Lessons from the IY Toddler
trial in Flying Start services
across Wales
Nia Griffith
March 2012
Presentation Content
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Flying Start
WAG funded RCT
Sample recruited
Sure Start comparison
Short-term findings and implications
Long-term findings and implications
Lessons learnt
Background to the study
Flying Start
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:
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Extra health visitor visits from dedicated Flying Start Heath Visitor
Free childcare
Basic skills courses, language and play
Parenting courses
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
The IY Toddler Parenting Programme
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
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 Clinical
Significant
SS Clinical
Significant
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 OUTCOMES
Follow-up one at 6-months post baseline
Analysis of WEMWBS
Mean mental wellbeing score
52
51
50.95
50
49
48
47
48.87
Intervention
47.37
47.33
Baseline
Follow-up 1
Control
46
45
Time
Figure: Mean mental wellbeing score for intervention and control
group at baseline and follow-up 1
A significant improvement at 6-months for the INTERVENTION group
compared to the CONTROL group (p= .01) using ANCOVA
Analysis of Negative Parenting
22.0
20.0
18.0
16.0
14.0
Intervention
12.0
Control
10.0
8.0
Baseline
Follow-up 1
Time
Figure: Mean observed negative parenting score for intervention
and control group at baseline and follow-up 1
A significant improvement at 6-months for the INTERVENTION group
when compared with the CONTROL group (p=.055)
Other short-term findings
 Non-significant changes for INTERVENTION when compared
with CONTROLS on the following measures:
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SOGS
BDI II
PSI-SF
PSOC
IT-HOME
Positive Parenting
Trend for improvement on all measures
LONG-TERM OUTCOMES
Baseline to 12-month follow-up
Trial completers assigned to intervention only (n=42)
Long-term changes
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
Significant improvements on all measures from baseline to 12month follow-up
Child Development
115.0
110.0
105.0
100.0
Intervention
Typical Devel
95.0
90.0
Baseline
Follow-up 1
Follow-up 2
Time
Change in child DQ from Baseline to 12-month follow-up for 42 trial
completers
A significant improvement at 12-months post INTERVENTION for trial
completers (p=<.001)
What happened to the high-risk…?
Sample split by indicators of risk to explore differential effect
for high versus low-risk families:
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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 highrisk 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.
Study Implications
and Lessons Learnt
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
Lessons from the IYTPP trial
 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 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
Thank you for listening!
Diolch am wrando!
[email protected]