1. Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme
Margiad Elen Williams

2. Behaviour Problems
Most common childhood mental health disorder (Polanczyk et al., 2015)
Increasing levels over the last decade (BMA, 2013; Hutchings et al., 2011)
Most common reason for referral to CAMHS (NCCMH, 2013)
Predict poor outcomes into adolescence and adulthood (Colman et al., 2009; Reef et al., 2009)
Most common are emotional and behavioural adjustment, sleeping, eating, and regulatory problems
Poorer outcomes up to 40 years later, including poorer mental health, poorer social and economic outcomes

3. Parenting Programmes Most effective interventions (NCCMH, 2013)
Different formats of delivery
Group programmes highly effective (Furlong et al., 2012)
Barriers to access for disadvantaged families
Many effective programmes in different formats e.g. group, individual, self-directed
Group not always accessible for disadvantaged families, i.e. lack of transport, increasing childcare costs

4. Individually Delivered
May be more appropriate (Lundahl et al., 2006)
Eliminate barriers
Tailored to family needs (Fettig & Ostrosky, 2011)
Tailored programmes involve parent in development of strategies; expert on their children and family routines
Helpful for disadvantaged families with multiple risk factors

5. Enhancing Parenting Skills
Developed in 1990s
Individually delivered
Three core components

6. Structured Assessment Case Analysis Intervention Strategies
What do we know about the family?
Why does the behaviour occur?
What strategies can be used?
Structured Assessment
Case Analysis
Intervention Strategies
What types of behaviour problems are evident?
What are the possible triggers?

7. Previous Research
Intensive Treatment trial (Hutchings et al., 2002, 2004)
Significant improvements compared to standard CAMHS, maintained at 4-years
Health visitor trial (Lane & Hutchings, 2002)
Significant improvements but small sample and no randomisation
Waterloo trial (Hutchings & Williams, 2013)
Significant improvements but small sample and no control group

8. EPaS 2014 trial Aim to address limitations Course re-designed
Day 1 – Structured Assessment
Day 2 – Case Analysis
Day 3 – Intervention Strategies
Tailored to support health visitors
See Williams & Hutchings (2015)

9. EPaS 2014 trial design
Multi-centre pragmatic randomised controlled trial
North West Wales
Central North Wales
North East Wales
Shropshire

10. EPaS 2014 trial design Health visitors recruit 2 families
Families randomised to intervention or TAU
Weekly visits for for up to 12 weeks
Data collection at baseline and 6-months
Child behaviour
Parenting skills
Parental depression
Observation of parent-child interaction

11. Health visitors 37 attended training Demographics All (N = 37)
Age, M (SD)
42.19 (9.26)
Female, n (%)
37 (100)
Years as a HV, Median (range)
4.00 (0 – 30)
Years in area, Median (range)
5.00 (0 – 30)

12. Families Child Demographics All (N = 58) Child age (months), M (SD)
40.52 (8.78)
Boys, n (%)
42 (72.4)
Parent Demographics
All (N = 58)
Parent age, M (SD)
30.55 (8.90)
Fathers, n (%)
1 (1.6)
Age birth 1st child, M (SD)
21.80 (5.59)
Single, n (%)
19 (32.8)
Low education, n (%)
45 (77.6)
Below poverty threshold, n (%)
53 (91.4)
Unemployment, n (%)
29 (50.0)

13. Baseline Scores Baseline scores (CO) Intervention M (SD) Above CO
Control
ECBI Intensity (131)
(30.07)
27 (93.1)
(27.56)
ECBI Problem (15)
20.31 (6.01)
26 (89.7)
20.31 (5.29)
Conners (15)
20.90 (5.60)
24 (82.8)
21.47 (4.97)
Median (range)
BDI (17)
18.00 (3-44)
17 (58.6)
18.00 (0-43)
18 (62.1)

14. HV Satisfaction Course Feedback n (%) Overall Course 13 (72.2)
Written Material
16 (88.9)
Continue to use methods
18 (100)
Recommend
12 (66.7)
“This has been an excellent course to give me and the parents a framework to tackle behavioural problems”
“I would have liked more 1:1 sessions … throughout the intervention phase as this was the most difficult period of the intervention to manage”

15. Parent Satisfaction Questions Helpful, n (%)
Discussing child’s history
14 (93.3)
Describing child’s day in detail
15 (100)
Keeping records of problem situations
Discussing reasons for child’s behaviour
Strategy for teaching new behaviour
Tasks to complete between sessions
Reading assignments
12 (80)
Health visitor
Overall process
Sufficient info about process
Recommend

16. Analyses Two types of analyses:
Complete case – families with baseline and follow-up data (Intervention n = 19; control n = 17)
Per-protocol – families who completed all 3 stages of EPaS (Intervention n = 13; control n = 17)

17. Complete Case
F (1, 33) = 5.22, p = .029, d = 0.88

18. Per-protocol F (1, 27) = 6.83, p = .014, d = 1.30

19. Conclusions Health visitors working with highly challenged families
High levels of satisfaction (HV and parents)
Promising results
Potentially useful tool for working with disadvantaged families

20. References
British Medical Association [BMA] Board of Science (2013). Growing up in the UK: ensuring a healthy future for our children. Retrieved from:
Colman, I., Murray, J., Abbott, R.A., Maughan, B., Kuh, D., Croudace, T.J., & Jones, P.B. (2009). Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. British Medical Journal, 338, a2981-a2989.
Fettig, A., & Ostrosky, M.M. (2011). Collaborating with parents in reducing children’s challenging behaviors: Linking functional assessment to intervention. Child Development Research, doi: /2011/835941
Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S.M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Cochrane review). Cochrane Database for Systematic Reviews, 2, doi: / CD pub2
Hutchings, J., & Williams, M.E. (2013). Report on the staff training project to support children with developmental challenges funded by the Waterloo Foundation. Bangor University: Children’s Early Intervention Trust
Hutchings, J., Lane, E., & Kelly, J. (2004). Comparison of two treatments for children with severely disruptive behaviours: A four-year follow-up. Behavioural and Cognitive Psychotherapy, 32, doi: /S
Hutchings, J., Williams, M. E., Martin, P., & Pritchard, R. O. (2011). Levels of behavioural difficulties in young welsh school children. Welsh Journal of Education, 15(1),
Hutchings, J., Appleton, P., Smith, M., Lane, E., & Nash, S. (2002). Evaluation of two treatments for children with severe behaviour problems: Child behaviour and maternal mental health outcomes. Behavioural and Cognitive Psychotherapy, 30, doi: /S
Lane, E., & Hutchings, J. (2002). Benefits of a course in behavioural analysis for health visitors. British Journal of Nursing, 11,
Lundahl, B., Risser, H.J., & Lovejoy, M.C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26,
National Collaborating Centre for Mental Health (2013). Antisocial behaviour and conduct disorders in children and young people: The NICE guideline on recognition, intervention, and management (No. 158). Leicester, UK: RCPsych Publications
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry. Advance online publication. doi: /jcpp.12381
Reef, J., Diamantopoulou, S., van Meurs, I., Verhulst, F., & van der Ende, J. (2009). Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatrica Scandinavica, 120, doi: /j x
Williams, M. E., & Hutchings, J. (2015). A pilot effectiveness study of the Enhancing Parenting Skills (EPaS) 2014 programme for parents of children with behaviour problems: Study protocol for a randomised controlled trial. Trials, 16, doi: /s y

21. Thank you for listening Diolch am wrando