1. Lessons from the IY Toddler trial in Flying Start services across Wales Nia Griffith March 2012

2.  Flying Start  WAG funded RCT  Sample recruited  Sure Start comparison  Short-term findings and implications  Long-term findings and implications  Lessons learnt Presentation Content

3. Background to the study

4. Flying start initiative aims to fund high quality services for children aged 0 - 3 years in disadvantaged areas in Wales Estimated 25,000 children aged 0 - 3 living within FS catchment areas Families targeted by area of residence, with investment of £2,000 per child per annum in the form of: Extra health visitor visits from dedicated Flying Start Heath Visitor Free childcare Basic skills courses, language and play Parenting courses Flying Start

5. Evaluation of the IY parenting intervention Trial Trial of new programme (preventative) Randomised Control Trial Small numbers Participants Parents of children aged between 12 and 36 months Targeted families living in Flying Start areas No other inclusion criteria Randomisation Random allocation by NWORTH (North Wales Organization for Randomised Trials in Health) Stratified for age and sex and allocated on 2:1 ratio Intervention: Waiting list control Control families wait 6 months for Intervention

6. STRUCTURE Twelve sessions Delivered weekly in 2 – 2 ½ hour sessions by two leaders Collaborative learning process using discussion and ideas drawn from watching video-clips of other parents Brainstorming/role-play/home activities Group structure providing for group problem solving and peer support CONTENT Relationship building through child led play, coaching children’s academic, social and emotional skills, praise and spontaneous incentives, handling separations and reunions, establishing routines, learning how to give clear instructions and how to ignore, distract and redirect children Learning to understand children’s development and safety awareness are themes that run throughout the programme The IY Toddler Parenting Programme

7. Measures Developmental Measures - Schedule of growing skills (SOGS) Measure of Home Environment - IT- HOME Parent Measures - Parenting Stress Inventory (PSI) - Beck Depression Inventory (BDI) - Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) -Parent Competence (PSOC) Direct Observation - Dyadic Parent-Child Interaction Coding Scheme (DPICS)

8. BASELINE DATA

9. Sample Characteristics 89 families Parent age at Baseline (M= 29.97, SD= 6.72) range 16-48 years 38% Single parents 54% <20 Years at birth of 1 st child 36% left school without any qualifications 61% living below recognised poverty indicator

10. Comparison with Sure Start MeasureFS M (SD) SS M (SD) P valueFS Clinical Significant SS Clinical Significant BDI10.82 (9.44) 16.48 (10.39) <0.00116%37% PSI-SF76.01 (20.54) 100.36 (23.47) <0.00121%67% SED61.99 (1.60)2.88 (1.48)<0.00155%80% Comparison of FS and SS on outcome measures for parent stress and depression at baseline

11. SHORT-TERM OUTCOMES Follow-up one at 6-months post baseline

12. Analysis of WEMWBS A significant improvement at 6-months for the INTERVENTION group compared to the CONTROL group (p=.01) using ANCOVA

13. Analysis of Negative Parenting A significant improvement at 6-months for the INTERVENTION group when compared with the CONTROL group (p=.055)

14.  Non-significant changes for INTERVENTION when compared with CONTROLS on the following measures:  SOGS  BDI II  PSI-SF  PSOC  IT-HOME  Positive Parenting  Trend for improvement on all measures Other short-term findings

15. LONG-TERM OUTCOMES Baseline to 12-month follow-up Trial completers assigned to intervention only (n=42)

16. Baseline12-month FU MeasureM (SD) P-ValueEffect Size SGS II94.98 (13.68)111.81 (16.59)<.0010.72 BDI II11.31 (9.28)5.07 (7.03)<.0010.56 WEMWBS47.02 (10.05)51.69 (7.86)<.0010.49 PSI-SF77.10 (21.73)67.81 (17.13).010.39 PSOC59.55 (9.54)64.21 (8.20).0020.48 IT-HOME35.60 (6.91)40.79 (4.26)<.0010.66 Long-term changes Significant improvements on all measures from baseline to 12- month follow-up

17. Child Development A significant improvement at 12-months post INTERVENTION for trial completers (p=<.001)

18. Sample split by indicators of risk to explore differential effect for high versus low-risk families:  Poverty Indicator (WAG)  Child Developmental Delay (SGS II DQ < 85)  Multiple Environmental Risks (SED5)  Clinical Levels of Depression (BDI II)  Clinical Levels of Stress (PSI-SF) Explored magnitude of Effect Size for High versus Low-risk families on a range of outcome measures What happened to the high-risk…?

19.  Findings….. A greater proportion of the families identified as high- risk in terms of poverty, multiple environmental risk, early signs of child developmental delay and clinical levels of depression and stress were experiencing medium and large effects. What happened to the high-risk…?

20.  What does this mean……. The families with the greatest level of need for intervention were the families who have BENEFITED THE MOST. What happened to the high-risk…?

21. Study Implications and Lessons Learnt

22.  Recruitment  Many families have a need for intervention  Several families despite their circumstances are functioning well  Resulted in the recruitment of families with a range of needs  Use of additional targeting measures identifies families with a greater need of intervention Study Implications and Lessons Learnt

23.  Short-term benefits to parental well-being and negative parenting  Preventative trial  Varying level of need  Ceiling effect on several measures …..Yet significant improvements were seen on both measures of parental well-being and negative parenting Study Implications and Lessons Learnt

24.  When evaluating an intervention within service setting  it is important to gather information about what other services families are accessing  real world research can be messy  Lots of services being offered Lessons from the IYTPP trial

25.  Families in greatest need improve the most..  Implications for service delivery  Highlighting the need to find those families at greatest risk, particularly when resources are scarce  Implications for evaluation  Have greater room to move on measurement scales Lessons from the IYTPP trial

26. Thank you for listening! Diolch am wrando! n.griffith@bangor.ac.uk