Mairead Furlong

A parenting intervention for childhood behavioral problems: a randomized controlled trial in disadvantaged community-based settings.

OBJECTIVE A community-based randomized controlled trial (RCT) was conducted in urban areas characterized by high levels of disadvantage to test the effectiveness of the Incredible Years BASIC parent training program (IYBP) for children with behavioral problems. Potential moderators of intervention effects on child behavioral outcomes were also explored. METHOD Families were included if the child (aged 32-88 months) scored above a clinical cutoff on the Eyberg Child Behavior Inventory (ECBI). Participants (n = 149) were randomly allocated on a 2:1 ratio to an intervention group (n = 103) or a waiting-list control group (n = 46). Child behavior, parenting skills, and parent well-being were assessed at baseline and 6 months later using parent-report and independent observations. An intention-to-treat analysis of covariance was used to examine postintervention differences between groups. RESULTS Statistically significant differences in child disordered behavior favored the intervention group on the ECBI Intensity (effect size = 0.7, p < .001) and Problem subscales (effect size = 0.75, p < .001). Intervention effects on child hyperactive-inattentive behaviors and social competence, as well as parent competencies and well-being, were also found. Moderator analyses showed that the effects of the IYBP intervention on the primary child outcomes were not moderated by child or family demographic characteristics or risk factors. CONCLUSION The results demonstrate the effectiveness of the IYBP in alleviating problem behavior among children and in improving well-being among families living in disadvantaged areas. The findings also highlight the importance of parental intervention in early childhood for parents and children most in need of support.

Behavioural/cognitive-behavioural group-based parenting interventions for children age 3-12 with early onset conduct problems

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness of behavioural/cognitive-behavioural group-based parenting interventions for children with early onset conduct problems in improving a) child behaviour outcomes and b) parenting skills and parental mental health. To critically appraise and summarise current evidence on the incremental resource use, costs and cost-effectiveness of behavioural/ cognitive-behavioural group-based parenting interventions when compared to treatment as usual.

The Incredible Years Parenting program in Ireland: A qualitative analysis of the experience of disadvantaged parents

Controlled trials demonstrate that parenting programs work, but less is known about the processes of change, contextual factors or intervention characteristics that influence trial outcomes. This qualitative study assessed the experiences of Irish parents involved in a randomized controlled trial of the Incredible Years BASIC parenting program, with a view to understanding how and why the program works, or does not work, within disadvantaged settings. Data from 33 parents of young children (aged 3–7 years) with conduct problems were collected by semi-structured interviews and analysed using constructivist grounded theory. Emerging themes indicated that parents perceived the program to have produced positive changes through learning key parenting skills (e.g. positive attention, empathy and problem-solving skills) and through enhanced parental mood/confidence, derived primarily from gaining non-judgmental support from the group. Parents also experienced cultural, personal and environmental challenges in learning the new skills, including discomfort with praise and positive attention, conflict with their partner and parenting within an antisocial environment. Parents dropped out of the course for largely circumstantial reasons. These findings should help to inform the future implementation of this well-known parenting program both in Ireland and elsewhere.

INSPIRE (INvestigating Social and PractIcal suppoRts at the End of life): Pilot randomised trial of a community social and practical support intervention for adults with life-limiting illness.

BackgroundFor most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT).DesignThe INSPIRE study will be conducted within the Medical Research Council (MRC) Framework for the Evaluation of Complex Interventions (Phases 0–2) and includes an exploratory two-arm delayed intervention randomised controlled trial. Eighty patients and/or their carers will be randomly allocated to one of two groups: (I) Intervention: GNP in addition to standard care or (II) Control: Standard Care. Recipients of the GNP will be asked for their views on participating in both the study and the intervention. Quantitative and qualitative data will be gathered from both groups over eight weeks through face-to-face interviews which will be conducted before, during and after the intervention. The primary outcome is the effect of the intervention on social and practical need. Secondary outcomes are quality of life, loneliness, social support, social capital, unscheduled health service utilisation, caregiver burden, adverse impacts, and satisfaction with intervention. Volunteers engaged in the GNP will also be assessed in terms of their death anxiety, death self efficacy, self-reported knowledge and confidence with eleven skills considered necessary to be effective GNP volunteers.DiscussionThe INSPIRE study addresses an important knowledge gap, providing evidence on the efficacy, utility and acceptability of a unique model of social and practical support for people living at home, with advanced life-limiting illness. The findings will be important in informing the development (and evaluation) of similar service models and policy elsewhere both nationally and internationally.Trial registrationISRCTN18400594 18th February 2015.

The longer term experiences of parent training: a qualitative analysis.

BACKGROUND Child conduct problems are a major public health priority. Group-based parenting programmes are popular in addressing such problems, but evidence for their longer-term effectiveness is limited. Moreover, process evaluations are rare and little is understood about the key facilitative and inhibitive factors associated with maintaining outcomes in the longer term. METHOD This study involved the use of qualitative methods as part of a larger process evaluation to explore the longer-term experiences of parents who participated in a randomized controlled trial (RCT) of the Incredible Years Parenting Programme (IYPP) in disadvantaged settings in Ireland. A series of one-to-one in-depth interviews was conducted with parents at 12- (n = 20) and 18-month follow-up (n = 8) and analysed using constructivist grounded theory. RESULTS Most parents reported positive child behaviour despite several challenges, but a substantial subset reported periods of relapse in positive outcomes. A relapse in child behaviour was linked to relinquishing skills in stressful times, the negative influence of an unsupportive environment, and the perceived ineffectiveness of parenting skills. Resilience in implementing skills despite adversity, and the utilization of available social supports, were associated with the maintenance of positive outcomes. CONCLUSIONS Strengthening resilience and social support capacities may be important factors in maintaining positive longer-term outcomes. Those who design, research and deliver parenting programmes might consider the possibility of including a relapse-prevention module and/or the provision of post-intervention supports for more vulnerable families.

Understanding the implementation and effectiveness of a group-based early parenting intervention: a process evaluation protocol

BackgroundGroup-based early parenting interventions delivered through community-based services may be a potentially effective means of promoting infant and family health and wellbeing. Process evaluations of these complex interventions provide vital information on how they work, as well as the conditions which shape and influence outcomes. This information is critical to decision makers and service providers who wish to embed prevention and early interventions in usual care settings. In this paper, a process evaluation protocol for an early years parenting intervention, the Parent and Infant (PIN) program, is described. This program combines a range of developmentally-appropriate supports, delivered in a single intervention process, for parents and infants (0–2 years) and aimed at enhancing parental competence, strengthening parent-infant relationships and improving infant wellbeing and adjustment.MethodsThe process evaluation is embedded within a controlled trial and accompanying cost-effectiveness evaluation. Building from extant frameworks and evaluation methods, this paper presents a systematic approach to the process evaluation of the PIN program and its underlying change principles, the implementation of the program, the context of implementation and the change mechanisms which influence and shape parent and infant outcomes. We will use a multi-method strategy, including semi-structured interviews and group discussions with key stakeholders, documentary analysis and survey methodology.DiscussionThe integration of innovations into existing early years systems and services is a challenging multifaceted undertaking. This process evaluation will make an important contribution to knowledge about the implementation of such programs, while also providing an example of how theory-based research can be embedded within the evaluation of community-based interventions. We discuss the strengths of the research, such as the adoption of a collaborative approach to data collection, while we also identify potential challenges, including capturing and assessing complex aspects of the intervention.Trial registrationISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.

Interventions to improve mathematical performance for children with mathematical learning difficulties (MLD)

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the comparative effectiveness of a range of interventions for students with mathematical learning difficulties (MLD) in improving mathematical performance compared to a control group of standard schooling, no treatment, waiting list or placebo. To explore moderators of intervention effectiveness in relation to characteristics of population (subtype of MLD, severity of MLD at pretest, age and equity variables), outcome (type of mathematical skill) and intervention (duration, individual- versus group-based). To examine the costs and cost effectiveness of interventions in improving mathematical performance.

A randomised control trial of parent and child training programmes (versus wait list control) for children with ADHD-type behaviours: A pilot study

ABSTRACT Objective: A randomised control trial was conducted to assess whether the combined Incredible Years parent training and child training programmes (PT + CT) led to improvements in ADHD-type behaviours in children, when compared to a PT-only group and a Wait List Control (WLC) group. Method: Forty-five families with a child aged 3–7 years who displayed ADHD-type behaviours were referred for treatment and randomised to a combined treatment group (PT + CT; n = 12), a PT group (n = 19) or a WLC group (n = 14). Programmes were delivered by community-based organisations. Short-term follow-up (six months) assessments were undertaken with parents and children based on parent reports of child behaviour and parent well-being and behaviour. A qualitative sub-study was also conducted with parent participants (n = 8) and programme facilitators (n = 5) to explore experiences and views of the combined programme. Results: Statistically significant differences were found between the PT group and the WLC group with regard to child hyperactivity (p < 0.001) and pro-social skills (p < 0.05). No significant differences were found between the combined group (PT + CT) and the PT group except for child hyperactivity (p < 0.05), which was significantly lower in the PT-only group. Significant effects were found for PT + CT versus WLC on the Strengths and Difficulties Questionnaire Impact subscale only. Conclusion: These findings suggest that the combined treatment (PT + CT) produced little added benefit for child hyperactive/inattentive behaviour post-intervention despite the very positive views expressed by parents in the qualitative interviews. The PT training alone was more effective in tackling some core ADHD behaviours when compared to the WLC group, but a need for further more large-scale research is indicated. Trial Registration: ISRCTN82596506.

WA40 The good neighbour partnership: why do we need it? who is going to do it? how on earth are we going to evaluate it?

This one-hour symposium considers Milford Care Centre’s Compassionate Communities Good Neighbour Partnership and it’s evaluation by an international team, led by Maynooth University and funded by the All Ireland Institute of Hospice and Palliative Care, The Irish Cancer Society, The Irish Hospice Foundation and Milford Care Centre. The symposium will be divided into three sections: 1. The Good Neighbour Partnership: Why do we need it? In this section we will describe the findings from a recent scoping study to determine the social and practical needs of community dwelling adults (and their families) living with advanced life limiting illness at home. We will consider the rationale for specialist palliative care services, working with community groups, to lead the development of a volunteer-based social model of care to address unmet need. 2. The Good Neighbour Partnership: How do we recruit and train volunteers? We will share our process and experience of recruiting and training 15 Compassionate Communities Volunteers to assess unmet social and practical need, and to mobile the person’s circle of community to meet those needs. An understanding of the motivating factors of volunteers will be shared. 3. The Good Neighbour Partnership: How on earth are we going to evaluate it? Here we describe the INSPIRE study – Investigating Social and Practical Supports at the End of life. An exploratory delayed intervention randomised controlled trial (framed by the MRC Framework for Complex Interventions) to assess the feasibility, acceptability and potential effectiveness of the Good Neighbour Partnership.