1. Lessons from the IY Toddler trial in Flying Start services across Wales Nia Griffith January 2012

2. Presentation Content Flying Start WAG funded RCT Sample recruited Sure Start comparison Short-term findings and implications Long-term findings and implications Lessons learnt

3. 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: Extra health visitor visits from dedicated Flying Start Heath Visitor Free childcare Basic skills courses, language and play Parenting courses

4. Evaluation of the IY parenting intervention Trial Trial of new programme 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

5. 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

6. 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 Direct Observation - Dyadic Parent-Child Interaction Coding Scheme (DPICS)

7. BASELINE DATA

8. 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 1 st child 36% left school without any qualifications 61% living below recognised poverty indicator

9. Comparison with Sure Start MeasureFS M (SD) SS M (SD) P valueFS Clinical Significant SS Clinical Significant BDI10.82 (9.44) 16.48 (10.39) <0.00116%37% PSI-SF76.01 (20.54) 100.36 (23.47) <0.00121%67% SED61.99 (1.60)2.88 (1.48)<0.00155%80% Comparison of FS and SS on outcome measures for parent stress and depression at baseline

10. SHORT -TERM OUTCOMES Follow-up one at 6-months post baseline

11. Additional Services Available: Extra health visitor support Free childcare Basic skills (Parenting courses – intervention only) Positive Impacts of living in a Flying Start area?

12. MeasureBaseline Score6-month FU Score Significance Level SOGS DQ96.98101.82P <.05 BDI II10.827.93P <.05 WEMWBS47.8549.93P <.05 PSI-SF76.0168.61P <.05 IT-HOME34.7737.37P <.05 Significant improvements on main outcome measures for sample as a whole over 6-month period. Main Measures

13. Added benefits of IY Toddler Parenting Programme for Intervention Families living in Flying Start areas?

14. Analysis of WEMWBS A significant improvement at 6-months for the INTERVENTION group compared to the CONTROL group (p=.01) using ANCOVA

15. Analysis of Negative Parenting A significant improvement at 6-months for the INTERVENTION group(p=.01) A non significant change for the CONTROL group (p=.13)

16. Analysis of Child Deviance A significant improvement at 6-months for the INTERVENTION group(p=.007) A non significant change for the CONTROL group (p=.16)

17. Other short-term findings Non-significant changes for INTERVENTION when compared with CONTROLS on the following measures: – SOGS – BDI II – PSI-SF – PSOC – IT-HOME – Positive Parenting – Language Promotion Trend for improvement on all measures

18. LONG-TERM OUTCOMES Baseline to 12-month follow-up Trial completers assigned to intervention only n=42

19. Long-term changes Baseline12-month FU MeasureM (SD) P-ValueEffect Size SGS II94.98 (13.68)111.81 (16.59)<.0010.72 BDI II11.31 (9.28)5.07 (7.03)<.0010.56 WEMWBS47.02 (10.05)51.69 (7.86)<.0010.49 PSI-SF77.10 (21.73)67.81 (17.13).010.39 PSOC59.55 (9.54)64.21 (8.20).0020.48 IT-HOME35.60 (6.91)40.79 (4.26)<.0010.66 Significant improvements on all measures from baseline to 12-month follow-up

20. Child Development A significant improvement at 12-months post INTERVENTION for trial completers (p=<.001)

21. What happened to the high-risk…? Sample split by indicators of risk to explore differential effect for high versus low-risk families: – 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

22. Findings….. A greater proportion of the families identified as high-risk 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…?

23. What does this mean……. The families with the greatest level of need for intervention were the families who have BENEFITED THE MOST.

24. Need for targeting Evaluating intervention within service setting Evaluating intervention with a sample with variable levels of risk Differential effects for high-risk participants Lessons from the IYTPP trial

25. Thank you for listening! Diolch am wrando! n.griffith@bangor.ac.uk