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Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme
Margiad Elen Williams
CEBEI, Bangor University
Supervisors: Professor Judy Hutchings Dr Helen Baker-Henningham
1 in 5 children are affected by emotional and/or behavioural problems (BMA Board of Science, 2013)
Risk factors – poor parenting, poverty, etc.
Background
*BMA Board of Science (2013). Growing up in the UK: Ensuring a healthy future for our children. Retrieved from http://www.bma.org.uk/working-for- change/improving-and-protecting-health/child-health/growing-up-in-the-uk*Caspi, A., Moffitt. T., Newman, D.L., & Silva, P.A. (1996). Behavioral observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort. Archives in General Psychiatry, 53, 1033-1039.
• Adverse outcomes in adolescence and adulthood including unemployment, substance misuse, teenage pregnancy, etc. (Caspi et al., 1996)
Early InterventionImportant way of tackling behaviour problems
Poor parenting is a significant risk factor (Patterson & Forgatch, 1995)
Group-based parenting programmes are effective for treatment and prevention (Furlong et al., 2012)
Not always appropriate for families
Alternative is one-to-one support*Patterson, G.R., & Forgatch, M.S. (1995). Predicting future clinical adjustment from treatment outcome and process variables. Psychological Assessment, 7, 275-285. *Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S.M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Cochrane review). Cochrane Database for Systematic Reviews, 2.
Enhancing Parenting Skills (EPaS)
Developed in 1990s
One-to-one delivery
Three core components
Structured assessment
What do we know about the family?
What is the history of the problem/s and what is happening on a day to day basis?
What types of behaviour problems are evident?
What are the strengths and skills that the family brings?
Case analysis
Why does the behaviour occur?
What are the possible triggers?
What are the alternative behaviours that will replace the problem behaviour/s?
Intervention strategies
What strategies can be used to teach the replacement behaviours and reduce the problem behaviour/s?
Intensive Treatment trial
*Hutchings, J., Appleton,, P., Smith, M., Lane, E., & Nash, S. (2002). Evaluation of two treatments for children with severe behaviour problems: child behaviour and maternal mental health outcomes. Behavioural and Cognitive Psychotherapy, 30: 279-295. *Hutchings, J., Lane, E., & Kelly, J. (2004). Comparison of two treatments for children with severely disruptive behaviours: a four-year follow-up. Behavioural and Cognitive Psychotherapy, 32: 15-30.
Significant improvements in child behaviour, maternal depression, and parenting skills compared to standard treatment
Health visitor trial
*Lane, E., & Hutchings, J. (2002). Benefits of a course in behavioural analysis for health visitors. British Journal of Nursing, 11, 702-714.
Eyberg Child Behaviour Inventory
Parenting Stress Index
Significant improvements in child behaviour and maternal mental well-being compared to control group
Waterloo Foundation grant in 2013 to evaluate a shorter version of the EPaS training delivered across
Wales
Re-designed programme Two-day training course Detailed intervention manual Parent help sheets
Training for staff working with children facing developmental challenges
Underlying principles work for all children
Waterloo Foundation study
Five locations across Wales
62 attended day 1 (assessment)
42 attended day 2 (case analysis & intervention strategies)
High levels of satisfaction with training & content
Increased use of behaviour principles
Waterloo Foundation study
Data from 25 families (10 complete)
Children with behaviour problems, parents with low mental well-being and problematic parenting skills
Significant improvements in child behaviour, parental mental well-being, and parenting skills (Hutchings & Williams, 2013)
Parents rated programme as useful and would recommend to others
*Hutchings, J., & Williams, M.E. (2013). Report on the staff training project to support children with developmental challenges. Bangor, UK: Children’s Early Intervention Trust Charity.
Limitations
Two days not enough
Staff had varied backgrounds & experience
Small sample
No control comparison group
EPaS 2014 trial
Aims to address limitations
Course redesigned to be delivered in three days and manual improved and expanded Day 1 – assessment Day 2 – case analysis Day 3 – intervention strategies
Tailored to support health visitors who already have good child development understanding
EPaS 2014 trial design
Multi-centre pragmatic randomised controlled trial
4 confirmed centres: North West Wales, Central North Wales, North East Wales, Shropshire
Possible 5th site
Recruitment
Aim to recruit 60 health visitors and 120 families
Health visitors will screen for child behaviour problems in children aged 30 – 60 months • Recruit those
scoring above clinical cut-off on Eyberg Child Behaviour Inventory
Data collectionBaseline and 6-month data collection points
Outcomes include: child behaviour parental mental health parenting skills observation parent-child interaction
EPaS 2014 trialHypotheses
Three days of detailed assessment, case analysis and behavioural intervention skills training will enable health visitors to effectively support families of high challenge pre-school children and achieve positive outcomes.
• This will demonstrate a scalable model for dissemination of effective training for health visitors
Progress so far …
Baseline measures have been collected from all families in Central North Wales and Shropshire
Currently collecting follow-up data from all participating families in North West Wales
Currently recruiting health visitors for North East Wales
