1. Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme Margiad Elen Williams CEBEI, Bangor University Supervisors: Professor Judy Hutchings Dr Helen Baker-Henningham

2. 1 in 5 children are affected by emotional and/or behavioural problems (BMA Board of Science, 2013) Risk factors – poor parenting, poverty, etc. Background *BMA Board of Science (2013). Growing up in the UK: Ensuring a healthy future for our children. Retrieved from http://www.bma.org.uk/working-for- change/improving-and-protecting-health/child-health/growing-up-in-the-uk *Caspi, A., Moffitt. T., Newman, D.L., & Silva, P.A. (1996). Behavioral observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort. Archives in General Psychiatry, 53, 1033-1039. Adverse outcomes in adolescence and adulthood including unemployment, substance misuse, teenage pregnancy, etc. (Caspi et al., 1996)

3. Early Intervention Important way of tackling behaviour problems Poor parenting is a significant risk factor (Patterson & Forgatch, 1995) Group-based parenting programmes are effective for treatment and prevention (Furlong et al., 2012) Not always appropriate for families Alternative is one-to-one support *Patterson, G.R., & Forgatch, M.S. (1995). Predicting future clinical adjustment from treatment outcome and process variables. Psychological Assessment, 7, 275-285. *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.

4. Enhancing Parenting Skills (EPaS) Developed in 1990s One-to-one delivery Three core components

5. Structured assessment What do we know about the family? What is the history of the problem/s and what is happening on a day to day basis? What types of behaviour problems are evident? What are the strengths and skills that the family brings? Case analysis Why does the behaviour occur? What are the possible triggers? What are the alternative behaviours that will replace the problem behaviour/s? Intervention strategies What strategies can be used to teach the replacement behaviours and reduce the problem behaviour/s?

6. Intensive Treatment trial *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: 279-295. *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: 15-30. Significant improvements in child behaviour, maternal depression, and parenting skills compared to standard treatment

7. Health visitor trial *Lane, E., & Hutchings, J. (2002). Benefits of a course in behavioural analysis for health visitors. British Journal of Nursing, 11, 702- 714. Eyberg Child Behaviour Inventory Parenting Stress Index Significant improvements in child behaviour and maternal mental well-being compared to control group

8. Waterloo Foundation grant in 2013 to evaluate a shorter version of the EPaS training delivered across Wales Re-designed programme  Two-day training course  Detailed intervention manual  Parent help sheets Training for staff working with children facing developmental challenges Underlying principles work for all children

9. Waterloo Foundation study Five locations across Wales 62 attended day 1 (assessment) 42 attended day 2 (case analysis & intervention strategies) High levels of satisfaction with training & content Increased use of behaviour principles

10. Waterloo Foundation study Data from 25 families (10 complete) Children with behaviour problems, parents with low mental well-being and problematic parenting skills Significant improvements in child behaviour, parental mental well-being, and parenting skills (Hutchings & Williams, 2013) Parents rated programme as useful and would recommend to others *Hutchings, J., & Williams, M.E. (2013). Report on the staff training project to support children with developmental challenges. Bangor, UK: Children’s Early Intervention Trust Charity.

11. Limitations Two days not enough Staff had varied backgrounds & experience Small sample No control comparison group

12. EPaS 2014 trial Aims to address limitations Course redesigned to be delivered in three days and manual improved and expanded  Day 1 – assessment  Day 2 – case analysis  Day 3 – intervention strategies Tailored to support health visitors who already have good child development understanding

13. EPaS 2014 trial design Multi-centre pragmatic randomised controlled trial 4 confirmed centres: North West Wales, Central North Wales, North East Wales, Shropshire Possible 5 th site

14. Recruitment Aim to recruit 60 health visitors and 120 families Health visitors will screen for child behaviour problems in children aged 30 – 60 months Recruit those scoring above clinical cut-off on Eyberg Child Behaviour Inventory

15. Data collection Baseline and 6-month data collection points Outcomes include:  child behaviour  parental mental health  parenting skills  observation parent-child interaction

16. EPaS 2014 trial Hypotheses  Three days of detailed assessment, case analysis and behavioural intervention skills training will enable health visitors to effectively support families of high challenge pre-school children and achieve positive outcomes. This will demonstrate a scalable model for dissemination of effective training for health visitors

17. Progress so far … Baseline measures have been collected from all families in Central North Wales and Shropshire Currently collecting follow-up data from all participating families in North West Wales Currently recruiting health visitors for North East Wales

18. Thank you for listening Email: margiad.williams@bangor.ac.ukmargiad.williams@bangor.ac.uk Tel: 01248 383 627