Background Children who lack social & emotional competence display anti-social behaviour & conduct problems. These children are at risk of developing early onset Conduct Disorder (CD). CD is the biggest child mental health problem and is increasing. Children with early onset CD have a poor long term prognosis. CD predicts school drop out, substance abuse & violence. CD is often associated with attention deficit hyperactivity disorder & a range of learning and other difficulties.
Background Parenting interventions work but are not sufficient for all high-risk children some of whom may need additional direct work. It is not possible to engage all parents. Interventions for children must strengthen social and emotional competencies and problem solving skills in order to reduce behaviour problems and achieve desired academic outcomes and school success. High risk children may need a targeted intervention in addition to universally delivered school based programmes in order to increase the childs opportunities to learn by discovery and experience.
Rationale Additional academic skills coaching for high risk children may not be effective unless they are first helped to learn basic social and emotional competencies £400k funding was awarded by the BIG Lottery research fund to IY Cymru charity to undertake a three year study in partnership with Gwynedd Education Service and Bangor University (April 2010 – March 2013). Children in KS1 in Gwynedd schools get the IY Classroom Dina Curriculum and their teachers are TCM trained. The study will establish whether the IY Therapeutic Dina Programme (small group), delivered to high-risk KS1 children in Gwynedd Schools, improves their social and emotional competencies and academic engagement.
Intervention The universal Classroom Dinosaur School Programme is an effective early years curriculum for most KS1 children The Therapeutic Dinosaur School programme (Webster- Stratton, 1990) produces significant benefits for clinically referred children in terms of reduced behaviour problems, increased problem solving skills and improved peer relationships The classroom curriculum is delivered to all KSI children in the 102 primary schools across Gwynedd, North Wales. There are a significant number of high-risk children in Gwynedd who might benefit from the additional coaching provided by the therapeutic Dinosaur School programme
The Dino School curriculum in Wales Aims to improves childrens ability to understand & communicate feelings, problem-solve, manage anger and make and keep friends. Was developed and researched in Seattle as both a clinical therapeutic and a preventive classroom programme The therapeutic programmme has been run successfully with CAMHS referred Welsh children (Hutchings et al 2007). A pilot study of the Therapeutic Programme was undertaken with high-risk children in Bro Lleu School, Gwynedd, where children already have the Classroom curriculum This demonstrated improved problem solving, reduced behavioural problems and increased positive behaviour towards teachers (Hutchings et al, submitted). This additional therapeutic programmme now needs to be researched in a larger randomised controlled trial.
Intervention Dinosaur School Curriculum How to do your best in school How to become a feelings detective How to solve problems How to manage anger How to make and keep friends The Therapeutic Dina Programme (Webster-Stratton, 1990) is delivered for two hours per week for a period of weeks to groups of six children. Sessions involve: homework review, introducing new material through discussion and by watching video-clips, role play practice, small group fun games and activities and homework activities
Study design First ever study of the added benefits of the IY therapeutic Dina curriculum for identified high-risk children already receiving the classroom curriculum A three year randomised controlled trial (RCT) intervention for two years and one year for data analysis and write-up Participants identified by teachers as within the cause for concern range on the Teacher Strengths and Difficulties Questionnaire (T-SDQ Goodman 1997) Participants randomised on a 1:1 basis to intervention or waiting-list control. Randomisation undertaken by North Wales Organisation for Randomised Trials (NWORTH). Schools deliver the programme to six intervention children in year one and to six control children the following year.
Sample Size Was based on previous power calculations and predicted reductions in the primary outcome measure (Strengths & Difficulties Questionnaire, Goodman, 1997). 20 schools, 10 to deliver the programme in the first year (Phase 1), and 10 the following year (Phase 2). 40 teachers and/or classroom assistants (2 per school) will deliver the programme. 240 children will participate (120 intervention, 120 waiting list control who receive an intervention the following year).
Sample Gwynedd Education service will identify the 20 schools. Key stage 1 children aged 4-7 years old. High risk children will be identified through teacher completed Strengths & Difficulties Questionnaires (T- SDQ, Goodman, 1997). Parents will be approached by teachers and offered the chance for their child to participate in the research and receive the Therapeutic Dinosaur School Programme.
Sample Randomisation will occur after baseline measures have been collected and will ensure a balanced distribution of both age and sex in the intervention and control samples Parents will be informed that their child will be chosen by chance as to whether they will receive the intervention during the first or second year.
Measures Will include standardised and validated measures: Demographic data School report & absenteeism Child problem-solving (Wally problem solving test, Webster-Stratton) Teacher & parent self-reports on stress & depression Teacher & parent reports on child social, behavioural and emotional competencies (SDQ & Eyberg Child Behaviour Inventory, ECBI, Eyberg & Ross, 1978) School-based observation (T-POT, Martin, in press) Teacher & parent satisfaction of the programme
Data Sources It is important to collect data from teacher, parents and children for triangulation purposes to establish; a)whether the different sources of information produce broadly similar outcomes b)whether there is generalisation of behaviour improvement across contexts, schools to home.
Data Collection Two phases, with 10 schools in each, to ensure high quality delivery and stagger data collection, training and delivery. Phase 1: Data collected from teachers, parents & children from first 10 schools for both intervention and control children, baseline data collected in September/October, intervention delivered November – April, follow- up measures collected May/June Phase 2: Similar pattern for phase 2 schools in second year Both sets of control children receive the intervention during the following school year
Data Collection strategy Home visits will be initially undertaken to discuss the research, to obtain written, informed consent and then to collect parent report data. All data will be collected by research staff who will be blind as to the childs condition (intervention or control) at both baseline and follow-up. Research staff will be trained in observation measures until 80% inter-rater reliability is obtained. Actual observation measures will be inter-rated for reliability for at least 20% of observations. All parent & teacher report data will be double scored for accuracy before being entered into the database.
Proposed Analysis Analysis of all children will be included according to trial allocation. Characteristics of the sample will be analysed and differences between the two groups will be established and controlled for. Data on demographic variables will be analysed to establish for whom the intervention works best and why. Differences between intervention and control will be based upon Analysis of Covariance (ANCOVA). Effect sizes will be calculated using Cohens (1998) guidelines to enhance replicability and comparability and to indicate practical significance.
Project Management A steering group committee will be established with Two nominated IY Cymru Charity Trustees Professor Judy Hutchings (Director) Gwynedd Education Service representative Bangor University representative. Committee will meet quarterly. Training in delivery of the programme will be organised and delivered through Incredible Years Wales.
Lottery funded staffing Professor Judy Hutchings – part time grant manager for the three years A full time Research Fellow for three years A half time Research Assistant for three years A F/T Research assistant for 6 months in year 2 to assist in data collection A part time Admin Officer for three years A half time teacher seconded from Gwynedd Education Service for two years to support school based staff in intervention delivery (additional PhD studentship funded by Bangor University and IY Cymru)
What makes this trial important This will be the first rigorous trial of the IY therapeutic Dina programme for high-risk young children who are already receiving the classroom curriculum It has been made possible by the lottery funding but also because of the innovative approach in Gwynedd to establish the classroom curriculum county-wide
Diolch For more information please contact: Professor Judy Hutchings Tel (01248) Website: research.bangor.ac.uk