Few studies have evaluated the effectiveness of empirically supported therapy in applied settings, or typical service in such settings. In this study, parents seeking help at a children’s mental health center for managing their 3- to 8pyear-old children’s behaviors were randomly assigned to one of three conditions: Webster-Stratton’s Parents and Children Series (PACS) parenting groups (146 families), the eclectic approach to treatment typically offered at the center (46 families), or a wait-list control group (18 families). After 15 weeks, mothers in both treatments reported fewer child behavior problems than mothers on the wait list. Mothers in the PACS program reported fewer behavior problems and greater satisfaction with treatment than mothers in the eclectic treatment. These findings support he effectiveness of the PACS program, relative to typical service, for parents seeking help managing their children’s behavior.
Incredible Years: All
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.
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.
Background: Traditional Korean American discipline is characterized by a lack of expression of affection and use of harsh discipline.
Objective: The purpose of this study was to pilot-test the effect of the Incredible Years Parenting Program among Korean American mothers.
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
School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct
problems and improve children?s social and emotional competence in developed countries; however, we are aware of no reports from a
developing country.We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and
emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if
this approach is appropriate for use with Jamaican pre-school teachers and children.
The Webster-Stratton Incredible Years (IY) Therapeutic Dinosaur School intervention was evaluated in clinically referred children with behavioural disorders. Results suggest that this is an effective intervention.
The diagnosis Conduct Disorder (CD) is used to refer to severely disruptive, aggressive and/or destructive behaviour characterised by a repetitive and persistent pattern of anti-social behaviour in children and adolescents with an estimated prevalence between 1.5 and 3.4% (Woolfenden, Williams, & Peet, 2002).
For conduct-disordered children the need to learn and use effective relationship skills in social situations is paramount. Considerable evidence has demonstrated that programmes which enhance parenting skills result in significant improvements in the behaviour of these children (Kazdin, 1995) and parent training is seen as the intervention of choice for these children. However, there is a place for interventions that teach relevant skills directly to children alongside or, when this is not possible, instead of working with parents.
The IY Dinosaur School programme (Webster-Stratton, Mihalic, Fagan, Arnold, Taylor, & Tingley, 2001) is one of a set of interlocking programmes for parents, children and teachers. It was developed as a clinical child-training intervention for small groups of children aged four to eight years. It teaches children to develop more appropriate social and problem solving skills.
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.
These therapies are getting a push because they have been shown in numerous clinical trials over the past decade to be effective on kids with severe behavioral problems, where other approaches have often failed. The techniques take a pragmatic approach, often using a set curriculum to teach new behaviors, rather than ferreting out the underlying emotional problem as with traditional psychotherapy. In another departure from traditional talk therapies, much of the counseling is often directed at parents.
Developed mostly in the past decade at academic centers, the therapies target kids with diagnoses like conduct disorder, oppositional defiant disorder or bipolar disorder, who are at risk of getting kicked out of school or breaking laws. By some
estimates, there are 1.4 million to 4.2 million children who meet the criteria for conduct disorders alone.
Both the government and local service providers in the UK are becoming increasingly aware of the possibility of improving child outcomes through the delivery of parenting programmes. Government initiatives, such as Sure Start, Pathfinders and Flying Start are a positive step forward, yet programmes sometimes fail to work in service settings. This article describes the components necessary to deliver effective interventions, exploring the need to choose an evidence-based parent programme, implement it with fidelity and evaluate the outcome. It describes the steps taken in North and Mid Wales to do this and reports briefly on the successful outcomes achieved by delivering the Incredible Years Basic Parenting Programme to the parents of high-risk children in Sure Start areas.
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.
Review of the Incredible Years (IY) Parent, Teacher and Child Training Curricula and summarize research on the effectiveness of these three programs for reducing risk factors and strengthening protective factors associated with children?s social emotional development and school success. The chapter will include a focus on the role of home-school partnerships in preventing and treating children?s behavior problems and improving their school readiness as well as practical tips for engaging schools in the prevention and intervention process.
While researchers have long considered intelligence to be a key predictor of success in school, recent studies indicate that the social and emotional adjustment of young children are strong predictors of early academic achievement even after controlling for variations in children?s cognitive abilities and family resources (Grolnick & Slowiaczek, 1994; Raver & Zigler, 1997).
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.
Families referred to child welfare for maltreatment and neglect are frequently mandated to attend parenting programmes. Evidence-based parenting programmes (EBPs) are underutilized or not delivered with fidelity for this population. The Incredible Years (IY) Parenting programme is an EPB that has been proven to reduce harsh parenting, increase positive discipline and nurturing parenting, reduce conduct problems, and improve children?s social competence. There is also promising preliminary evidence that IY is an effective for families involved in child welfare (Hurlburt, Nguyen, Reid, Webster-Stratton, & Zhang, under review) and for foster parents (Linares, Montalto, MinMin, & S., 2006). The current paper describes how the updated IY parenting basic programme is delivered with fidelity to this population.
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.
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.
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.
Estimates have indicated that child conduct disorders encompass from one-third to one-half of all child and adolescent clinic referrals. Moreover the prevalence of these disorders is increasing, creating a need for service that far exceeds available personnel and resources.
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.
Abstract – This study examined the program satisfaction of the Incredible Years parenting program, Basic implemented and used in four Danish municipalities: Holstebro, Herning, Ikast-Brande and Aalborg. Since spring 2006 the parenting program has been a preventive service or treatment for parents with a child with conduct problems.
Conclusion – Some of the data are from the first round of the parent programs, starting in spring 2006, at the same time as translation and implementing the program began, and all the data in the study are parent programs lead by non-certificated group leaders. Under these conditions it is even more positive that the data shows a high satisfaction. It is important to have focus on the method integrity of the group leaders to ensure a continuous high quality of the parent program. It is also important to continue looking at the program satisfaction in the future to ensure high quality and to identify possible parts that could need further development or changes either because of error in implementing the program or in the program because of cultural differences in the Danish and American context.
Aggressive children lacking prosocial strategies are often disliked by their peers and they tend to relate to friends in contexts, where there are high levels of aggression in the peer-group, which in turn may increase levels of child of aggression and other conduct problems (15). Interventions that lead to peer acceptance and enhanced social competence in the child with early conduct problems may disrupt the behavioural trajectories leading to lasting psychosocial problems.
Abstract: In the present study, predictors of persistent conduct problems among children aged 4?8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program, or combined parent training and child treatment. Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.
The ability of young children to manage their emotions and behaviors and to make meaningful friendships is an important prerequisite for school readiness and academic success. Socially competent children are also more academically successful and poor social skills are a strong predictor of academic failure. This article describes The Incredible Years Dinosaur Social Skills and Problem Solving Child Training program, which teaches skills such as emotional literacy, empathy or perspective taking, friendship and communication skills, anger management, interpersonal problem solving, and how to be successful at school. The program was first evaluated as a small group treatment program for young children who were diagnosed with Oppositional Defiant and Conduct Disorders. More recently the program has been adapted for use by preschool and elementary teachers as a prevention curriculum designed to increase the social, emotional, and academic competence, and decrease problem behaviors of all children in the classroom. The content, methods, and teaching processes of this classroom curriculum are discussed.
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
High correlations were observed between mothers’ and children’s behaviors in the unstructured clinic observation and the home observations. Results are discussed in relation to the potential of structured clinic observations to provide more relevant and efficient information about mothers and conduct-problem children.
There is now widespread acceptance that evidence-based interventions treat a range of mental health and behavioral problems. Yet these evidence-based practices are often not adopted in applied settings. As a result, strategies need to be developed to overcome potential barriers to the widespread adoption of evidence-based interventions. Group-based interventions frequently rank high on lists of evidence-based practices, with studies demonstrating that well-designed group-based models are often at least as effective as the best alternative one-on-one approaches.
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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.
Early-onset conduct problems predict antisocial and criminal behaviour in adolescence and adulthood, including violent offending, and these problems occur with greater frequency in disadvantaged communities. Parenting is implicated in the development and maintenance of these problems. To address them the government in England and Wales is funding Sure Start services, but so far it has not specified that evidence-based programmes should be delivered. Sure Start areas were targeted to provide services for high-risk families in disadvantaged areas. Certain family characteristics such as low income, low education level, isolation, teenage pregnancy, high stress levels, single parenthood (or high levels of marital discord), depression, parental psychiatric illness or criminal history, and inconsistent, or harsh, parenting practices put children at high risk of developing conduct disorder and perpetuating particular family characteristics. Within disadvantaged areas there is considerable variation in crime levels. The purpose of this paper is to establish whether crime rates predict outcomes from a parenting intervention, the Webster-Stratton Incredible Years (IY) BASIC Parenting Programme, delivered in 11 Sure Start areas across north and mid-Wales. Parent participation in the programme demonstrated significant improvements in both child and parent behaviour. The current paper reports on the analysis of the effect of community crime levels on outcome. Regression analyses showed that crime rates were not predictive of outcome: the BASIC programme is effective in areas with both higher and lower crime levels..
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.
Children?s aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems.
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.
Two MPs from opposing parties – Iain Duncan-Smith MP and Graham Allen MP – have authored a unique collaboration with a unique answer to many of society’s ills.
Early Intervention, Good Parents, Great Kids, Better Citizens is published by the Smith Institute and the Centre for Social Justice and was launched in September 2008 in the House of Commons.
The authors’ thesis is that a more grown-up, all-party approach is now necessary, after thirty years of failure by governments of all parties, to tackle the fundamental causes of the symptoms of social deprivation including teenage pregnancy, anti-social behaviour, low educational attainment, drug and alcohol abuse and poor parenting.
Their remedy is Early Intervention – which they argue is both cheaper, and more effective, than the current expensive and failed philosophy of Late Intervention. Their long term plan for Early Intervention is designed to break the intergenerational cycle of underachievement, evident in so many of our inner and outer city estates, by helping all 0-18 year olds become good parents, not least to optimise their impact on the 0-3 age group when positive nurturing has its greatest impact.
This is supported not only by a rigorous analysis in the book, but by reference to the practical Early Intervention package being implemented in Nottingham by the Local Strategic Partnership (One Nottingham). For the first time in the UK, this Early Intervention package pulls together a comprehensive “Virtuous Circle” of policies across the 0-18 age group. These include: preconception support, a family/nurse partnership (intensive health visiting for 150 single mums and babies), children’s centres, the teaching of SEAL (Social and Emotional Aspects of Learning) to every primary school child, an anti-crime course for every 10 year old in the city, a drug and alcohol aware programme for every pre-teen child in Nottingham, 11-16 Life Skills,pre-parenting courses for every teenager and many other specific interventions being pioneered by One Nottingham.
Iain and Graham* have met the three party leaders, and in the book detail 7 specific requests they have made of them regarding: the next manifesto, proper research, a national policy centre, action by local government, the comprehensive spending review, a local plan and treasury study.
“We are challenging out dated thinking in all parties. We need to build a social and political consensus if we are to go beyond treating the symptoms, and break once and for all, the inter-generational nature of our social problems. We hope our personal collaboration is the forerunner of something at national level.”
* Graham is member of parliament for the constituency with the highest teenage pregnancy rate in western Europe, and the fewest number of young people going on to university.
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.
Are the correlates for girls with early-onset conduct problems necessarily the same as for boys? It has been shown that externalizing symptoms such as disruptive, impulsive, hyperactive, inattentive, and overtly aggressive behaviors are important risk factors for boys’ continuing development of ODD and CD, whereas internalizing symptoms are not. In the absence of evidence, one cannot assume that this is equally true for girls.
This study aims to evaluate the effectiveness of a parent training program in improving parenting practices, parents? feeling of self-efficacy and parents? perception of their child?s behavior, implemented in a child
Though the implementation of an evidence-based parent training program by professionals in a child protection service presents specific challenges, results suggest that it can contribute to improvements in parenting practices and in parents? perception of their child?s behavior.
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.
Findings from this study indicate that the Incredible Years Parent Training programme is a valuable intervention for many pre-school children displaying early signs of ADHD.
Attention Deficit Hyperactivity Disorder (ADHD; American Psychiatric Association [APA], 1994) is characterised by developmentally inappropriate levels of inattention, impulsivity, and over activity (APA, 1994; Barkley, 1997). These problems typically emerge in early childhood, are relatively persistent, and result in cross-situational impairment (e.g. at home and at school; APA, 1994). The current Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) specifies three subtypes of ADHD: predominantly inattentive subtype; predominantly hyperactive/impulsive subtype; or combined subtype. Problems must be evident in two or more settings (e.g. home and school), and the child must show significant impairment in social, school, or work functioning (APA, 1994; 2000). Prevalence estimates indicate that between 3-6% of school-aged children meet diagnostic criteria for ADHD (APA, 1994; 2000; Szatmari, 1992).
Left untreated, the long-term prognosis for these children is poor. Children with ADHD are at a much greater risk of experiencing problems in the educational, personal and social domains (Daley, 2006). Children with ADHD are also at a heightened risk of developing conduct problems, substance abuse, and interpersonal and occupational difficulties that can persist into adulthood (Manuzza et al., 1991; Taylor et al., 1996).
The IY parenting program has positive impacts for parents with a history of reported child maltreatment. While similar benefits were observed for both groups of parents in this study, results support delivering evidence-based parenting programs of longer duration and higher intensity than often used by agencies in the community serving parents in contact with child welfare. Practice: Agencies serving parents referred for child maltreatment should carefully examine the characteristics of the parenting programs they deliver. Use of a parenting program that has a sound base of empirical support, such as IY, and sufficient intensity and duration are likely necessary to make substantial changes in parents’ child-rearing practices.
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 impact of difficult child behaviour on family functioning has a compounding effect on the physical, emotional, and psychological welfare of the child, the family unit, and the wider community. Additionally, untreated behaviour problems increase the risk of negative outcomes in adulthood (Breen & Barkley, 1998; Reyno & McGrath, 2006).
Indeed, apart from the impact on the child, recent research has confirmed earlier findings that parents of children with ADHD experience elevated stress levels, and have fewer effective parenting practices compared to parents of children without this disorder (Treacy, Tripp, & Barid, 2005). To address parenting issues and these other factors, an effective, low cost intervention strategy would obviously be a useful addition to the range of services available in everyday settings.
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).
Abstract (abstract only) Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered videotape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.
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.
Behaviour management problems (BMP) are common among children (4-12%) and the prevalence seems to be rising. Persistent antisocial behaviour often leads to poor long-term psychosocial adjustment. Structured parent-training programmes have proven to be the most effective way of treating BMP in young children. The Incredible Years Series (IYS), which is a manual-based programme, was introduced in Sweden in 2001. Its aim was to evaluate the effectiveness of IYS in diverse clinical settings in Sweden. Parents of 113 children (3-9 years), recruited through the IYS-trained group leaders? ordinary services, participated in the study. The parents answered various questionnaires regarding their children?s symptoms and their own psychological well-being before and after participating in the parent-training groups. The results are very encouraging; significant reduction of BMP in the children was found on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found. The IYS seems to work in Sweden, even when used by group leaders who are in training. The importance of using a well-documented manualized method when implementing new models is accentuated.
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.
Background: While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. Method: In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5?6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5?6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview.
Results: While all children qualified for a diagnosis of ODD/CD before treatment, 5?6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5?6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems.
Conclusion: The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.
This paper presents 2-year follow-up data for a sample of 159, 4- to 7-year-old children with oppositional-defiant disorder (ODD) who were randomly assigned to: parent training (PT), parent plus teacher training (PT + TT), child training (CT), child plus teacher training (CT + TT), parent plus child plus teacher training (PT + CT + TT). At the 2-year follow-up, approximately 75% of children were functioning in the normal
range according to parent and teacher reports. Twenty-five percent of children were classified as treatment nonresponders at home and/or at school. Teacher training added significantly to long-term school outcomes for children who had pervasive behavior problems. Baseline, post, and 1-year follow-up parenting practices distinguished between home treatment responders and nonresponders (parents of nonresponders were more critical and less positive). For children with baseline pervasive home-school problems, baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home at the 2-year follow-up.
In addition, 80% of pervasive children whose mothers were highly critical immediately posttreatment were classified as school nonresponders at the 2-year follow-up.
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.
Théo, 3 ans, ne veut pas aller au lit le soir, se lève de nombreuses fois et finit par s?endormir dans le lit des parents ; Mélanie, 7 ans, refuse tous les fruits et les légumes, est très sélective dans les viandes, ne mange pas de poisson?; Victor, 8 ans, se bagarre avec ses 2 frères plus jeunes, casse leurs jouets.
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.
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.
Aims: To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population.
Methods: Parents of children aged 2-8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin?s Parenting Stress Index, and Rosenberg?s Self Esteem Scale to measure parents? mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up.
Results: The intervention was more effective at improving some aspects of the children?s mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range. Conclusion: This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.
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.
This randomized trial targeted preschool teachers? classroom practices for improvement. Teachers (including lead teachers and assistant teachers) were invited to participate in five trainings on Saturdays, each lasting six hours.A behaviorally and evidence-based teacher training package was selected and purchased, and a seasoned trainer with Licensed Clinical SocialWorker (LCSW) qualifications delivered the 30 h of teacher training over fall and winter, adapting the Incredible Years Program teacher training module.
Using this experimental design and this model of intervention, what were the goals of this research project? Our long-term goal was to test whether this package of classroom-based services reduces children?s risk of behavioral difficulty and increases their chances of school readiness by improving teachers? classroom practices. While there have been a large number of experimental prevention trials targeting parenting practices for families with children with elevated behavior problems (for reviews, see Brotman et al., 2005; Raver, 2002; Webster-Stratton et al., 2001), we know of very few classroom-based interventions aimed at supporting teachers? practices in preschool settings. Yet, early educational settings represent a promising opportunity for interventions targeting children?s socioemotional difficulties.
Our experimental results suggest that classroom quality can be increased by as much as one-half to three-quarters of a standard deviation if programs make a clear, sustained commitment to program improvement by offering a package of intervention services that include workshops on classroom management paired with in-class mental health consultation. This is in keeping with findings from other recent randomized trial interventions targeting teachers? classroom practices (Gorman-Smith et al., 2003; Webster-Stratton et al., 2001).
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/
Kevin was very reluctant to participate in a parent group, commenting,
The first night I went I couldn’t wait for it to be over. I couldn’t imagine continuing for 12 weeks listening to these family service workers who were two women I didn’t know tell me how to raise my kids, and then there were so many mothers and only two other dads in the group.
However, Kevin was drawn to the parent group by the prospect of the support he work receive. He reflected,
I’m not sure if I was abused or not, but I know I used to go to school with welts, from being hit. My parents had an ironong cord that they cut off an iron and stripped the rubber so it was bare metal. That is what we used to set spanked with.
This study was conducted by the Clondalkin Partnership; Incredible Years Initiative in Clondalkin, Ireland.
Children in schools within disadvantaged areas have been found to have emotional disorders of a much more severe nature. Emotional and behavioural problems develop in a dynamic social context within the child?s home, school and community and exert a significant toll on children and young people. The research suggests that one of the most effective means of tackling these problems lies in family-based approaches. Generally, these are targeted at pre-school or slightly older children with conduct or emotional and behavioural problems, with the parent(s) or primary carere as the central focus of the intervention.
The Clondalkin Partnership began the implementation of the Incredible Years (IY) programme in 2004 in order to create a community-based solution to a national problem. The IY BASIC Parent Training program was the first to be implemented on a trial basis. The pilot study reported here was designed and implemented by staff at the Clondalkin Partnership in part collaboration with researchers at NUI Maynooth in order to assess the overall effectiveness of the IY BASIC Parent Training Program.
The quantitative findings in this study indicate important positive changes in many different aspects of the children?s behaviour, which were supported and amplified by the qualitative data. The benefits accrued by parents ? both personally and in terms of their improved relationships
with their child ? as well as their overwhelmingly positive views of the IY program itself, were important and recurring themes identified from the qualitative analysis. Thus, the overall results provide convincing evidence for the effectiveness of the IY program, albeit within the context of a small, localised pilot study without the inclusion of a control group. The results also suggest that any future implementation of the entire IY program (with all three of its training components) would be very well received in Clondalkin.
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.
The programme developed by Professor Carolyn Webster-Stratton had produced a significant level of research to suggest that it is the best way to treat early onset conduct disorders by teaching parents to change their behaviour which in turn changes their child’s behaviour (social learning theory). In Essex 296 parents have taken part in groups and self completed questionnaires have shown an improvement in all the following areas; family life, parent-child relationship, level child problem behaviours, frequency of child problem behaviours, strengths and difficulties, parental stress and general health. This shows that the Incredible Years Parent Training Program is a success.
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.
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.
This interdisciplinary training program prepares 9 Michigan State University doctoral students from school psychology and special education-emotional impairment for leadership roles in the development, implementation, and evaluation of interventions and prevention programs for youth exhibiting disruptive behaviors within the school setting. The objectives of this project include: (a) recruit and admit qualified candidates using effective strategies to recruit students from underrepresented populations including individuals with disabilities, (b) advise, provide financial assistance, and provide graduated and sustained training in areas and contexts that match doctoral leadership training goals, (c) plan, manage, and evaluate the project via involvement of parents of children with disruptive behaviors, interdisciplinary faculty who specialize in this population, and through the involvement of school, community, and administrative personnel (d) evaluate the program repeatedly across time to assure successful student completion and validation of the training methods and procedures, (e) help students assume leadership roles at local, state, or national levels, (f) institutionalize and disseminate our training model to other institutions and constituents across the country.
Our 4 A?s (Affiliate, Apprentice, Active Learner, Action Researcher) training model provides the methodology by which we will prepare doctoral students in a carefully sequenced set of activities within their current doctoral programs in the areas of teaching, research, and service. Comprehensive activity logs, supervisor ratings, and research to practice projects will serve as a means of evaluating our student leaders. Moreover, variables related to leadership in our respective fields (e.g., conference presentations, teacher in-service activities, preservice teacher instruction, journal publications) will be examined. Our participation in the Teacher Training Workshop in Seattle, WA was one example of the types of activities that the students are working on during the second year of the training grant.
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.
A decade ago parenting programs were not in fashion. It was commonplace to talk about the effects of family breakdown or the problems of single mothers, but relatively few people were paying much serious attention to what parents did or to how parenting behaviors could be changed with children’s health and development in mind. Not so today: many jurisdictions are awash with programs, most of them of doubtful value.
The Incredible Years is a case apart. It was developed by Carolyn Webster-Stratton twenty years before most of today?s plethora of programs were dreamed up, and it is now among the most successful and widely applied in the world.
The Incredible Years is often represented as a construction of eight building blocks. At the base are five modules designed for children at successive stages of development ? infancy, preschool, early years and the first years of formal education. At the next level are two more that involve children directly and seek to improve their social, emotional and cognitive competencies. The eighth block is focused on teachers, providing skills to manage difficult behavior and a curriculum that encourages emotional self-regulation.
The catalyst for this week?s series of articles on The Incredible Years is a conference today in Dublin when the Minister for Children, Barry Andrews TD, launches the implementation and rigorous evaluation of Carolyn Webster-Stratton’s program in the Republic of Ireland as part of a broader commitment to prevention and early intervention. The initiative is being led by Margaret Maher, Director of a new NGO called Archways that has been set up to shelter The Incredible Years in Ireland.
Keynote speaker Judy Hutchings almost single-handedly showed the UK Government how its flagship prevention program Sure Start ? floundering elsewhere ? could be made successful. She put The Incredible Years, already a proven model, at the heart of Sure Start in Wales. She then led an experimental evaluation that demonstrated impact on children’s health and development.
After covering her contribution tomorrow, on Wednesday we profile the program?s originator Carolyn Webster-Stratton. On Thursday we turn to an experiment led by Stephen Scott, Director of Research at the new National Academy for Parenting Practitioners in London. Before spearheading this new initiative Scott led an experimental evaluation of The Incredible Years in four London mental health services. He found it had clear benefits and that it cost no more than conventional and unproven interventions to run.
The week is rounded off by a conversation between Carolyn Webster-Stratton and Judy Hutchings about the future of The Incredible Years in particular and parenting programs in general. Huge steps forward have been made in the last few years but they have depended on the guile, determination and rigor of pioneers in the handful of countries that take prevention seriously.
The challenge moving forward is twofold. For all the success of The Incredible Years and the only other proven parenting model, Triple-P, most policy makers and practitioners have yet to get to base camp when thinking about improving parenting.
At the the bottom of the mountain is a stony cutter of parenting interventions, all of them unproven. Some are stray fragments The Incredible Years and Triple-P thrown together. In the worst cases they owe nothing at all to the years of work of Webster-Stratton or pioneers in the field such as Albert Bandura and Jerry Patterson.
Base camp is the place for the rigorous implementation and evaluation of proven models like The Incredible Years and Triple-P. It should be possible to share ideas here and openly disseminate the results.
Further up the mountain there is much uncharted territory. How do we make parenting programs as routinely valuable and unobtrusive as ante natal services? How do we help parents encourage desirable behavior while responding sensitively to their children?s needs? Such is the focus of all the stories in Prevention Action this week.
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.
Wally is a celebrity among kindergartners at Ben Franklin Elementary School. When he shows his tan-fabric face and brown, curly, yarn hair, kids call out to him and come running to give him a hug or a high five.
Yes, Wally is a puppet, but a beloved puppet, who, with the help of Patti Miller from Olmsted County Child and Family Services, helps teach kids social/emotional behavior skills.
Using Wally, other puppets, music and pictures, Miller and DeeDee Weidman, of Zumbro Valley Mental Health Center, are teaching Franklin kindergartners the Incredible Years curriculum. Through the curriculum, the kids learn how to deal with their emotions and find solutions to problems, said Susanne Griffin-Ziebart, the school’s principal.
In Stephanie Sirek’s class on Friday, 19 5- and-6-year-olds sat cross-legged in a circle on a rug, with their eyes on Miller and Wally. Miller had just asked the students to “show me five,” which, basically, means quiet down and pay attention. /p>
Miller sat on the rug with the kids, holding the puppet and making his mouth and left arm move. She’s not a ventriloquist, but no matter — the kids intently watched Wally, not her.
“They think he’s real, but they think he’s a real puppet,” Miller said with a smile.
Wally talked to the kids about what to do when they have a conflict with another child. Some of the many solutions included: Use your words, share, and ask a parent or teacher to help.
Griffin-Ziebart hopes to expand the program through grade three if funding can be found.
“It really gives kids very consistent messages about how they can use their social/emotional behavior skills in the best way possible,” she said.
Why is it important? For one, 57 percent of Franklin’s kindergartners assessed last fall were considered academically at-risk, Griffin-Ziebart said, and Incredible Years helps them get ready to learn.
Sirek said she and the other Franklin teachers love Incredible Years.
“It’s totally changed the way we teach kindergarten,” Sirek said. “We’ve always been on the same page when it comes to curriculum, and now we’re on the same page for social skills. We have the same language.”
Sirek is spending a lot less time dealing with misbehavior and a lot more time focusing on positive reinforcement — that’s “catching them being good,” she said.
Incredible Years came to Franklin by way of a $38,000 grant from the Rochester Area Foundation’s First Steps program. The county and school district also have pitched in for staffing and training.
More than 20 Franklin staff members are now trained in Incredible Years, and 15 students’ families are participating in a 12-week class so they can reinforce the skills at home, Griffin-Ziebart said.
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.
Long-term follow-up of 83 mothers and 51 fathers who had received one of three parent training programs 3 years earlier for their preschoolers’ conduct problems. Follow-up results indicated overall improvements in parent reports of the children’s behaviors compared to baseline reports. However, only treatment that combined videotape modeling with therapist-led group discussion achieved stable improvements. Evaluation of the “clinical significance” of the treatment programs indicated that, after e years, 25% to 46% of parents and 26% of teachers reported significant child behavior problems. The families whose children were maladjusted were characterized by single-parent status, increased maternal depression, lower social class status, and family history of alcoholism and drug abuse.
Background and Methods: Fifty-eight boys and twenty girls with early onset conduct problems whose parents received the Incredible Years (IY) parent treatment program when they were 3?8 years (mean 58.7 months) were contacted and reassessed regarding their social and emotional adjustment 8?12 years later. Assessments included home interviews with parents and teenagers separately.
Results and conclusion: Adolescent reports indicated that 10% were in the clinical range on internalizing behaviors, 23% had engaged in major delinquent acts, and 46% reported some substance use. Eighteen percent of children had criminal justice system involvement and 42% had elevated levels of externalizing behaviors (mother report). Post-treatment factors predicting negative outcomes (delinquent acts) were maternal reports of behavior problems and observed mother?child coercion.
Stripped of its dependence on video technology and other resources to be found in most US and UK schools, the Incredible Years prevention program has shown that with expert modification it can still be effective even in difficult social conditions.
Dyed in the wool prevention scientists will tell you that for a program to be truly valuable it must have the potential to be effective anywhere and in any conditions ? even in a country sometimes portrayed as being among the most dangerous in the world.
The location here in question is Jamaica. In 2005 more than 1,600 people were murdered on the island and there is widespread concern about violence in schools. The program under scrutiny is the normally resource-intensive Incredible Years, successful in developed Western conditions and a key component of a recently-announced public health initiative in Ireland.
The Jamaican experiment was led by Helen Baker-Henningham of the University of West Indies against the troubling background of a survey of more than 3,000 Jamaican adolescents conducted in 2000 by colleagues Kola Soyibo and Michael Lee.
This study examined whether the link between marital con?ict management style and child conduct problems with peers and parents is direct or mediated by mothers’ and fathers’ parenting style (critical parenting and low emotional responsivity). One hundred and twenty
children, aged 4 to 7 years, were observed interacting in our laboratory playroom solving a problem with their best friend as well as at home with their parents. In addition, all the children’s parents were observed in our laboratory trying to solve two family problems as
well as at home interacting under more natural conditions with each other and with their children. Mothers and fathers completed questionnaires assessing marital problem solving as well as reports of their children’s behavior problems. Results indicated that a negative
marital con?ict management style had direct links with children’s conduct problems. In addition, the linkage between negative marital con?ict management and children’s interactions with parents and peers was found to be mediated by both mothers’ and fathers’ critical parenting and low emotional responsivity, thereby supporting the indirect as well as the direct model of negative family interactions. The ?ndings are discussed in relation to the implications for treatment.
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.
It is important to determine in what ways families with conduct problem children who seek out clinic services differ from families with “normal” children in order to design successful treatment programs. More recently research has attempted to discern if parental behavior and reports are more potent than child behavior for differentiating between clinic and nonclinic families.
NICE technology appraisal guidance 102. Parent-training/education programmes in the management of children with conduct disorders.
The full guidance and quick reference guide are also available at http://www.scie.org.uk/publications/children.asp
For printed copies of the quick reference guide or ?Understanding NICE guidance?, phone the NHS Response Line on 0870 1555 455.
This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems. In addition, it describes indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder. Emphasis is placed on empirically supported programs that have identified key malleable risk factors in children, families, and schools, which have been shown in longitudinal research to be related to later development of substance abuse, delinquency, and violence. We have targeted preschool and primary grade chi ldren, ages 0-8 years, in this review because research suggests that the most effective interventions can nip in the bud risk behaviors in the early years, before antisocial behaviors become crystallized. Guidelines for selecting effective interventions are provided.
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.
Assessed the effectiveness of ?The Incredible Years Parent Training Program? on the functioning of families of children with ADHD within a community clinic setting. A multiple baseline across participants design was employed with four research participants in a group of nine parents attending a 2-hour treatment session weekly for twenty weeks, with planned booster sessions at 2 and 4 months following treatment. Participants were all solo mothers with sons between 6 and 9 years of age who met the DSM IV criteria for ADHD. Family functioning was assessed from the pre-treatment interview schedule, measures of child behavior (Conners, Strengths and Difficulties Questionnaire, daily ratings of child behavior) and parental functioning (BDI-II, Parental Stress Index, weekly ratings on specific areas of family functioning, group goals). Participants also completed program satisfaction and evaluation measures. Results overall showed (a) some improvement in teacher and parent reports of child behavior, including targeted child behavior goals, (b) improved targeted family functioning problems, (c) increased parental confidence, (d) reduced stress and depression levels for most parent participants, and (e) reports of better parent-child relationships. Additionally, participants all reported being highly satisfied with the program. Findings support the use of the Incredible Years Parent Training Program and planned booster sessions as an effective low cost intervention to improve the functioning of solo mothers and of children with ADHD. Discussion considers the use of this intervention in an overall multiple gating, stepped care approach, particularly in light of a need for continuing services for one of the mothers.
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.
There is substantial evidence that improving parenting skills through parent training programs can significantly reduce the development and persistence of conduct problems and improve the quality of parent-child relationships (Kazdin, 1997; McMahon, 1999; Serketich & Dumas, 1996; Tucker & Gross, 1997). Specifically, when parents limit their use of coercive child management strategies (e.g., yelling, hitting, and verbal aggression) and increase their use of positive, supportive responses (e.g., encouragement, praise, and physically positive behaviors), child conduct problems and parenting self-efficacy significantly improve. These positive outcomes have mostly been achieved with early schoolaged children and adolescents. However, those findings have led to increasing interest in providing training for parents when their children are toddlers and preschoolers, before child conduct problems become firmly entrenched and more difficult to treat (Wakschlag & Keenan, 2001; Yoshikawa, 1994).
The authors tested a 12-week parent training program with parents (n=208) and teachers (n=77) of 2-3 year olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to one of four conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting-list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained one year later. Benefits were greatest when parents directly received training.?
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.
All parents of ADHD children who participated in the PTP were less likely to use harsh and inconsistent discipline at post test compared to parents in the control group. This result is coherent with previous findings on the relevance of PTP for parents of ADHD children. The emphasis of Incredible Years on positive parenting is observed in parents using less harsh and inconsistent discipline as a result of their participation in the PTP.
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.
The most thoroughly tested video modeling approach has been developed by Webster-Stratton and her colleagues. In the parent component of their Incredible years Training Series, a therapist shows brief videos of parent-child interactions to groups of mothers and fathers and leads discussions on themes illustrated in the videos. This chapter describes some of the videos.
Discourse on the application of PT with ethnic minority families has enumerated potential cultural barriers to engagement among parents whose own socialization experiences fall outside middle-class European American heritage. Given that parent?child relations and discipline practices are the proximal targets of change, many have cautioned that cultural barriers may threaten the generalizability of PT. Wide cultural variation in parenting practices and values across ethnic groups may influence receptivity to proscribed changes in parent?child interaction patterns, perhaps accounting for increased attrition or lowered participation among ethnic minorities. As such, PT interventions targeting ethnic minority families have been enhanced by attending to cultural barriers to engagement.
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.
Early-onset behavioural problems such as aggression and non-compliance are the best predictors of antisocial and criminal behaviour in adolescence and Randomised controlled trial of a parenting intervention. Untreated, up to 40% of children with early difficulties develop subsequent conduct disorder, including drug misuse, criminal and violent behaviour. Early behavioural difficulties predicting long-term problems are easily identifiable and effective interventions prevent progression into more severe difficulties. There are severe financial costs if conduct disorder is not prevented. Utilisation of health, social, education and legal services is ten times higher for this population, mostly borne by publicly funded services, especially in areas of social exclusion. Parenting behaviour contributes to the establishment of conduct disorder and many children learn, develop, or establish problem behaviours because parents lack, or inconsistently use, key parenting skills9. When ineffective parenting is the problem, cognitive-behaviourally based parenting programmes can provide an effective solution but are more effective with younger children. When both child problems and parenting patterns are less well-established parents can more easily influence their children?s behaviour. One UK government strategy is Sure Start early preventive parenting support for families of pre-school children living in identified high-risk, disadvantaged areas. Since its launch in 2001 ?3.1 billion has been invested in the scheme11. This funding was provided without direction from government about which services should be delivered. As a result, widely varying services were provided, many lacking evidence of effectiveness from randomised trials.
A recent and compelling study entitled ‘Neurons to Neighborhoods’, conducted by the Board on Children, Youth, and Families of the Institute of Medicine (USA) calls attention to the importance of early emotional development in young children. Based on a careful review of neuroscience and developmental science, it highlights compelling evidence that a child?s earliest experiences and relationships set the stage for how he or she manages feelings and impulses, and relates to others (Raver & Knitzer, 2002). This paper discusses data from studies of behavioural and emotional problems and prosocial behaviour in a community sample of 362 Portuguese preschool children (age 3 to 6 years) and examine how these problems vary, as hypothesized, with parental practices. Each mother/father completed the Portuguese translation of two measures: Parenting Practices Questionnaire (adapted from the Oregon Social Learning Centre?s discipline questionnaire and revised for young children by Webster-Stratton, Reid and Hammond, 2001); Strengths and Difficulties Questionnaire (Goodman, 1997). Implications for prevention and intervention, in terms of parenting education and support, and for the development of social policies are discussed. Key words: parental practices; emotional and behavioural problems; prosocial behaviour; preschool; parenting training; parental education; SDQ.
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.
Also of related interest: The ?Spokes? Project: Supporting Parents On Kids Education
Department Of Health Project Funded By The Parenting Initiative?
Authors: Stephen Scott, Reader in Child Health and Behaviour, Institute of Psychiatry, King?s College London and the Maudsley Hospital, and Kathy Sylva, Professor of Educational Psychology, University of Oxford
The objective of supporting parents is to enable them to develop a nurturing, stimulating relationship with their child, so they develop the child’s emotional and intellectual well-being. The question arises how best to support parents. This project sought to implement and evaluate a programme to support directly improvement of the quality of the parent-child relationship, rather than address the indirect factors that can stress it.
The consequences of inadequate parenting often lead to child behavioural difficulties and school failure. Without effective intervention, the behaviour problems have a high degree of continuity and lead to behaviours such as theft, violence to persons and property, and use of illegal drugs; disorders such as alcoholism, drug dependence, and antisocial personality disorder. The school failure has a high continuity with unemployment and receipt of state benefits. The children grow up into adults with a high rate of marital violence, family break-up, and abuse of the next generation of children.
These difficulties contribute to a greatly increased economic cost – one recent UK study showed that by the time they are 28 years old, individuals who were antisocial as children cost society ten times more than children without it. There is therefore a need for effective intervention to prevent serious, lifetime social exclusion of children, and strain and distress of parents. To address the need for early intervention, this project operated early, when the children were 5 and 6 years old in primary school.
Nature of Project
This project carried out an innovative community-based intervention to support parents in managing the two sets of child difficulties for which they most frequently seek help, namely behaviour and learning. Its aim was to see whether this parenting support package would improve the functioning of the children at risk for social exclusion, by looking at two crucial outcomes: reduction in antisocial behaviour; and their reading ability, a central skill for coping throughout life.
Implementation questions Question one: Could the groups easily be held in an everyday life venue – the local primary school, so that it could be widely replicated? Question two: Would a substantial proportion of parents with children at risk choose to enrol in the courses? Question three: Would the starting population taken as a whole show improvement? Even if there were useful improvements in those parents who attended most of the course, some would drop out.?
Parent support programme
The intervention package was delivered in 8 primary schools over three school terms. In term 1 there was a basic 12 week parenting course addressing the parent-child relationship and how to handle difficult child behaviour, in term 2 there was a 10 week reading programme, and in term 3 a 6 week combined course.
Term one: Personal development programme This was the basic ?Incredible Years? Webster-Stratton videotape parenting programme, backed up by home visits to maximise effectiveness. The scenes show parents and children in a variety of common situations, with the parents sometimes behaving in a way that leads to the child being calm and obedient, and sometimes in a way which leads the child to be miserable and have tantrums. Through careful observation and group discussion, the elements that led to successful child management were drawn out, and then parents role-played how they would apply these with their own children. They were then given homework to put this into practice during the following week.?
Term two: Intervention to support child literacy development. Professor Sylva and the team devised a new intervention with relatively intensive parental involvement and considerable specific instruction in technique. It centred around engaging maximal parental commitment and giving parents detailed training in how to encourage and shape reading skills in their child. The literacy intervention lasted 10 weeks. Term three: Combined programme This addressed communicating and problem solving with your child, and had a top-up element for literacy. It lasted six weeks.
Sample Strengths and Difficulties Questionnaires (SDQs) were completed on 733 reception and year one children by teachers, representing 99.5% of children in their classes. Parents of 433 children returned SDQs, a rate of 61%. 394 were correctly filled in and usable. A cutoff score was applied, giving 134 or 34% of the sample, who were deemed at risk of social exclusion through a high level of antisocial behaviour. 103 took part. The sample was a typical inner-city, multi-ethnic disadvantaged population. Half of the children were allocated to the parent support programme, the control half were offered an advice helpline. All 8 schools approached were extremely cooperative and welcomed the project.
Attendance by parents allocated to the intervention Personal development programme (term 1) mean attendance was 7 out of a maximum 12 sessions. Literacy programme (term 2) the mean was 6 out of a possible 10 sessions. Combined programme (term 3) the mean was 4 out of a possible 6 sessions?
Antisocial behaviour On the primary outcome, the PACS interview score, there was a significant effect in favour of the intervention group. The effect size was 0.51 standard deviations, substantial for a prevention trial. The reduction in antisocial behaviour corresponds to an improvement for the participants from being within the worst 15% of antisocial children to being outside the most antisocial 35%. The effect size for hyperactivity was also significant, 0.43. Hyperactivity is an important independent risk factor for social exclusion.?
Parent defined problems. Problems parents reported included arguing, disobedience, fighting, whining, spitefulness, jealousy etc. The intervention group showed a significant improvement compared to the controls, with an effect size of 0.64.?
Eyberg Child Behaviour Inventory.
The Intensity Score, which is a measure of the frequency of difficult behaviours, reduced significantly more in the intervention group, with an effect size of 0.28.?
Parent Satisfaction 93% of parents said they were well or extremely satisfied with the programme.
The intervention group gained seven months in reading skills, an effect size of 0.43. This result held up unchanged after multiple regression correction for age and gender. Race, parent education, parent income, and child age and gender did not affect degree of change in the intervention group compared to the control group, suggesting that the programme is robust and suited to disadvantaged populations.
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.
If left untreated, early-onset conduct problems (e.g., high rates of aggression, noncompliance, oppositional behaviors, emotional dysregulation) place children at high risk of recurring social and emotional problems, underachievement, school dropout, and eventual delinquency. The development of emotional self-regulation and social competence in the early years plays a critical role in shaping the ways in which children think, learn, react to challenges, and develop relationships throughout their lives.
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.
All children in this sample scored above the 90th percentile on the Eyberg Child Behavior Inventory (ECBI) for home problems, and met the criteria for a possible or a confirmed diagnosis of oppositional defiant behaviours. The proportion of children with pervasive conduct problems was high, 83%. Teachers in day-care and school reported children in the pervasive group to have significantly more attention and internalizing problems as well as lower social competence scores than those in the non-pervasive group. Children in the pervasive group also showed consistently more problems in their relationships both with teachers and peers than those in the non-pervasive group. The implications for assessment and treatment of children with conduct problems in these age-groups are discussed.
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.
Methods – Parents of 117 children with ODD, ages 3-6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist.
Results – More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. Conclusions Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.
Several investigations have revealed that parent psychological and cognitive factors may be responsible for success or failure in parent training. Pretreatment levels of parental depression and anxiety were found to be significantly related to treatment failure and dropout during therapy and during followup.
There is a need to bolster the impact of parent training programs both by lengthening their treatment programs and by providing ongoing expanded therapy which focuses on families’ specific needs such as life crisis management, depression, problem-solving, budget planning, marital therapy, and so forth. Only by addressing the broader ecological needs of families can we begin to reach those 30-50% of families who fail to benefit from the traditional parent training approaches.
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.
With the occurrence of multiple homicides on school campuses during the 1997-1998 and 1998-1999 academic years-such as in Springfield, Oregon and Littleton, Colorado-there has been a growing public perception that an increasing number of students may “go Off” at any time and cause serious harm to themselves and/or others. In response to this perception, school administrators, lawmakers, and prosecutors have recently “cracked-down” on juvenile violence. Metal detectors, security guards and police, crisis drills, “zero tolerance” discipline policies, and alternative programs for aggressive children are now found in many schools that previously saw little need for such measures. Several stats now require that children who commit violent crimes be tried as adults. Lawmakers have also proposed school prayer, mandatory student uniforms, mandatory use of “ma’am” or “sir” when responding t teachers, and the school-wide posting of the Ten Commandments as partial solutions to the widely perceived rising tide of school violence. Although well intended, too often such “solutions” have been misguided, based on little, if any, empirical research supporting their effectiveness in preventing school violence and promoting children’s mental health.
Emotional self-regulation and social competence play a key role in young children?s future interpersonal adjustment and academic success. Unfortunately, exposure to multiple poverty-related risks increases the odds that children will demonstrate less social and emotional competence and more behavior problems. School curricula designed to promote children?s social competence, emotional regulation, and school readiness that are offered to high-risk, socioeconomically disadvantaged populations in the early years would seem a strategic prevention strategy. This randomized trial evaluated the Incredible Years (IY) social, emotion, and problem-solving curriculum (Dinosaur School) as a selective prevention program for socioeconomically disadvantaged children enrolled in Head Start, kindergarten, or first grade classrooms in schools selected because of high rates of poverty.
The authors studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the ‘highest risk’ at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.
Young children with aggressive and oppositional behavior are at risk for serious antisocial behavior that may persist into adolescence and adulthood. Most parents wish to discuss parenting difficulties and their child?s social and emotional development during well-child visits. Parent training programs are an effective option to promote positive parenting and discipline strategies and enhance a child?s social skills, emotional self-regulatory skills, and problem-solving ability. Key parenting principles can be incorporated into developmental surveillance and anticipatory guidance during periodic well-child visits to prevent disruptive behavior problems, address parenting concerns, and nurture the optimal development of children?s social-emotional competency.
Responding to serious behaviour problems requires new practice answers and emphases. Best practice principles and a developmental perspective indicate that the family should be the focus of preventative work. The Incredible years parent training series is described as an important example of an empirically-supported programme that is presently being used in Tauranga and elsewhere 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.
Identification and selection of an ‘evidence-based,’ ’empirically validated,’ or ‘best practices’ mental health program is only the first step in service delivery. In order to obtain similar results to those published by the developer of a program, attention must be given to supervising the quality of the implementation of that program. It is important to assure that the program is delivered with the highest degree of fidelity possible. Fidelity means that the program is delivered in its entirety, using all the components and therapeutic processes recommended by the developer. The Incredible Years Parent, Teacher, and Child Training Programs have been proven in numerous randomized control group studies to be effective for promoting positive parent and teacher interactions with children, strengthening children?s emotional, social, and self-regulation competence and reducing behavior problems in both prevention and clinic populations. A number of training processes are recommended to ensure that replication of the Incredible Years programs can be achieved with fidelity: standardized training, detailed treatment manuals, standardized session protocols, peer review, mentoring and supervision, and leader certification. This chapter will provide a description of these training methods and supervision processes to deliver the Incredible Years training programs with a high degree of fidelity.
The Incredible Years series is a set of comprehensive curricula targeting children age 2 to 10 years old and their parents and teachers. The curricula are designed to work jointly to promote emotional and social competence and to prevent, reduce, and treat children?s behavioral and emotional problems.
The Incredible Years Parent-Training program includes four separate components targeting parents of high-risk children or children displaying behavior problems. In all four training components, facilitators use videotaped scenes to encourage group discussion, problem-solving, and sharing of ideas. The “BASIC Parent-Training Program?Early Childhood” (BASIC?Early Childhood) is a core component of the Incredible Years series and includes 12 to 14 two-hour weekly sessions targeting children age 2 to 7 years old. The BASIC?Early Childhood curriculum emphasizes parenting skills to promote children?s social competence and to reduce behavior problems, and it teaches parents how to play with children, help children to learn, give effective praise and incentives, use limit-setting, and handle misbehavior.
The four add-on parent-training components, “Advance Parent Training Program?School Age (ADVANCE),” “BASIC Parent Training Program?School-Age (BASIC-School Age),” “Supporting Your Child?s Education?School Age”, and the school readiness supplements “Child-directed Play” and “Interactive Reading” may be offered as supplements to the early childhood BASIC component. ADVANCE targets school-age children 4 to 10 years old and includes eight to ten two-hour sessions that emphasize parents? interpersonal skills, such as effective communication, anger management, problem-solving between adults, and ways to give and receive support. The BASIC?School Age program is similar to the early childhood program but emphasizes strategies for older children, including logical consequences, monitoring, helping children learn to problem solve with children, and family problem-solving. The Supporting Your Child?s Education?School Age component for children age 5 to 10 involves four two-hour sessions and highlights approaches to parenting to promote children?s academic skills, including nurturing reading skills, setting up homework routines, and building collaborative relationships with teachers. The school readiness supplements may be used with parents of 3- to 5-year-olds, and includes an emphasis on building children?s social, emotional and academic skills, as well as fostering pre-reading and reading skills using the interactive reading approach.
Child Training Programs
There are two separate child-training components in the Incredible Years series. The first is the classroom program for children age 4 to 8 years. The Classroom Child-Training program uses the “Dina Dinosaur” curriculum which has more than 60 lesson plans (with preschool, kindergarten and grade one and two curricula), and may be offered over multiple years from preschool to grade two. The program seeks to improve peer relationships and reduce aggression both at home and at school. The curriculum is delivered to the entire classroom by regular teachers, two to three times a week through 20 – 30 minute group discussions followed by small-group practice activities. Home activity manuals encourage parents? involvement in teaching their children school rules, social skills, and problem-solving.
The second child-focused program is the “Dinosaur Child-Training” curriculum, a treatment program for small groups of children age 4 to 8 years who are exhibiting “conduct” problems (defined as high rates of aggression, defiance, and oppositional and impulsive behaviors). The curriculum emphasizes communicating feelings, empathy for others, friendship development, anger management, interpersonal problem-solving, and obeying school rules. The Dinosaur Child-Training program is offered to groups of five to six children in two-hour sessions held weekly for 20 to 22 weeks. The program can be delivered by counselors or therapists to treat conduct-disordered children in small groups, or can be used by schools as a “pullout” program for children with special behavioral and emotional needs.
Teacher Training Program
The training program for teachers emphasizes classroom management skills, such as the effective use of praise and encouragement, proactive teaching strategies, and ways to manage inappropriate classroom behavior and build positive relationships with students. Training can be provided through either four to six full-day workshops or 14 to 20 two-hour sessions.
The BASIC Parent-Training Program?Early Childhood component and the small-group Dinosaur Child-Training program have been rigorously evaluated, and the remainder of this description of the Incredible Years series focuses on these two components. The ADVANCE, BASIC?School Age, Supporting Your Child?s Education, and school readiness parent-training components, the Teacher-Training program, and the Dina Dinosaur classroom curriculum currently do not have sufficiently rigorous research evidence that clearly assesses impacts on child outcomes.
The Promising Practices Network (www.promisingpractices.net) is a Rand Corporation website
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.
Carolyn Webster-Stratton adores and understands kids who throw things, bite, kick, refuse to obey every request or command and who rarely get invited to birthday parties. Kids who are asked to leave preschools and, if they are invited to a play date, are never asked again.
And through every encounter Webster-Stratton appears as a woman wrapped in calm, a calm that puts visitors at ease the minute she enters a room.
Carolyn Webster-Stratton, whose work focuses on helping children ages 3 to 8, uses the puppets shown in her University District office to interact during therapy sessions. Her office is a dinosaur haven and her windowsills overflow with stuffed animals and a multiracial classroom of puppets, some of them in sizes and shapes similar to her clients. Children talk to the puppets, and this clinical psychologist listens.
Webster-Stratton is an ally of children who bring parents to their knees — children with conduct problems, a generic term for children who are highly oppositional, defiant, aggressive. These disruptive disorders affect about 8 percent of the population.
“That’s a lot of kids, and services for these children are few and far between,” she said. “Aggressive behavior is an important risk factor related to later violence.”
That’s why she’s focused on children ages 3 to 8, a key time to break the trajectory. Without early intervention, these children are at risk of getting kicked out of schools, living with anti-social behaviors, abusing drugs and alcohol and eventually facing criminal charges as they age.
She’s shown that these children can be helped, and dreams of the day when parents and educators are as attuned to developing emotional skills as academic skills.
“All kids yell, hit, bite, scream,” Webster-Stratton said of her subjects. “These kids do it at a greater frequency and intensity.” Most children are aggressive at 2 and 3, but that aggression decelerates at 4 or 5.
“A typical 5-year-old will disobey about one-third of the time, but do what is asked two-thirds of the time,” she said. “Children with defiance or conduct disorders refuse most of the time. Unless they obey, they can’t be socialized or taught.
“Highly aggressive children tend to stay that way throughout life unless they are helped. Both parents and teachers need to be involved in promoting social skills and replacing aggressive behavior.”
That means learning how to share, follow directions and use words to ask for what they want, for example.
Webster-Stratton said society, unfairly, tends to blame parents for kids with misbehavior issues: “The biology a child gets isn’t something they can do anything about.”
She cites three factors affecting a child with conduct problems: biology, family and school.
Biologically, a child’s “wiring” could be off, making him difficult to deal with. He might have additional issues such as an attention deficit disorder.
Family factors include neglect, high stress, poverty, harsh punishments and abuse.
Schools can add a high student-to-teacher ratio, not enough help, a teacher who isn’t tuned in to these disorders.
A combination of these risk factors can be overwhelming for an affected child.
Webster-Stratton has spent more than 30 years working to break that cycle. She’s worked with children, their families and teachers. She’s researched, developed and published curricula, books and videotapes — programs that are now used in countries throughout the world.
And she’s been at it long enough to track the results, which are impressive. On a three-year follow-up, more than two-thirds of the children were in the normal range on standardized measures completed by teachers and parents.
In the late 1970s this UW psychologist and professor began a parenting program with middle-class families, teaching them how to bring out the best in their kids and to deal with common behavior problems. But when she tried to publish it, editors said, “Who cares about the middle class?”
“It led me to take the program to lower-income families, often single-parent families with a child,” Webster-Stratton said. “That’s what hooked me on this population.”
She taught classes at Children’s Hospital and Regional Medical Center to highly motivated parents who made huge efforts (as in several bus transfers) to learn ways to deal with their children.
Those classes led to programs for children, parents and teachers — prevention programs usually focused on schools with high rates of children in free-lunch programs. Teachers have been trained to deal with behavior and to offer a social and emotional curriculum. Parents are often offered classes in the schools their children attend, parenting classes open to all.
Webster-Stratton’s years in the field and follow-up studies have proved that an increase in social competence decreases aggressive behavior.
John Bancroft, director of Head Start for Puget Sound, has known Webster-Stratton and her work for a long time. She worked with him in a Head Start program for three years in the early 1990s.
“I liked her involvement of parents,” Bancroft said. “She was willing and eager to train parents to train other parents. There’s no professional aloofness. I would say it was one of the most successful parent education programs we’ve done in Head Start.”
Another mark of her success was having 70 percent to 80 percent of parents participate. “That was unheard of,” Bancroft said.
It was information to help all parents, not just parents of challenging children.
Webster-Stratton’s dream is for social and emotional curriculums to be regarded as being as important as reading or math. “You can’t separate them,” she said. “Better social/emotional skills (lead to) better academic outcomes.”
She also noted that we can take courses in almost any subject, but courses in parenting are rare. “We should ‘immunize’ parents to be the best parents they can be,” Webster-Stratton said.
She speaks from professional and personal experiences. A native of Canada, she has a nursing degree from University of Toronto, two master’s degrees from Yale — one in public health and another as pediatric nurse practitioner, and a doctorate in educational psychology from the UW.
After working with children for years, she had two sons, now 20 and 22. Did motherhood cause her to rethink any of her programs?
The question made her laugh. She said that’s when she developed her Advanced Parenting Program focusing on anger and depression management, problem solving, communication skills and giving and getting support.
Social skills are as important as numbers and the alphabet for preschoolers.
If parents feel they’ve lost control with their child, they should seek help.
Teachers are good at spotting problems because they have more perspective.
Parents can get away with some “slop” in their parenting skills with typical kids, but not with those with conduct problems.
Children with conduct disorders can be so inattentive they miss both praise and commands.
Attention is a powerful reward. It works when teachers ignore kids who are out of their seats and praise those who stay seated, for example.
Don’t reinforce misbehavior.
Develop a meaningful relationship with your child and partner with your child’s teacher.
— Source: Carolyn Webster-Stratton
TO LEARN MORE
To learn more about Webster-Stratton, her programs and books, go to incredibleyears.com
Children’s Hospital and Regional Medical Center in Seattle offers parenting classes and other programs. Call the hot line: 206-987-2500.
The University of Washington Parenting Clinic is accepting families of children 4 to 6 years of age with attention deficit hyperactivity disorders. For information, call 206-543-6010
A decade ago parenting programs were not in fashion. It was commonplace to talk about the effects of family breakdown or the problems of single mothers, but relatively few people were paying much serious attention to what parents did or to how parenting behaviors could be changed with children’s health and development in mind. Not so today: many jurisdictions are awash with programs, most of them of doubtful value.
After spending two years practicing among the Haida and Tlingit Indians of Alaska, Carolyn Webster-Stratton came to the conclusion that showing parents how to play with their children was more effective than telling them how to do it. When sl1e arrived at the University of Washington in 1976 to teach in the nurse practitioner program, she began the process of videotaping families to show them what worked with their children and what didn’t. Today, Webster-Stratton is a professor of nursing at the University of Washington where, in 1980, she con1pleted her doctoral dissertation in educational psychology on the effectiveness of videotape modeling parental education as a therapeutic tool.
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.
The Early Childhood Longitudinal Study (ECLS), a nationally representative sample of more than 22,000 kindergarten children, suggests that exposure to multiple poverty-related risks increases the odds that children who are socioeconomically disadvantages will demonstrate less social and emotional competence and more behavior problems than more economically advantaged children.
In the present study, generalisation effects from home to day-care/school settings were examined in a clinic sample of children aged 4-8 years treated because of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) with The Incredible Years Parent Training programme or Parent Training combined with Classroom Training.
A striking characteristic of the sample was that 83% of the children exhibited clinical levels of conduct problems both at home and in day-care or school settings before treatment. Overall, the combined Parent Training + Classroom Training treatment produced more positive generalisation effects than the Parent Training only group, in particular after treatment. Analyses of differences between group means between pre- and posttreatment were conducted by means of ANCOVAs using pretreatment scores as covariate and treatment condition.
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.
This study compares consumer satisfaction of three cost-effective methods for training parents of conduct problem children. Seventy-nine mothers and 52 fathers completed weekly evaluations and extensive one-month post treatment evaluations. One year later 84 percent of the mothers and 75 percent of the father completed the consumer follow-up evaluation.
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.
There has been recent increased emphasis in the use of performance-training methods to increase the effectiveness of parent-training programs. Once such method has been the use of live modeling, a technique whereby the experimenter or another parent demonstrates the behaviors the parents are to acquire. This method has been shown to be a powerful agent to enhance the effectiveness of parent-training programs.
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.
Child depression is a serious public health burden without any currently accepted empirically supported treatments. Given the dire consequences of life-course persistent depression and the developmental roots of depression in childhood, effective treatments and prevention strategies are urgently needed. The parent behavior-management intervention used in the present study is a widely used and accepted treatment. Given mounting pressures toward time-limited therapy and the widely accepted high rates of co-occurring behavior problems in children, clinicians and researchers welcome any evidence that single interventions can promote change in multiple problem areas. Current evidence suggests that the parent behavior-management program tested in this study offers a viable treatment for reducing depressive symptoms in young children.
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
Over the past several years, a large amount of information has been collected on the risk and protective factors for violence. Research has also identified prevention programs that can modify these risk and protective factors. The Blueprints initiative has been in the forefront in identifying exemplary programs that have been evaluated in rigorous, controlled trials, and much attention has been focused nationally on selecting and implementing quality programs. However, identification of effective programs is only the first step in the efforts to prevent and control violence. Widespread implementation of effective programs is unlikely to affect the incidence of violent crime unless there is careful attention given to the quality of implementation, the degree to which a program is delivered as intended (American Youth Policy Forum, 1999; Biglan & Taylor, 2000; Lipsey, 1999). Research demonstrates that successful implementation is not guaranteed by a site?s decision to adopt a best practices program. Many science-based programs have been adopted in different settings with widely varying outcomes. In fact, a high quality implementation of a poor program may be more effective than a low quality implementation of a best practice program (Gottfredson, Gottfredson, & Czeh, 2000). Until recently, little emphasis has been given to implementing programs with fidelity in both the science and practice of prevention. As a result, most people do not recognize the importance of implementation fidelity and feel that implementation of at least some program components will be better than doing nothing. However, this may be an erroneous belief, since we typically do not know which components of a program may be responsible for the reductions in violence. Programs must be implemented with fidelity to the original model to preserve the behavior change mechanisms that made the original model effective (Arthur & Blitz, 2000).
This report has been prepared to provide an account of the Norwegian The Incredible Years programme, in accessible form. Beside a description of the programme, it concentrates on the results of clinical trials carried out in Trondheim and Troms? in 2001-2003, and presents material from a user evaluation carried out in 2003-2004. A brief examination of implementation issues is also included. Important project components in the programme seen as a whole have had to be omitted here, either because they are not yet complete or because space did not allow their inclusion. The treatment trial material presented here is based on work carried out by Bo Larsson, Willy-Tore M?rch, May Britt Drugli and Sturla Fossum. The user evaluation material is based on work carried out by Jim Lurie and the undersigned. Charlotte Reedtz, Jim Lurie and the undersigned have worked on collection of material to standardise instruments used in the research.
Background: Controlled evaluations of psychosocial interventions for young children with behavioural problems are sparse. However, in a series of experimental studies, professor Webster- Stratton and her collaborators in Seattle have examined the effects of various forms of parent and child therapy for 4-8 year-old children with aggressive and noncompliant behaviours. In the studies various forms of basic parent and child training have been compared to waiting-list controls, a more comprehensive parent training program, and in addition to a school-based (teacher) intervention. No previous replications have been made in Scandinavia, but two such studies have been conducted in Canada and one recently in England, both with positive outcomes.?
Aims and study design: To replicate one of Webster-Stratton’s studies comparing the basic training program for parents (12 sessions) with parent training and child therapy (“The Dinosaur School”)(18 sessions) and waiting-list controls in an experimental study including a total of 150 Norwegian children aged 4-8 years; 60 families will be randomized into each of the active treatment groups and 30 families to the waiting-list. To examine the maintenance of treatment effects one year after treatment, in addition to generalisation of treatment effects from home to school settings.?
Measures: After screening for children’ s noncompliant and aggressive behaviours as rated by parents and teachers (Eyberg Child Behavior Inventory-EBCI), parents of children with high scores are interviewed to obtain psychiatric diagnoses of either oppositional defiant disorder (ODD) or conduct disorder (CD). Parents rate their practices, involvement in child care and rearing disagreement, in addition to their own anger, depression and stress. Observations of child and parent interaction are made at home and in the clinic. In the school and preschool the children’s behavioural problems are observed and compared with children with no such problems. The child reports on its feelings of loneliness and takes a problem-solving test. School and day care teachers assess the children’ s behaviour and social competence, in addition to their own home involvement.?
Implementation and intervention: The planning of the project started 1998 and has been subjected to an evaluation by the Norwegian Research Council before implementation. Extensive contacts were established with professor Carolyn Webster-Stratton, who helped training of therapists and the mentor. Because no normative data existed for the screening measure (EBCI), it was first standardised in a survey including about 640 children aged 4-8 years from Trondheim and Troms?. Many of the assessment instruments and the video vignettes were translated into Norwegian.?
Since the fall of 200l recruitment of children and families has taken place. Today, about half of the final sample (N=78) has been recruited in the project, which will continue unti1 summer 2003. Treatment is administered to parents and children in groups over a 3-4 month period. Two therapists conduct the group treatment, which is highly structured and manual.?
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.
For this paper the researcher took the unusual approach of interviewing the deliverers of the parent training programme in Tauranga, rather than the recipients. The perspective taken was that the programme facilitators are usually highly qualified psychologists and social workers who collectively have an enormous amount of knowledge, experience and insights. The Incredible Years parent training programme has been found to be highly successful in Tauranga as it provides a supportive group environment in which parents can share concerns and ideas, and it is adaptable to different cultural and individual needs.
Young children who present for treatment with oppositional-defiant disorder (ODD) and conduct disorder (CD) frequently exhibit these symptoms across settings and often show comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or internalizing symptoms such as anxiety or depression. Parent training programs to treat these children must be flexible and comprehensive enough to address these issues. This article outlines a case in which the Incredible Years Parent, Teacher, and Child Training programs were used to treat a young boy, John, with ODD. His problems were pervasive and occurred at home, at school, and with peers. This case study outlines how a multimodal, manualized treatment can be applied flexibly to attend to individual family needs and address issues of comorbidity.
The Clinical Problem :
The incidence of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in children is alarmingly high, with reported cases of early-onset conduct problems in young preschool children 4-6% (Egger & Angold, 2006) and as high as 35% for low-income families (Webster-Stratton & Hammond, 1998). Developmental theorists have suggested that, compared to typical children, ‘early starter’ delinquents, that is, those who first exhibit ODD symptoms in the preschool years, have a two- to threefold risk of becoming tomorrow’s serious violent and chronic juvenile offenders (Loeber et al., 1993; Patterson, Capaldi, & Bank, 1991; Snyder, 2001; Tremblay et al., 2000). These children with early-onset CD also account for a disproportionate share of delinquent acts in adulthood, including interpersonal violence, substance abuse, and property crimes. Indeed, the primary developmental pathway for serious conduct disorders in adolescence and adulthood appears to be established during the preschool period.
To address the parenting, family, child, and school risk factors, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (ages 2-8 years). This chapter reviews these training programs and their associated research.
Although our programs were first designed and evaluated to be used as clinic-based treatments for diagnosed children, our recent work has tended our clinic-based treatment model to school settings and has targeted high-risk populations. As more is known about the type, timing, and dosage of interventions needed to prevent and treat children?s conduct problems, we can further target children and families to offer treatment and support at strategic points. By providing a continuum of prevention and treatment services, we believe we will be able to prevent the further development of conduct disorders, delinquency, and violence.
Effective interventions for children with conduct problems ideally target multiple risk factors and are best offered as early as possible. Conduct disorder becomes increasingly resistant to change over time, so early intervention is a crucial strategy for the prevention or reduction of conduct problems, violence, substance abuse, and delinquency. Children with ODD and CD are clearly identifiable as early as 3-4 years of age, and there is evidence that the younger the child is at the time of intervention, the more positive the behavioral adjustment at home and at school following treatment. Intervention that is delivered prior to school entry and during the early school years can strategically target risk factors across multiple domains; home and school, and through multiple change agents; parent, teacher, and child. Unfortunately, less than 20% of young children meeting DSM-IV criteria for ODD are referred for mental health services (Horwitz, Leaf, Jeventhal, Forsyth, & Speechley, 1992). Even fewer of those referred obtain evidence-based interventions.
To address the parenting, family, child, and school risk factors for children or adolescents with conduct problems, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (from birth to 12 years). This chapter reviews these training programs and their associated research findings.
The Hospital Education Service provides education for children and young people attending or admitted to hospital. One of the main roles of this service is to ensure minimal disruption to children’s education during these difficult times.
This service is provided by Glasgow City Council and serves children and young people from 3 to 18 years of age from all local authorities in Scotland and, on occasion, from other areas in the United Kingdom. The service offers a range of interventions to support children and their families in addressing the additional support needs of children and young people with medical conditions and/or social, emotional and behavioural difficulties.
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.