1. 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

2. Powys – Mid Wales

3. 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

4. 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

5. 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

6. 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

8. 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

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

10. 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.

11. 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

12. 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

13. 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)

14. ITV News Presentation

15. 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

16. 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

19. 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

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

21. 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

22. 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

23. 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”

24. 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

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

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

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

28. 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

29. 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.

30. 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
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31. 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.

32. 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.

33. 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.

34. 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: 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.

35. “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”

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

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

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

39. THANK YOU FOR LISTENING.