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.
Incredible Years: Implementation and Dissemination
Although co-morbid diagnoses often are not the presenting problem for a child with ODD, they convey additional risk in short- and long-term treatment outcomes and may be directly or indirectly contributing to the externalizing behavior problems (C. Webster-Stratton, 1985, 1990). Thus, treatments that target children?s oppositional and aggressive behaviors, such as the Incredible Years (IY) Child Dinosaur Curriculum must be flexible enough to meet the needs of children with complicated profiles. Since young children cannot easily communicate their feelings or worries and the reasons for their misbehavior, it is important for therapists to look beyond the aggressive symptoms to the underlying reasons for the misbehavior.
Over the past thirty years, hundreds of carefully controlled studies have demonstrated that there exist today a number of effective therapies and services for children and families which can reduce behaviour problems and delinquency, improve mental health, assist abusive parents to improve their child-rearing, and increase family functioning (Weisz and Weiss, 1993). Yet in spite of this evidence, few empirically supported interventions have been widely adopted in applied settings (Kazdin, Bass, Ayers, and Rodgers, 1991). In the paper, we describe an empirically supported parenting intervention developed and evaluated by the first author, including the strategies used to make it easy for clinicians in the field to implement with integrity.
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.
Raising children is one of the hardest jobs facing adults in our society and one for which there is least preparation. Moreover, several aspects of the job of parenting have become more difficult in recent years. Much has been learned about the risk and protective factors associated with different developmental outcomes for children and the important role parents can play in promoting children’s social, emotional and academic capacity and competence. Our current understanding is that many parents are not well prepared to do their best for their children.
In this chapter we consider factors that can make parenting more challenging and describe the growing number of interventions, in statutory and voluntary services, that have been developed to support parents and children within their own communities.
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.
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.
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.
This paper describes the implementation.
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.
Multi-component interventions for conduct disorder target several contexts of a child?s life (e.g., both home and school environments) and are generally more effective than single-component behavioral interventions. Whether the multi-component approach is cost-effective remains an unanswered question. This article analyzes two decades of data from the Incredible Years (IY) Series to examine the costeffectiveness of delivering multiple, stacked intervention components versus a single-component delivery approach. Cost-effectiveness analysis (CEA) provides decision makers with important economic information that can be used to aid in the selection of a program delivery format from one of several competing approaches. CEA concepts, including explicit budget constraints and strict dominance, are demonstrated using IY data; guidelines for interpreting CEA results are provided. Our analyses suggest that combining intervention components is a cost-effective approach to treating behavioral problems in a clinic-based youth population.
In most cases, implementation strategies have been limited to paper-based manuals that focus on describing interventions without providing complementary information on necessary implementation resources and activities. Because of this, they do not facilitate the real-world application of innovative, research-based practice.
Recently, researchers have begun to study implementation in an effort to understand the key ingredients for successful program implementation. This brief will define implementation, highlight why the effective implementation of evidence-based practices is critical to achieving outcomes, and outline six core components that drive successful program implementation, referred to as “drivers.”
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/
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.
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.
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.
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.
This paper reports on a quantitative evaluation of a group-based programme designed to promote parent infant attachment and child.
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.
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.
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).
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 Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over.
This paper focuses on the Incredible Years Teacher Training (IY TT) intervention as an example of an EBP that embeds fidelity and adaptation within its design. First, the core features of the IY TT program along with the methods and processes that make the intervention effective are described. Second, the support mechanisms (training, mentoring, consultation, and IY TT coaching) necessary to facilitate high fidelity of implementation of IY TT are highlighted. The goal is to clarify the underlying principles and layered supports needed to effectively disseminate the IY TT program to audiences with diverse backgrounds and skills who work with students with varying developmental, academic, and social-emotional needs. Often fidelity and adaptation are thought of as mutually exclusive, but in the IY model they are considered both complementary and necessary. Implications for school psychologists and prevention science are discussed.
Challenges to delivering evidence-based practice in the “real world” have the potential to undermine their acceptance, efficacy, and sustainability in community settings. The Incredible Years Series is one preventive intervention with demonstrated effectiveness in settings facing multiple dissemination challenges, including Head Start. We established a university-community partnership to deliver Incredible Years Series in a local Head Start, including the Teacher Classroom Management Training Program and the Child Dina Classroom Training Program.
ABSTRACT: This study examined the perceived effectiveness, acceptability, and integrity of the self-administered format of the Incredible Years Parent Training Program, for children exhibiting behaviors associated with attention-deficit/hyperactivity disorder. To assess perceived effectiveness, an AB pretest-posttest design was used across 10 weeks. Improvements in parents’ rating of adaptive skills were replicated across five participants.
It is essential that sound theory and research support new treatment and that procedures are described elearly and are followed closely. This chapter describes the training, supervisory and organizational requirements to implement the Incredible Years (IY) Training Series to prevent and to treat early onset of conduct problems in children. Five key elements are identified and descussed.
AbstractThe aim of the present study was to investigate residential child care staff satisfaction with.