1. The Incredible Years Parenting Programme in Scotland
PAS May 3rd 2012
Brenda Renz
Consultant Clinical Psychologist
Programme Director, Psychology of Parenting

2. Scottish policy environment
Early Years Framework and Taskforce
Preventive Spending Review
Parenting Strategy
Children’s Services legislation
GIRFEC
GUS data
Healthcare Quality Strategy
Mental Health Strategy

3. Why parenting interventions?
The quality of care a child receives from his main caregiver is a primary mediator of child outcomes
AND……….
positive parenting is a key protective factor buffering children against the full impact of risk laden adversities
AND………………...some actually work!

4. Knowing which programmes work best?
Commissioners Toolkit database
Interventions for
Promoting Early Child
Development for Health
An environmental scan with special reference to Scotland
The highest quality parenting programmes contain several key elements:
• They are specifically designed and delivered as parenting programmes. They must include specific interventions to improve the parent-child relationship with detailed strategies to deal with common problems. This does not include other general programmes (e.g. life coaching or couples counselling) that may have a minor element of parenting or the child-parent or the childparent relationship in them.
• Targeted populations and explicit recruitment processes. Good programmes clearly specify their target population and include
explicit processes to ensure that appropriate families (as determined by their level of need or risk) can be recruited into and
participate in the programme.
• Explicit content based on sound theory. What parents learn and how information is delivered to parents needs to be based on
explicit and sound theoretical frameworks that have evidence for being effective when working with the targeted population.
• Best practice in training, supervision and fidelity of programme. The developers need to carefully consider and specify their training,
supervision and implementation procedures so that their programme can be replicated and delivered in new and independent settings.
• A robust evidence base. Developers need to ensure that they have collected and analysed data to show that participation in the programme results in positive, substantial and long-lasting improvement on targeted outcomes for parents and their children.
Parent-training/ education programmes in the management of children with conduct disorders - recommendations
Programmes should be
-group based
-structured and informed around principles of social-learning theory
-include relationship-enhancing strategies
-8-12 sessions long
-enable parents to identify their own parenting objectives
-incorporate role play and homework
and….be delivered by appropriately trained and skilled facilitators who are appropriately supervised
The Toolkit is a searchable database of parenting interventions designed to provide information and guidance for commissioners, service managers and programme developers on the quality and effectiveness of parenting programmes/approaches. On behalf of the DCSF, the National Academy for Parenting Research (NAPR) has developed an evaluation tool, the Parenting Programme Evaluation Tool (PPET), to enable commissioners to have clear and objective information to enable them to invest in effective parenting programmes. The Toolkit presents commissioners with detailed descriptions of parenting programmes and ratings to help inform their decisions. Using the PPET, programmes are rated on a 5 point scale (where 4 is high and 0 is low) on 4 main elements common to high quality programmes

5. The Incredible Years Series of Programmes
Teacher
Classroom ManagementProgramme
Child Dinosaur Programme: Classroom
2 sessions per week, 30 weeks
Child Dinosaur Programme:
Treatment
weekly sessions
School Readiness Parent
Programme:
4 sessions,
4-5 years
ADVANCED Parent Programme: 8 sessions helping adults problem solve
BASIC
Pre-school Parent Programme:
14-18 weekly sessions,
3-6 years
Babies and Toddler
Parent Programmes
School Aged BASIC Parent Programme:
14-20 sessions,
6– 12 years 5

6.
Groups of up to 12 parents meet weekly for (14-18 wks)
2 group leaders engage collaboratively and in a non-judgemental and nurturing fashion with parents
Video-clips of parent-child interactions guide group discussion to help parents derive principles of positive parenting
in-session practice primes home activities
Group support is fostered 6

7. The evidence base Multiple RCTs and prestigious awards
Independent replications in various countries (including England and Wales) – in real life settings
2/3 of “diagnosable” children move out of clinical range after a 12 week parenting group
Outcomes maintained up to at least 6 years after intervention
High parent-satisfaction ratings
AND…… health economists conclude they are cost effective!
Outcomes
Increases in positive parenting
Decreases in harsh discipline
Reductions in conduct problems (independent observations)
Increases in children’s social, emotional competence

8. Cost of doing nothing
by age 28 the costs to the public purse for children with conduct disorder in childhood were 10 times higher (£70,019) than for those with no behavioural problems (£7,423)
(2001 figures)

9. 9

10. Psychology of Parenting Project (PoPP)
to improve outcomes for children with significant levels of early-onset disruptive behaviour problems
to increase workforce capacity around evidence-based parenting interventions for such children and their families

11. Practice scan in Scotland (2010)
Annual training events hosted since 2005
Number of practitioners trained = approx 200
Scotland-wide peer network
Few groups running -most in CAMHS and not being delivering with fidelity

12. Some lessons to be learned from “Implementation Science”..
Only a combination of effective interventions and effective implementation produces good outcomes
Interventions that work are
rarely simple
inexpensive
easy to implement

13. More lessons to be learned
Organisational support is required at all levels
The “train and hope” approach does not work
Local stakeholder involvement is essential
Fidelity is not a natural default position
In 1742, following real life experiments, the British naval commander and Scottish doctor, James Lind, begged the British Navy to institute a program for making citrus foods available on all voyages.
Lind was practically ignored for his advice. But 62 years later, the British Navy did adopt the procedure after Captain Cook succeeded in avoiding scurvy altogether by giving his sailors lime juice on three successive voyages

14. How IY addresses implementation challenges
Standardised Intervention materials
Clinician manuals
Video vignettes designed to elicit group discussion and social learning theory principles
Book for parents
Home activity fridge notes
Standardised trainings (3 days)
Delivered only by accredited trainers who
teach content and underlying theory
and model collaborative therapy processes
Post –training accreditation scheme
Competence in delivery of content and adherence to collaborative therapeutic process is assessed at each stage of accreditation through e.g.;
video-tape review of adherence to model
positive evaluations by parents
Self-and peer evaluations
Session process checklists
Supervisory structures
Self-monitoring checklists
Peer supervision
Peer coaching by accredited group leaders
Consultation days with accredited mentors and trainers

15. PoPP plan
Scotland-wide 4 year roll-out focus on 3 and 4 year olds with elevated levels of behaviour problems
Health-led initiative promoting interagency delivery aligned with local needs and GIRFEC
A robust implementation plan designed to maximise fidelity and sustainability
the training and educational infrastructure required to deliver the programmes with fidelity.
standardised trainings,
robust supervisory mechanisms
accreditation schemes specific to each programme
a multi-agency changing working practices approach, negotiated in line with local needs
the organisational supports required to complement this initiative
staff selection
staff job plans
staff and systems support
the leadership framework required

16. PoPP implementation Improved Outcomes
Aligning evidence-based activity with strategic objectives
High
fidelity
Standardised core training
data-driven , “intelligent” decision-making
Continuous learning and accreditation
Identifying local champions
“On the job” supervision and coaching
Systems that value and nurture staff development
Organization Drivers
Competency Drivers
Supportive resource allocation systems
Video-based peer supervision
Sustainable
evidence-based
parenting programmes
Distribute printed copies of PoPP implementation infrastructure graphic
Robust data management systems
Self-regulating practitioners
Leadership
Technical support
Adaptive leadership, co-ordination and technical support

17. Progress to date Widespread support for the plan
2 Early Implementer sites
Over 100 more staff trained
Parent groups being delivered ( with supervisory support)
Lothian
GG&C ( Refrewshire)
Borders
Ayrshire
Fife
Forth valley

18. Fidelity: Doing what it says on the tin
Manualised materials
Standardised trainings
Process checklists
Supervision and on-going support
Accreditation scheme
Organisational support

19. A recipe for poor fidelity
I didn't have potatoes, so I substituted rice.
Didn't have paprika, so I used another spice.
I didn't have tomato sauce, so I used tomato paste.
A whole can, not a half - I don't believe in waste.
My friend gave me the recipe - she said you couldn't beat it.
Something must be wrong with her, I couldn't even eat it! 19

20. Wanted!! Well-trained and committed staff Who have adequate resources
Who are adequately supervised
And who have managerial support