal behaviour. The economic implications of severe behavioural problems in childhood are serious. It has been estimated that by age 28 the costs of publicly resourced services for those with conduct disorder in childhood were 10 times higher (?70,019) than for those with no behavioural problems (?7,423). Parenting is a key determinant in child behaviour. Parents who encourage pro-social behaviour have children with fewer behaviour problems. Parenting-training programmes are effective in helping families with children at risk of developing conduct disorders.
School-based social-emotional learning programs are cost saving for the public sector, with education services likely to recoup the cost of the intervention in five years. Lack of investment in well-being (mental health) promotion in schools is likely to lead to significant costs for society. The Incredible Years is a good example of an evidence-based intervention that can “go to scale”, and help parents and teachers work together to achieve common goals.
Conduct problems are the most common reason for referral for psychological and psychiatric treatment in childhood. The prevalence rate of conduct disorder is 5?10%. It can lead to negative life outcomes including criminal behaviour and psychiatric disorders, with increased costs to the education, health, social and criminal justice services. The study involved an evaluation of an universal school-based approach ? the Incredible Years Teacher Classroom Management programme ? which was developed in the US and implemented in Jamaica to help reduce conduct problems in young children.
Parents raising young children with Autism Spectrum Disorder (ASD) experience disproportionately high levels of stress and burden, which are associated with a plethora of other negative child and family outcomes. Yet, few interventions address parent mental health or related outcomes in this population.
Chapter 1 describes a comprehensive review of randomized controlled trials which included parents of preschool-age children with ASD. Seven interventions met the review criteria. The studies were strengthened by the use of fidelity measures and developmentally-appropriate interventions. However, while all of the studies collected parent measures, none reported significant posttest improvements in parent mental health or other outcomes. Furthermore, numerous issues, such as unclear randomization strategies, small sample sizes, and poor external validity further limited the ability to draw significant conclusions regarding the promise of the interventions. The chapter concludes with a call to develop and rigorously test family-centered interventions aimed at improving both child and parent outcomes.
Chapter 2 highlights the feasibility of implementing an existing evidence-based practice, The Incredible Years, tailored to parents of children with ASD. Two groups of parents raising preschool-age children (ages 3 to 6) with ASD (N =17) participated in a 15-week pilot trial of the intervention. The fidelity of the program was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, parent stress management, social support, and visual resources.
Chapter 3 reports on a mixed method test of the acceptability and results from the trial described in Chapter 2. Attendance was high (88% to 100% weekly) and attrition was modest (18%). Participants reported high acceptability of all aspects of the program (mean 3.3 out of 4). Parent stress decreased significantly after program completion, as compared to baseline. Parents highlighted several barriers to their success in the program, including trouble finding time to focus on their own needs and difficulty applying some program content (e.g., time-out for noncompliance) to children with sensory or self-regulation challenges. However, parents reportedly enjoyed the strengths-based, play-based approach of the program, as well as opportunities for social support and peer learning.
The findings point toward the overall utility and cost-effectiveness of the IY TCM programme in an Irish context. The programme led to improvements in the classroom environment, including a reduction in teacher reported stress and negative classroom management strategies, as well as fewer incidences of disruptive behaviour amongst pupils in the classroom. Some improvements were also seen in teacher reports of social, emotional and behavioural difficulties in the intervention group children when compared to their control group counterparts including, in particular, a significant reduction in emotional symptoms. Teacher reports also underline the acceptability and benefits of the programme to teachers and possibly other staff within the Irish education system.
While there is now compelling evidence for the efficacy of parent management training programmes in reducing rates of childhood conduct problems, installing these programmes into a new social context such as New Zealand raises a number of issues. In particular, before such programmes can be accepted as part of established practice in a new context there is a requirement to show (i) that these programmes can be delivered effectively within that context; (ii) that programme efficacy in the new context is established; and (iii) that the cultural appropriateness of the programme is assessed.
Against this background, the present research note summarizes the findings of a preliminary examination of the effectiveness and cultural acceptability of the Incredible Years Basic Parent Programme delivered in New Zealand.
The early childhood period is associated with profound development across cognitive, social, emotional, behavioral, and physical domains. Early childhood mental health is characterized by social-emotional competence and behavior regulation within healthy and supportive relationship contexts. However, children may demonstrate significant disruptions in social, emotional and behavioral functioning from early on, with approximately 12% of preschoolers in the general population and up to 30% in high-risk, low income samples identified as having serious behavioral difficulties. These challenges are associated with an elevated risk of future emotional, academic, and relationship problems. Specifically, children exhibiting early-onset behavioral problems are at especially high risk for life-course delinquency, substance use, violent behavior, academic failure, and depression. Although conduct problems are the most frequent reason children are referred for mental health services, young children’s mental health problems remain underrecognized and undertreated.
This article presents long-term effects of a preventive intervention for young children at high risk for antisocial behavior. Ninety-two children (M age ? 4 years) were randomly assigned to an 8-month family intervention or no-intervention control condition and assessed 4 times over a 24-month period. Intent-to-treat analyses revealed significant intervention effects on observed child physical aggression, and significant intervention effects found at the end of the program were maintained at follow-up for responsive parenting, harsh parenting and stimulation for learning. Parent ratings of child aggression did not show significant effects of intervention.
IYS has also been evaluated as a preventive intervention with low-income preschoolers and toddlers (Gross et al., 2003; Webster-Stratton, 1998; Webster-Stratton, Reid, & Hammond, 2001). As a preventive intervention, the program has been found to have short-term benefits on parenting practices, child social competence, and conduct problems in Head Start children (Webster-Stratton, 1998; Webster-Stratton et al., 2001). The program was found to be effective for a higher risk subgroup of the Head Start sample, defined as children of mothers with mental health problems and children with elevated behavior problems (Baydar, Reid, & Webster-Stratton, 2003; Reid, Webster-Stratton, & Baydar, 2004). However, long-term effects on parenting practices and child physical aggression are not known. The study presented here extends this work by testing the long-term effects of an adapted version of the IYS on parenting practices and physical aggression in children at especially high risk for antisocial behavior because of their family history of delinquency. Specifically, our study included children with delinquent siblings, a group that has proven to be at significant risk for antisocial behavior (Bank et al., 2004; Compton, Snyder, Schrepferman, Bank, & Shortt, 2003; Conger & Rueter, 1996; Patterson, 1984; Reid, Patterson, & Snyder, 2002; Reiss, Neiderhiser, Hetherington, & Plomin, 2000; Rodgers et al., 2001; Rowe, Almeida, & Jacobson, 1999; Rowe, Rodgers, & Meseck-Bushey, 1992; Slomkowski et al., 2001; Wasserman, Miller, Pinner, & Jaramillo, 1996).
In 2004, the Amherst H. Wilder Foundation introduced the Incredible Years programs to the community. This set of evidence-based programs is designed to teach positive interaction skills, social problem-solving strategies, anger management, and appropriate school behaviors to young children. The programs also strengthen parent-child relationships and help parents develop positive behavior guidance strategies.
Wilder introduced the Incredible Years programs as part of their 100-year history of combining direct services, research, and community development to address the needs of the most vulnerable people in Ramsey County, Minnesota. At Wilder, three of the Incredible Years programs have been implemented and two additional programs were added in November 2009.
As pediatric mental health problems have become more prevalent, pediatricians face the need to hone their skills in identifying and managing these issues in practice. The American Academy of Pediatrics has advocated for competency in mental health care for all pediatricians. Despite these recommended changes, ongoing deficiencies and barriers to developmental?behavioral pediatrics (DBP) training in residency persist, including inadequate faculty development, gaps in training, and funding. Graduates report feeling inadequately prepared to handle DBP issues.
The aim of the present study was to evaluate whether a short parent-training program (PT) reduces risk factors related to development of childhood socio-emotional and behavior problems in a non-clinical community sample. Data were obtained from parents in a randomized controlled trial (RCT) on PT for children aged 2 to 8 years (N = 186) at pre-intervention, post-intervention and one-year-follow up. There were significant differences in the changes in the two groups, with reductions in harsh parenting and child behavior problems, an enhancement of positive parenting and of the parents? sense of competence in the intervention group. The effects on parenting and parents? satisfaction all lasted through one-year follow up. Our findings suggests that a shortened version of a well-structured parenting intervention, The Incredible Years program, implemented in primary care at community level, reduces harsh parenting and strengthens positive parenting and parents? sense of competence, as reported by the parents. Issues related to a public health approach to promote positive parenting are discussed.
The programme is one of Webster-Stratton?s Incredible Years (IY) programmes developed and researched for parents, children and teachers. The programme is being offered to parents of pre-school children at risk of developing conduct disorder and who are living in identified Sure Start areas across North Wales. The programme is being delivered by certified group leaders through seven participating Sure Start centres across North Wales.
There is a pressing need for cost-effective population-based interventions to tackle early-onset antisocial behaviour. As this is determined by many factors, it would seem logical to devise interventions that address several influences while using an efficient means of delivery. The aim of this trial was to change four risk factors that predict poor outcome: ineffective parenting, conduct problems, attention deficit/hyperactivity disorder (ADHD) symptoms, and low reading ability.
This study is the first in a middle-income country to show that training teachers in classroom behaviour management and social skill promotion can lead to significant and clinically important reductions in child conduct problems and increases in social skills among pre-school children with antisocial behaviour. Benefits were demonstrated by direct observation as well as by teacher and parent report.
What can we do better with our programme delivery to ensure a higher rate of retention among participants of the Incredible Years Parent Programmes (IYP) we offer in the Central North Region? In particular, is there anything we can be doing more effectively that will enable Māori participants to complete the course?
The benefits of this school-based intervention support its implementation for disruptive behavior in schools. This model of intervention also provides effective ways to meet the needs of an underserved population. Children with significant needs for behavioral and social/emotional intervention can be treated in the same environment where the need is greatest: the community school.
Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social learning theory-based treatment promoted change in qualities of parent-child relationship derived from attachment theory.
AbstractChildren in residential care have experienced high levels of social, emotional and behavioral difficulties and behaviour control by staff is an issue.
Childhood antisocial behaviour has high immediate and long-term costs for society and the individual, particularly in relation to mental health and behaviours that jeopardise health. Managing challenging behaviour is a commonly reported source of stress and burn out among teachers, ultimately resulting in a substantial number leaving the profession. Interventions to improve parenting do not transfer easily to classroombased problems and the most vulnerable parents may not be easily able to access them. Honing teachers’ skills in proactive behaviour management and the promotion of socio-emotional regulation, therefore, has the potential to improve both child and teacher mental health and well-being and the advantage that it might potentially benefit all the children subsequently taught by any teacher that accesses the training.
The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time.
Objective: To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). Method: Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4?6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. Results: Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. Conclusions: We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.
Behavioral treatment research for preschoolers (ages 4 to 6 years) with ADHD is not extensive; however, parent training for young children diagnosed with ADHD has shown some preliminary promising outcomes. One of the core methods for the IY parent program is that therapists work collaboratively with parents to develop individual goals for each parent and child. IY therapists collaborate with parents to tailor the program content to each parent and child?s particular situation. For parents of children with ADHD, this tailoring process often involves helping parents understand ADHD and how it aff ects children?s social, emotional, and academic development, setting developmentally appropriate goals around increasing children?s att ention and focus and reducing misbehavior, strengthening children?s emotion regulation skills, and also changing the environment to support children?s need for movement, structure, predictable routines, scaffolding, and immediate feedback.
For example, parents of children who are impulsive, hyperactive, and inattentive learn about temperament and how their children?s biological make-up makes it more difficult for their children to listen, follow directions, and play appropriately with other children. They learn the importance of clear limit setting and consistent follow through and ways to help coach their children?s academic and social skills during play with other children. On the other hand, adoptive or foster parents are more likely to be focused on helping their children develop trusting relationships with them. This means they will spend more time on child-directed play, emotional coaching and building the relationship or attachment building components of the curriculum.
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The content and international evidence for the Incredible Years programmes for children and teachers are described. This is followed by a description.
This article describes a pilot project whose objective was to explore whether the Webster-Stratton Parenting Programme may be effective for hearing parents and their deaf children who present with conduct disorders and other emotional, behavioural and developmental problems. Outcome measures aimed at overall impact in decreasing behavioural problems and improving overall family function were used. Participants were hearing parents of deaf children referred to our specialist service whose assessment had recommended a parenting skills group as treatment of choice. The children had been diagnosed with behavioural problems with or without additional comorbidity. This pilot phase focused deliberately on one participant, in order to explore whether the approach justified further, more comprehensive evaluative research. Outcome was positive, suggesting that modified Webster-Stratton approaches may well be of use in deaf children of hearing parents.
Reference only for this article.
Theoretical and empirical evidence suggests that two of the most common childhood syndromes, disruptive behaviors and depression, have similar developmental antecedents and may respond to similar interventions. Recent evidence suggests that parenting interventions that target more nurturing and less harsh parenting risk factors lead to reduced internalizing symptoms in children (Webster-Stratton & Herman, 2008) in addition to the well-established effects on child conduct problems. For instance, Webster-Stratton and Herman (2008) found that children whose parents participated in the IY Parent Training (PT) program had reduced depressive symptoms at post-treatment compared to children in a wait-list control condition. Effects were mediated by changes in parenting effectiveness.
The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on “what works,” and included the implementation and evaluation of three evidence-based programmes in regular children’s services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four?six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four?nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children’s behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children?s relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience
Evidence-based psychosocial interventions such as parent training programs are strongly recommended as first-line treatment for preschool-age children with or at-risk of attention deficit/hyperactivity disorder (AD/HD).
Evaluate the effectiveness of the Incredible Years Basic Parent Training (IY) in hyperactive and inattentive behaviors of Portuguese preschoolers.
One hundred children, between three and six years-old, with AD/HD behaviors, who were part of a larger randomized controlled trial in which participants were allocated to either an intervention or control group. In this subsample analysis, there were 52 participants in the intervention condition (IYC) and 48 in the waiting-list control condition (WLC). Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 14-week intervention.
Medium-to-large intervention effects were found in primary caregivers? reported measures of children?s AD/HD behaviors and on self-reported parenting practices. Independent observations indicated significant short-term effects on positive parenting and coaching. Primary caregivers had a high attendance rate and reported high satisfaction with the program. Additionally, 43 % of children in the IYC clinically improved in the primary AD/HD outcome measure, compared with 11 % in the WLC.
Preliminary results suggest that IY parent training seems to be an effective tool, making the difference in the behavior of Portuguese preschoolers with early signs of AD/HD and their mothers.
Background: Early childhood behavioural difficulties are becoming more prevalent (Collishaw et al., 2004) and increase the risk of poorer outcomes later in life, including academic difficulties, antisocial behaviour, criminality, and poor social adjustment. A growing body of literature highlights the importance of early intervention and prevention programmes, such as parent-training or school-based programmes, for the prevention and treatment of early childhood behavioural problems and promotion of child well-being. The Webster-Stratton Incredible Years (IY) Parent, Teacher and Child Training Series was designed for the early treatment and prevention of conduct disorders in childhood (Webster-Stratton & Hancock, 1998). The IY series comprises a suite of comprehensive, specially designed programmes, which target children aged 0-12 yrs, and their parents and teachers, with a view to improving social and emotional functioning and reducing or preventing emotional and behavioural problems. The implementation of the IY programme in several community-based agencies and schools in Ireland began in 2004 – spearheaded by Archways, the national co-ordinator of the IY programme in Ireland – as a means of preventing and treating emotional and behavioural difficulties in children.
Study 1 (Section 1): Examining the longer-term benefits of the Incredible Years BASIC parent training programme in Ireland
Study 2 (Section 2): Examining the longer-term utility and implementation of the Incredible Years Teacher Classroom Management Programme in Ireland
This article describes an evidence-based preventive group intervention, Incredible Years Parent Training Program (IY). Decades of research have shown that IY strengthens parent and child competencies and in turn reduces child risks for developing conduct problems and other negative life outcomes. The purpose of this article is to examine IY through a resilience lens and highlight how it capitalizes on group process mechanisms to serve as a model preventive group intervention. Future directions and implications for research, practice, and training are discussed.
The Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over.
This paper focuses on the Incredible Years Teacher Training (IY TT) intervention as an example of an EBP that embeds fidelity and adaptation within its design. First, the core features of the IY TT program along with the methods and processes that make the intervention effective are described. Second, the support mechanisms (training, mentoring, consultation, and IY TT coaching) necessary to facilitate high fidelity of implementation of IY TT are highlighted. The goal is to clarify the underlying principles and layered supports needed to effectively disseminate the IY TT program to audiences with diverse backgrounds and skills who work with students with varying developmental, academic, and social-emotional needs. Often fidelity and adaptation are thought of as mutually exclusive, but in the IY model they are considered both complementary and necessary. Implications for school psychologists and prevention science are discussed.
This article focuses on the Incredible Years Teacher Classroom Management Training (IY TCM) intervention as an example of an evidence-based program that embeds coaching within its design. First, the core features of the IY TCM program are described. Second, the IY TCM coaching model and processes utilized to facilitate high fidelity of implementation of IY TCM by classroom teachers are highlighted. The goal is to demonstrate the use of coaching as a support system toward effective generalization of the IY TCM strategies among teachers with diverse backgrounds and skills who work with students with varying developmental, academic, and social?emotional needs. Implications for school psychologists, researchers, and implementation science are discussed.
The aim of this paper is to present the research protocol for the randomised controlled trial (RCT) designed to primarily establish whether the IY Therapeutic Dinosaur School Programme, when delivered as a school-based targeted intervention, improves ?at risk? children?s social, emotional and behavioural competencies compared with a waiting list control condition.
Families of 97 children with early-onset conduct problems, 4 to 8 years old, were randomly assigned to 1 of 4 conditions: a parent training treatment group (PT), a child training group (CT), a combined child and parent training group (CT + PT), or a waiting-list control group (CON). Post treatment assessments indicated that all 3 treatment conditions had resulted in significant improvements in comparison with controls. Comparisons of the 3 treatment conditions indicated that CT and CT + PT children showed significant improvements in problem solving as well as conflict management skills, as measured by observations of their interactions with a best friend; differences among treatment conditions on these measures consistently favored the CT condition over the PT condition. As for parent and child behavior at home, PT and CT + PT parents and children had significantly more positive interactions, compared with CT parents and children. One-year follow-up assessments indicated that all the significant changes noted immediately post treatment had been maintained over time. Moreover, child conduct problems at home had significantly lessened over time. Analyses of the clinical significance of the results suggested that the combined CT + PT conditions produced the most significant improvements in child behavior at 1-year follow-up.
As has become all too evident to researchers in the field as well as to the general public, the incidence of conduct problems in young children is increasing. Current estimates are that 7% to 25% of children are affected. This trend is disturbing, both in itself and in its social implications, for research has shown that the emergence of early-onset conduct problems in young children (in the form of high rates of oppositional defiant, aggressive, and noncompliant behaviors) is related to a variety of health and behavioral problems in adolescence – peer rejection, drug abuse, depression, juvenile delinquency, and school dropout (Campbell, 1991; Loeber, 1991).
In response to this growing social problem, a variety of innovative parent training interventions have been designed with the aim of reducing children’s conduct problems. The rationale for targeting parenting behavior as the primary focus of intervention arises from the considerable body of research indicating that parents of children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) lack certain fundamental parenting skills.
This book chapter summerizes the Incredible Years Parent and Child Training Series: how to deliver IY parent and child core program principles and adapt the program with fidelity to meet the needs of intact families referred by child welfare as well as families where the children have been removed from the home. These evidence-based interventions have demonstrated ability to improve parent-child relationships and to build parents? own sense of competence and self-control as well as strengthen their supportive family and community networks. While it is not uncommon for child welfare agencies to seek briefer interventions than the Incredible Years, these families are complex and in the highest risk category for re-abuse and maltreatment if not adequately trained and supported. Data in the parenting literature support the notion that parenting curricula need to be substantial to produce sustainable effects with challenging populations (Kazdin & Mazurick, 1994). Data from the IY programs have shown that the dosage of the intervention received and fidelity with which it is delivered are directly linked to changes in parenting and child behaviors (Baydar, Reid, & Webster-Stratton, 2003; Eames et al., 2009). Our standard treatment recommendation for child welfare families referred because of abuse and neglect is a minimum of 18 2-hour parent and child group sessions delivered by accredited IY group leaders who have high levels of support and consultation.
Parent participation in the full IY program is expected to accomplish the following: improve the parent-child relationship; increase parents? sense of competence and self-control; increase the use of positive discipline strategies, predictable schedules and monitoring; and reduce the rates of harsh and physical discipline. Child participation in the full IY child program is expected to improve children?s emotional regulation, social skills and to strengthen problem-solving skills as well as attachment and trust with parents. In the long term, we expect that these improvements in parenting and parent-child relationships will lead to lower rates of re-abuse, fewer re-reports to Child Welfare Services and more academically, emotionally, and socially competent children. In order to break the intergenerational cycle of parent-child violence and neglect and child conduct problems, it is also necessary to provide enough training and support to therapists to assure program fidelity with the goal of these children getting the best parenting possible.
This artcle summarizes the Incredible Years Series. The training series consists of three empirically validated and integrated programs for parents, teachers and children that are designed to promote social competence and prevent, reduce and treat conduct problems in young children. The training methods, content and processes are explained.
This study examined changes in preschool teachers? perceptions of classroom management strategies following group training in the recently revised Incredible Years Teacher Classroom Management Program (C. Webster-Stratton, 2006). The authors used a pre/post follow-up design across 2 groups that each met for 8 sessions over an 8?10-week period for a total of 32 hr of training. Twenty-four preschool teachers from one of the lowest income and highest unemployment counties in the state of Michigan participated in the program. To examine short-term maintenance effects, the authors collected follow-up data 16 weeks after all teachers completed the training. The authors found improvements in teachers? perceptions of positive classroom management strategies and their use. Transporting this evidence-based teacher training program to schoolbased mental health service delivery settings warrants additional study.
BACKGROUND: Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process.
AIM: To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. Methods An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder.
RESULTS: The Leader Observation Tool (LOT) achieved high internal reliability and good code?recode and inter-rater reliability. Evidence of concurrent validity was also obtained. Conclusions Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome.
A recent UK government-commissioned report on early intervention stated that ?what parents do is more important than who they are? (Allen, 2011, p. xiv). The report emphasised the importance of support for families at disadvantage at an early age before behavioural and social problems become entrenched and more expensive to tackle. Children classified as securely attached in the first 12 to 18 months develop better peer relationships at pre-school (Sroufre, Fox, & Pankake, 1983) and achieve better academic outcomes (Pearson et al., 2011).
The increased emphasis on investing support for families before children enter school has increased the need for assessment tools that support and encourage positive parenting. Identifying the positive parental behaviours that promote healthy child development is challenging as many of the current observational codes have been designed for parents? interactions with older children. This article describes the development of a new observational code to analyse the behaviour of mothers playing with their baby in the first 18 months. The six predetermined positive parenting behaviours are analysed using video recordings from the home. Practitioners can be trained to use the code and a manual facilitates future researchers and clinicians to evaluate parent behaviour with their infant in a natural environment and with minimal disturbance to the family.
Challenges to delivering evidence-based practice in the “real world” have the potential to undermine their acceptance, efficacy, and sustainability in community settings. The Incredible Years Series is one preventive intervention with demonstrated effectiveness in settings facing multiple dissemination challenges, including Head Start. We established a university-community partnership to deliver Incredible Years Series in a local Head Start, including the Teacher Classroom Management Training Program and the Child Dina Classroom Training Program.
ABSTRACT: This study examined the perceived effectiveness, acceptability, and integrity of the self-administered format of the Incredible Years Parent Training Program, for children exhibiting behaviors associated with attention-deficit/hyperactivity disorder. To assess perceived effectiveness, an AB pretest-posttest design was used across 10 weeks. Improvements in parents’ rating of adaptive skills were replicated across five participants.
La incidencia del trastorno oposicionista desafiante (TOD) y el trastorno disocial (TD) (conduct disorder) en ni?os es alarmantemente alta, con informes de inicio temprano de problemas de conducta en ni?os preescolares en tasas que van del 4-6% y tanto como un 35% para las familias de bajos ingresos.
It is essential that sound theory and research support new treatment and that procedures are described elearly and are followed closely. This chapter describes the training, supervisory and organizational requirements to implement the Incredible Years (IY) Training Series to prevent and to treat early onset of conduct problems in children. Five key elements are identified and descussed.
The current study aims to investigate if LOT skills subgroups predict change in parenting behaviour, for parents with preschool children at risk of developing CD who attended IY PT groups within Sure Start areas in North and MidWales and the borders (see Hutchings et al. 2007 for full details of the trial). The hypotheses are twofold. First, it is predicted that greater exposure will produce greater change in observed positive parenting behaviours and change in self-reported parenting style. Second, it is hypothesized that observed change in positive parenting will predict change in observed child outcome scores, and change in parent-reported parenting style will predict change in parent-reported child behaviour problems.
Background: Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome.
Aims: To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme.
Results: Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome.
Conclusions: Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment.
Even with the use of effective universal classroom management practices, some students will need additional behavioral supports. However, to translate implementation of new strategies into the classroom, professional development programs need to be adaptive to the complexities teachers face in providing instruction and managing classroom behaviors among diverse learners. Teachers also need support to successfully implement universal practices as well as to develop and enact plans for supporting students with disruptive behavior. This article describes a universal classroom management program that embeds coaching within the model. The coach supported teachers both in implementing universal strategies and in developing and implementing behavior support plans for students with disruptive behavior. The study evaluates the effectiveness of the behavior support plans and the types of coaching activities used to support these plans. Findings indicated that during meetings with teachers, coaches spent time action planning and providing performance feedback to teachers on their implementation of the behavior support plans. In addition, teachers reduced their rate of reprimands with the targeted at-risk students. Students receiving behavioral supports demonstrated decreased rates of disruptive behavior, increased prosocial behavior, and a trend toward improved on-task behavior. In comparison, a matched sample of students with disruptive behaviors did not demonstrate improved outcomes. Implications for practice are discussed.
AbstractThe aim of the present study was to investigate residential child care staff satisfaction with.
Abstract Appropriate implementation of timeout has been shown for decades to produce positive outcomes ranging from.
There is a modest but growing literature in the parenting field, based on secondary analysis of randomized trials suggesting that change in observed positive parenting skill may be an important predictor of change in child outcome. Furthermore, several studies suggest that, at least in early childhood, positive rather than negative parenting may be a developmentally more important predictor of child problem behavior outcome, based on converging evidence from both randomized intervention trials and longitudinal studies of natural development. We chose to focus on overt parenting skill as a postulated intervention mechanism, because this is consistent with the theoretical underpinnings of cognitive-behavioral parenting interventions, which assume that parenting skill is the primary mechanism underlying both development and change in children?s conduct problems.