Complex interventions, such as parenting programs, are rarely evaluated from a public sector, mul... more Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multiagency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children's conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multiagency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial setup costs were £3305.73; recurrent delivery costs for the program based on eight parents attending a group were £752.63 per child, falling to £633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were £1509.28 per child based on eight parents, falling to £1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively.
Journal of Child Psychology and Psychiatry, Sep 19, 2019
Background: Parenting programs suitable for delivery at scale in low-resource contexts are urgent... more Background: Parenting programs suitable for delivery at scale in low-resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low-cost 12-session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2-9. Methods: Two hundred and ninety-six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t 0 , and at 4-5 months (t 1) and 17 months (t 2) after randomization, research assistants blind to group assignment assessed (through caregiver self-report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165371); Pan African Clinical Trial Registry (PACTR201402000755243); Violence Prevention Trials Register (http://www.preventviolence. info/Trials?ID=24). Results: Caregivers attended on average 8.4 sessions. After adjustment for 30 comparisons, strongest results were as follows: at t 1 , frequency of self-reported positive parenting strategies (10% higher in the intervention group, p = .003), observed positive parenting (39% higher in the intervention group, p = .003), and observed positive child behavior (11% higher in the intervention group, p = .003); at t 2, both observed positive parenting and observed positive child behavior were higher in the intervention group (24%, p = .003; and 17%, p = .003, respectively). Results with p-values < .05 prior to adjustment were as follows: At t 1 , the intervention group self-reported 11% fewer child problem behaviors, 20% fewer problems with implementing positive parenting strategies, and less physical and psychological discipline (28% and 14% less, respectively). There were indications that caregivers reported 20% less depression but 7% more parenting stress at t 1. Group differences were nonsignificant for observed negative child behavior, and caregiver-reported child behavior, poor monitoring or supervision, and caregiver social support. Conclusions: PLH for Young Children shows promise for increasing positive parenting and reducing harsh parenting.
for conducting the live observation visits. Finally, we would like to thank the parents and child... more for conducting the live observation visits. Finally, we would like to thank the parents and children who took part in the randomised controlled trial from which this data was drawn, for their commitment to the project and for providing us with this data.
Purpose of review The government is recognizing the need to deal with the growing numbers of anti... more Purpose of review The government is recognizing the need to deal with the growing numbers of antisocial young people through investing in early preventive parenting support. It is important that the services provided are evidence-based and delivered effectively. This review briefly discusses the contribution of parenting to the development of child mental health difficulties, particularly externalizing problems, and reviews some effective early intervention preventive programmes. Recent findings Over 30 years of research have established both that parenting behaviours influence the development of childhood conduct disorders and that behavioural family interventions targeting specific parenting skills are the most effective way of preventing or reducing child behaviour problems. Until recently, however, those children at highest risk have often had the poorest outcomes from intervention. Recent research has identified the factors that make parenting interventions effective and how to engage the multi-stressed, hard-to-reach families whose children are most at risk. Summary Research has identified risk factors that are associated with the development of conduct disorder and affect the quality of parenting. This has made it possible to provide preventive interventions, targeting families that are most at risk. Evaluations have shown, however, that getting effective preventive services to those most at risk is not straightforward and programmes need to address the problem of recruiting parents who, by virtue of their multiple problems, have traditionally been hard to engage. Emphasis is placed on the importance of using evidenced-based programmes in service settings in ways that are effective.
Background: Hunger can influence healthy development of children and has been shown to be associa... more Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors-lack of financial, mental, familial, and social resources. Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress. Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.
This paper puts forward an explanation for the frequent co-occurrence of attachment and behavior ... more This paper puts forward an explanation for the frequent co-occurrence of attachment and behavior problems in children and the implications of this for interventions; presents preliminary evidence that some behaviorally based parenting programs reduce child behavior problems through two separate, but mutually reinforcing, processes—improved attachment relationships and increased parental use of behavior management techniques; and suggests next steps for the field to improve outcomes for those children who, without interventions that addresses both relationship building and behavior management, are at risk of significant long-term difficulties.
Objectives This study reports on the feasibility and initial effectiveness of an individually del... more Objectives This study reports on the feasibility and initial effectiveness of an individually delivered parent programme for parents of young children with behaviour problems. Whilst parenting programmes are known to be effective in reducing behaviour problems, numerous barriers can prevent families from accessing programmes. Individually delivered parent programmes may be more accessible. In the UK, health visitors provide support to all families with a child under 5 years of age and are ideally placed to deliver interventions for child behaviour problems. Methods Fifty-eight parents reporting children with behaviour problems were recruited from four areas to intervention (n = 29) and treatment as usual, wait-list control (n = 29) conditions. Feasibility outcomes included recruitment, retention, programme delivery, and satisfaction. Baseline and six-month post-randomisation follow-up measures were collected in parents' homes and included parent-report measures of child behaviour, parenting skills, and parental mental health as well as an observation of parenting behaviour during a parent-child play task. Results Significant changes in child behaviour, lax parenting, and parental mental health were found for the whole sample but there were no significant differences between conditions. Recruitment and retention rates were lower than expected questioning the feasibility of delivering the parent programme as it is in existing services. Conclusions This paper provides limited evidence for the feasibility of the Enhancing Parenting Skills programme delivered in existing health services. Further feasibility work, particularly for recruitment and retention, would be needed before conducting a larger study to examine the effectiveness of the programme.
ABSTRACT Purpose – Socio-economic disadvantage is linked to poor parenting skills and subsequentl... more ABSTRACT Purpose – Socio-economic disadvantage is linked to poor parenting skills and subsequently poorer child development. The most deprived geographical areas in Wales have been targeted under the Welsh Government Flying Start scheme to receive additional resources. Unfortunately, many in-need families either lived outside these areas or required further intervention above what was provided. The Welsh Government decision to extend Flying Start is appropriate but the proposed targeting method may still fail to reach all high-risk families. The purpose of this paper is to explore an alternative targeting method. Design/methodology/approach – The current study examined the association between five socio-economic and demographic risk factors and parenting outcomes in a sample of Flying Start families. Findings – Quality of housing (overcrowding and housing standards) played a significant role in predicting poorer parenting outcomes in terms of language and home stimulation. Exposure to multiple risk predicted poorer outcomes regardless of which risk factors were present. Originality/value – This paper contributes to discussion about effective ways of allocating limited resources to best effect.
Targeted vs universal provision of support in high-risk communities: comparison of characteristic... more Targeted vs universal provision of support in high-risk communities: comparison of characteristics in two populations recruited to parenting interventions.
Compliance with Ethical Standards Ethical approval: All procedures performed in studies involving... more Compliance with Ethical Standards Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Background the incidence of conduct disorder in young children is 10% in the general population a... more Background the incidence of conduct disorder in young children is 10% in the general population and 37% among fostered children. Up to 40% of untreated children diagnosed with conduct disorder develop problems later in life including drug misuse, criminal and violent behaviour. There are more than 80 000 looked after children in the UK, with 5000 in Wales. Challenging child behaviour is the main reason for placement breakdown and has huge cost implications as challenging children cost up to 10 times more in service use than children without conduct disorder. The Incredible Years (IY) evidence-based parenting programme is an effective, low cost solution in improving child behaviour and social competence in 'conventional' families and thus has the potential to support foster carers in managing difficult behaviours. Our main aims were to establish: • The feasibility of delivery and the effectiveness of the IY parenting programme in supporting carers in managing difficult behaviour in looked after children. • Service use costs for foster carers and looked after child. Methods This was a 12-month trial platform study with 46 foster carers in three authorities in Wales. Carers were allocated 2:1 intervention to waiting-list control. Validated measures were used to assess 'parenting' competency, carers' depression levels, child behaviour and service use. Measures were administered at baseline and 6-month follow-up. Intervention carers received the programme between baseline and follow-up. Results Analyses showed a significant reduction in child problem behaviour and improvement in carers' depression levels for intervention families at follow-up, compared with control. Unexpectedly, there was a significant improvement in control carers' self-reported 'parenting' strategies. Special education was the greatest service cost for looked after children. Conclusions Initial foster carer training could incorporate the IY programme to support carers in establishing positive relationships and managing difficult child behaviour. Programme participation may lead to reduced service use and improved placement stability.
Complex interventions, such as parenting programs, are rarely evaluated from a public sector, mul... more Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multiagency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children's conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multiagency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial setup costs were £3305.73; recurrent delivery costs for the program based on eight parents attending a group were £752.63 per child, falling to £633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were £1509.28 per child based on eight parents, falling to £1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively.
Journal of Child Psychology and Psychiatry, Sep 19, 2019
Background: Parenting programs suitable for delivery at scale in low-resource contexts are urgent... more Background: Parenting programs suitable for delivery at scale in low-resource contexts are urgently needed. We conducted a randomized trial of Parenting for Lifelong Health (PLH) for Young Children, a low-cost 12-session program designed to increase positive parenting and reduce harsh parenting and conduct problems in children aged 2-9. Methods: Two hundred and ninety-six caregivers, whose children showed clinical levels of conduct problems (Eyberg Child Behavior Inventory Problem Score, >15), were randomly assigned using a 1:1 ratio to intervention or control groups. At t 0 , and at 4-5 months (t 1) and 17 months (t 2) after randomization, research assistants blind to group assignment assessed (through caregiver self-report and structured observation) 11 primary outcomes: positive parenting, harsh parenting, and child behavior; four secondary outcomes: parenting stress, caregiver depression, poor monitoring/supervision, and social support. Trial registration: ClinicalTrials.gov (NCT02165371); Pan African Clinical Trial Registry (PACTR201402000755243); Violence Prevention Trials Register (http://www.preventviolence. info/Trials?ID=24). Results: Caregivers attended on average 8.4 sessions. After adjustment for 30 comparisons, strongest results were as follows: at t 1 , frequency of self-reported positive parenting strategies (10% higher in the intervention group, p = .003), observed positive parenting (39% higher in the intervention group, p = .003), and observed positive child behavior (11% higher in the intervention group, p = .003); at t 2, both observed positive parenting and observed positive child behavior were higher in the intervention group (24%, p = .003; and 17%, p = .003, respectively). Results with p-values < .05 prior to adjustment were as follows: At t 1 , the intervention group self-reported 11% fewer child problem behaviors, 20% fewer problems with implementing positive parenting strategies, and less physical and psychological discipline (28% and 14% less, respectively). There were indications that caregivers reported 20% less depression but 7% more parenting stress at t 1. Group differences were nonsignificant for observed negative child behavior, and caregiver-reported child behavior, poor monitoring or supervision, and caregiver social support. Conclusions: PLH for Young Children shows promise for increasing positive parenting and reducing harsh parenting.
for conducting the live observation visits. Finally, we would like to thank the parents and child... more for conducting the live observation visits. Finally, we would like to thank the parents and children who took part in the randomised controlled trial from which this data was drawn, for their commitment to the project and for providing us with this data.
Purpose of review The government is recognizing the need to deal with the growing numbers of anti... more Purpose of review The government is recognizing the need to deal with the growing numbers of antisocial young people through investing in early preventive parenting support. It is important that the services provided are evidence-based and delivered effectively. This review briefly discusses the contribution of parenting to the development of child mental health difficulties, particularly externalizing problems, and reviews some effective early intervention preventive programmes. Recent findings Over 30 years of research have established both that parenting behaviours influence the development of childhood conduct disorders and that behavioural family interventions targeting specific parenting skills are the most effective way of preventing or reducing child behaviour problems. Until recently, however, those children at highest risk have often had the poorest outcomes from intervention. Recent research has identified the factors that make parenting interventions effective and how to engage the multi-stressed, hard-to-reach families whose children are most at risk. Summary Research has identified risk factors that are associated with the development of conduct disorder and affect the quality of parenting. This has made it possible to provide preventive interventions, targeting families that are most at risk. Evaluations have shown, however, that getting effective preventive services to those most at risk is not straightforward and programmes need to address the problem of recruiting parents who, by virtue of their multiple problems, have traditionally been hard to engage. Emphasis is placed on the importance of using evidenced-based programmes in service settings in ways that are effective.
Background: Hunger can influence healthy development of children and has been shown to be associa... more Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors-lack of financial, mental, familial, and social resources. Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models. Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress. Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.
This paper puts forward an explanation for the frequent co-occurrence of attachment and behavior ... more This paper puts forward an explanation for the frequent co-occurrence of attachment and behavior problems in children and the implications of this for interventions; presents preliminary evidence that some behaviorally based parenting programs reduce child behavior problems through two separate, but mutually reinforcing, processes—improved attachment relationships and increased parental use of behavior management techniques; and suggests next steps for the field to improve outcomes for those children who, without interventions that addresses both relationship building and behavior management, are at risk of significant long-term difficulties.
Objectives This study reports on the feasibility and initial effectiveness of an individually del... more Objectives This study reports on the feasibility and initial effectiveness of an individually delivered parent programme for parents of young children with behaviour problems. Whilst parenting programmes are known to be effective in reducing behaviour problems, numerous barriers can prevent families from accessing programmes. Individually delivered parent programmes may be more accessible. In the UK, health visitors provide support to all families with a child under 5 years of age and are ideally placed to deliver interventions for child behaviour problems. Methods Fifty-eight parents reporting children with behaviour problems were recruited from four areas to intervention (n = 29) and treatment as usual, wait-list control (n = 29) conditions. Feasibility outcomes included recruitment, retention, programme delivery, and satisfaction. Baseline and six-month post-randomisation follow-up measures were collected in parents' homes and included parent-report measures of child behaviour, parenting skills, and parental mental health as well as an observation of parenting behaviour during a parent-child play task. Results Significant changes in child behaviour, lax parenting, and parental mental health were found for the whole sample but there were no significant differences between conditions. Recruitment and retention rates were lower than expected questioning the feasibility of delivering the parent programme as it is in existing services. Conclusions This paper provides limited evidence for the feasibility of the Enhancing Parenting Skills programme delivered in existing health services. Further feasibility work, particularly for recruitment and retention, would be needed before conducting a larger study to examine the effectiveness of the programme.
ABSTRACT Purpose – Socio-economic disadvantage is linked to poor parenting skills and subsequentl... more ABSTRACT Purpose – Socio-economic disadvantage is linked to poor parenting skills and subsequently poorer child development. The most deprived geographical areas in Wales have been targeted under the Welsh Government Flying Start scheme to receive additional resources. Unfortunately, many in-need families either lived outside these areas or required further intervention above what was provided. The Welsh Government decision to extend Flying Start is appropriate but the proposed targeting method may still fail to reach all high-risk families. The purpose of this paper is to explore an alternative targeting method. Design/methodology/approach – The current study examined the association between five socio-economic and demographic risk factors and parenting outcomes in a sample of Flying Start families. Findings – Quality of housing (overcrowding and housing standards) played a significant role in predicting poorer parenting outcomes in terms of language and home stimulation. Exposure to multiple risk predicted poorer outcomes regardless of which risk factors were present. Originality/value – This paper contributes to discussion about effective ways of allocating limited resources to best effect.
Targeted vs universal provision of support in high-risk communities: comparison of characteristic... more Targeted vs universal provision of support in high-risk communities: comparison of characteristics in two populations recruited to parenting interventions.
Compliance with Ethical Standards Ethical approval: All procedures performed in studies involving... more Compliance with Ethical Standards Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Background the incidence of conduct disorder in young children is 10% in the general population a... more Background the incidence of conduct disorder in young children is 10% in the general population and 37% among fostered children. Up to 40% of untreated children diagnosed with conduct disorder develop problems later in life including drug misuse, criminal and violent behaviour. There are more than 80 000 looked after children in the UK, with 5000 in Wales. Challenging child behaviour is the main reason for placement breakdown and has huge cost implications as challenging children cost up to 10 times more in service use than children without conduct disorder. The Incredible Years (IY) evidence-based parenting programme is an effective, low cost solution in improving child behaviour and social competence in 'conventional' families and thus has the potential to support foster carers in managing difficult behaviours. Our main aims were to establish: • The feasibility of delivery and the effectiveness of the IY parenting programme in supporting carers in managing difficult behaviour in looked after children. • Service use costs for foster carers and looked after child. Methods This was a 12-month trial platform study with 46 foster carers in three authorities in Wales. Carers were allocated 2:1 intervention to waiting-list control. Validated measures were used to assess 'parenting' competency, carers' depression levels, child behaviour and service use. Measures were administered at baseline and 6-month follow-up. Intervention carers received the programme between baseline and follow-up. Results Analyses showed a significant reduction in child problem behaviour and improvement in carers' depression levels for intervention families at follow-up, compared with control. Unexpectedly, there was a significant improvement in control carers' self-reported 'parenting' strategies. Special education was the greatest service cost for looked after children. Conclusions Initial foster carer training could incorporate the IY programme to support carers in establishing positive relationships and managing difficult child behaviour. Programme participation may lead to reduced service use and improved placement stability.
Uploads
Papers by Judy Hutchings