Jess Crumpton, Clinical Psychologist in Training From Research into Practice The Powys’ Strategy, Outcomes, Challenges and Lessons Learnt Dr Sue Evans, Consultant Child Psychologist, Lead for Parenting and Children’s Social Competence Programmes, Powys Teaching Health Board Jess Crumpton, Clinical Psychologist in Training

Powys – Mid Wales

Powys Five towns recognised a Flying Start areas with additional WG funding for parenting, childcare and enhanced HV support Issues in delivering services in a predominantly rural area

Key Principles Multi Agency workforce Development and delivery Holistic and integrated interventions across child, family, home and school Evidence based programmes/approaches at every level Capacity Building and Empowerment for services and individuals

Delivery Model FAMILY Home – School Child & Family An integrated multi agency workforce Capacity Building Programmes for Universal Service providers Integrated Family and Behaviour Support Service Joint Assessment Family Framework (JAFF) FAMILY Child & Family Home – School

Our Evidence Based Training Framework Prevention Remedy KS3 & 4 KS2 Incredible Years® Programmes – parent, school. child IY Small Group Dina Restorative Justice/Approach Individual CBT Friends Group/individual CBT Restorative justice Motivational Interviewing Protection Motivational Interviewing Solihul programme KIVa programme JAFF training incl information sharing Pre school and foundation phase

Supporting Fidelity with IY Programmes IY Trainer/Mentor Basic Parent, Baby, Teacher, Dina , Home Coaching, ASD Peer Coach Accredited leaders Accredited leaders Leaders Important with evidence based programme to deliver with fidelity. Mentor in all programmes 2/3 peer coaches in training for Parent Peer coach in Dina – Seattle trained Number of leaders whose tapes have been passed off for accreditation in small group Dina Delivering with fidelity requires considerable investment of time and energy Regular supervision offered for all progs, need to agree to attend supervision explicit in new contact for FABSS

Almost 85% in clinical range pre course – reduced to 50% post course- 30% moved out of clinical range

Statistically significant reductions on all subscales All subscales apart from emotional symptoms started off in the clinical range and moved out of the clinical range byb the end of then course.

Challenge How to provide an intervention for KS2 to promote emotional health and well being which met key principles: Complemented the IY programmes Could be rolled out to scale at low cost Had a strong evidence base, with scope for building local evidence Multi Agency workforce Development and delivery Holistic and integrated interventions across child, family, home and school Capacity Building and Empowering for staff

KiVa™ universal and indicated actions Presentation graphics for student lessons, for the meeting of the school staff, and for the meetings with parents  Student lessons and materials involved (teachers’ guides, short films, and other auxiliary materials) Preventive Interventive Monitoring Highly visible vests for persons supervising recess time Antibullying computer games  Online surveys with feedback of progress Monitoring implementation and long-term effects KiVa™ team Clear guidelines for tackling bullying

KiVa Anti- Bullying Programme in Powys A strategic decision to provide support for KiVa to be rolled out county wide as a key strand in emotional health and well being strategy: link with depression, anxiety, motivation for school and learning Training delivered through Powys THB with local trainer Funding for training, materials and start up via CYPP Delivered by schools as whole school approach Parental involvement key (an important issue for parents)

ITV News Presentation http://www.itv.com/news/wales/2015-05-12/anti-bullying-scheme-encourages-classmates-to-speak-out/

Current Situation in Powys 44 Schools trained since 2014 (more than 50%) 13 are in third year of implementation 19 in second year of implementation 9 began implementation in September 2016 Capacity to train further schools by Summer 2017 On-going audit and evaluation involving clinical psychology and educational psychology service and the Clinical Psychology Department at Bangor University

Powys Evaluation Based on annual online survey 2,300 children at one year follow up 1,000 children at two year follow up Additional evaluation from survey of school staff

Outcomes School connectedness significantly improved after two years of KiVa Bullying significantly reduced after one year of KiVa with further reductions after two years High levels of school satisfaction Reflected in Estyn inspection reports

Challenge How to fill the gap in effective post diagnostic interventions for parents of children with ASD? 5 groups since Jan 2017

IY ASD PROGRAMME: The Powys model Trainer accredited Local PTHB Coordinated by commissioned service- Action for Children Delivered by Specialist practitioners Strategic link with new ND Service and ISAP Part of strategic post diagnostic pathway Partnering in research- building local evidence base

Feedback from practitioners working with IY ASD Has enabled weekly contact with some families on our caseload where contact may have only been monthly Integrates into specialist practitioner role and empowers parents to have successful interactions with their children Principles can be used with parents outside of the group and are the foundation of 1to 1 therapy Promotes a common foundation of skills for specialist intervention to build upon Intensive early intervention from specialist practitioners

Parental Feedback “ This course has been a lifesaver for us as a family. The support from other parents has been invaluable and the feelings that we are not alone has been hugely supportive. Despite my initial apprehensions the skills we are developing have had an immediate impact on family life. We no longer walk on eggshells and no longer feel as though Autism dictates our lives. We feel so lucky to have had this opportunity. Thank you”

lessons Don’t ‘train and hope’, build and fund a supportive infrastructure Expect and plan for set backs e.g. change of personnel, need for retraining Develop a strong business plan with multi- agency strategic sign up Help the intervention speak for itself, encourage cooperation between schools Develop local trainers to ensure low cost role out Plan for succession

THE INCREDIBLE YEARS® OUTCOMES FOR POWYS Jessica Crumpton Trainee Clinical Psychologist 22nd March 2017

Overview Outcomes for 2016 to date Factors contributing to outcomes and reflections

Groups, attendance, outcome measures Outcomes Data from last year 2015-2016 and then most recent data Q1, 2 and 3. Groups, attendance, outcome measures

Groups Delivered 12 Groups run 5 IY Basic 2 IY Toddler 3 IY Baby 2 IY ASD IY School readiness 2 started in Q3 not completed until Q4. Be included in Q4 data. 19/20 groups by end of quarter 4

Engagement and Retention Total Attendance 139 parents signed up 91% (123) continued beyond introductory session Group Attendance Average group size was 9 Demographics 32% from Flying Start areas 93% female, 7 % male *We know that parents start to make gain if they attend 50% or more of the programme, but make the most significant gains if they attend 75% of more of the programme.

OUTCOME MEASURES 01 02 03 04 Mental Health and Wellbeing General Health Questionnaire (GHQ-30) 02 Measure of problem behaviours Eyberg Child Behaviour Inventory (ECBI) Parental Confidence Karitane Parenting Confidence Scale 03 ECBI- Toddler, BASIC, ASD groups Karitane – Baby groups 04 Text Title Place your own text here

Mental Health and Wellbeing Statistically significant Clinical cut off = 5 3.7 Reduction significant at P=0.05. (0.02) Of the parents that completed the GHQ, there was a reduction in the percentage of parents in the clinical range from 25% (19) to 14% (11).* Although the average score prior to the group was below the clinical range, there was an overall reduction in scores on the GHQ, suggesting that there is an increase in parental self-report mental health and wellbeing. Data available for 77 out of a possible 123 parents.

Measure of Problem Behaviours: Number Statistically significant At the start of the course, 60% (35) of parents reported clinical levels of problem behaviour in their child (based on parents scores on the “problem scale”). This reduced to 39% (15) at the end of the course. This shows that there is an improvement in parental reports of the number of problematic behaviours. The overall scores of parents reporting of problem behaviours in their children decreased significantly. This result is statistically significant using a paired-samples t-test. Data available for 58 out of a possible 95 parents.

Measure of Problem Behaviours: Frequency Statistically significant 128.5 49% (28) in the clinical range pre group, 32%(19) post group. The average score on parental reports of the frequency of problem behaviour was in the clinical range pre group (based on parents scores on the “intensity” scale). This dropped to well within normal limits by the end of the group. This decrease was significant, using a paired samples t-test. This shows that there is an improvement in parental reports of the frequency of problem behaviour. Data available for 59 out of a possible 95 parents.

Parental Confidence 42.4 40.1 Clinical Cut off = 39 For those parents that complete pre and post measures*, there was an increase in parents self-report rating of confidence (see fig. 6). Although both pre and post group score were outside the clinical range, these scores suggest that the group has helped to improve parental confidence. Not typical of all groups: 2015-2016 data: There was a measurable improvement in parenting confidence post group, which wasn’t quite significant statistically but was clinically significant. 43% of parents scored within the clinical range on this measure pre group. This reduced to 18% post group, with more than a 50% reduction in parents in the clinical range. Data available for 16 out of a possible 31 parents.

“It’s a lot better than I expected” Qualitative Feedback from Parents “It’s a lot better than I expected” “Its given me confidence that I am doing the right thing” “It works” “I can see the changes its made”

Reduction in parental report of number and frequency of problem behaviours Improvement in parental mental health and wellbeing Improvement in parental confidence

Factors contributing to positive outcomes Data from last year 2015-2016 and then most recent data Q1, 2 and 3.

Factors contributing to positive outcomes Frequency of trainings; Action for Children; Regular supervision and consultation; Engagement of partner agencies. Support for accreditation

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