Lessons from the IY Toddler trial in Flying Start services across

Wales

Nia Griffith

March 2012

Flying Start WAG funded RCT Sample recruited Sure Start comparison Short-term findings and implications Long-term findings and implications Lessons learnt

Presentation Content

Background to the study

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

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

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

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)

BASELINE DATA

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 1st child•36% left school without any qualifications•61% living below recognised poverty indicator

Comparison with Sure Start Measure

FS M (SD)

SS M (SD)

P value FS ClinicalSignificant

SS ClinicalSignificant

BDI 10.82 (9.44)

16.48 (10.39)

<0.001 16% 37%

PSI-SF 76.01 (20.54)

100.36 (23.47)

<0.001 21% 67%

SED6 1.99 (1.60)

2.88 (1.48)

<0.001 55% 80%

Comparison of FS and SS on outcome measures for parent stress and depression at baseline

SHORT-TERM OUTCOMESFollow-up one at 6-months post baseline

Analysis of WEMWBS

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

Analysis of Negative Parenting

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

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

LONG-TERM OUTCOMESBaseline to 12-month follow-upTrial completers assigned to intervention only (n=42)

Baseline 12-month FU

Measure M (SD) M (SD) P-Value Effect Size

SGS II 94.98 (13.68) 111.81 (16.59) <.001 0.72

BDI II 11.31 (9.28) 5.07 (7.03) <.001 0.56

WEMWBS 47.02 (10.05) 51.69 (7.86) <.001 0.49

PSI-SF 77.10 (21.73) 67.81 (17.13) .01 0.39

PSOC 59.55 (9.54) 64.21 (8.20) .002 0.48

IT-HOME 35.60 (6.91) 40.79 (4.26) <.001 0.66

Long-term changes

Significant improvements on all measures from baseline to 12-month follow-up

Child Development

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

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…?

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…?

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…?

Study Implications and Lessons Learnt

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

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

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

Families in greatest need improve the most..

Implications for service deliveryHighlighting the need to find those

families at greatest risk, particularly when resources are scarce

Implications for evaluationHave greater room to move on

measurement scales

Lessons from the IYTPP trial

Thank you for listening!

Diolch am wrando!

n.griffith@bangor.ac.uk