Sinead McGilloway

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.

A cost-effectiveness analysis of the Incredible Years parenting programme in reducing childhood health inequalities

Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.

Mental illness in the UK criminal justice system: A police liaison scheme for Mentally Disordered Offenders in Belfast

Background: This paper describes and appraises an inter-agency police liaison scheme for MDOs in Northern Ireland. Aims: To examine administrative outcomes and psychiatric assessment data (including some follow-up information) and to assess the views of service-users and key stakeholders. Method: A battery of measures was devised to assess mental health status, drug and alcohol abuse and risk-related behaviour. Outcomes were assessed (as far as possible) within a prospective follow-up design including a survey of service professionals and interviews with MDOs. The performance of the scheme was measured using objective indicators. Results: Ninety-one per cent of all assessed detainees (n = 382) were judged to have a mental health problem. Sixty-eight per cent were GHQ cases whilst 62% attained “above-threshold” BPRS scores; 48% and 53% respectively had a history of harming self or others. Improvements in mental health were recorded for MDOs who were linked to services and who could be followed up. The service was valued highly by service-users and key stakeholders. Conclusions: The scheme effectively identified, assessed and linked most MDOs to existing services. However, significant changes in mainstream mental health services are required before the full potential of the service can be realized. Declaration of interest: Funding was received from the Northern Ireland Office. The views expressed are those of the authors.

Effectiveness of Criminal Justice Liaison and Diversion Services for Offenders With Mental Disorders: A Review

OBJECTIVE The authors reviewed studies of the effectiveness of criminal justice liaison and diversion (CJLD) services in which outcomes of participants in these services were compared with those of offenders with mental illness who received no intervention or a standard intervention. The authors synthesized existing evidence with respect to changes in mental health status or criminal recidivism. METHODS A comprehensive search (1980-2012) of more than 30 generic and specialist databases identified 6,571 published and unpublished studies. The studies, which varied considerably in methodological approach and overall quality, were systematically appraised according to Campbell-Cochrane guidelines. Ten studies met inclusion criteria. Key outcomes included a reduction in offending and postintervention changes in mental health. RESULTS Synthesized findings indicated that CJLD services appeared to be effective in identifying offenders with mental disorders and that participation in CJLD services had a positive impact on criminal justice and mental health outcomes. CONCLUSIONS Although the methodologies of existing studies are only moderately rigorous, the overall findings suggest that CJLD services can be beneficial. Their effectiveness depends on the model of service delivery, the availability of community services, and the engagement of offenders with mental disorders in treatment. The successful implementation of CJLD services requires a clearer recognition of the importance of systems-of-care principles.

The nature and use of bereavement support services in a hospice setting.

This study formed part of a larger project designed to evaluate a hospice-based bereavement support service in Ireland. It involved a detailed assessment of the views of service attenders and non-attenders. A postal survey was administered to all bereaved clients who were invited to one or more bereavement support services (n = 517). Respondents (n = 243; 47%) completed: 1) a Bereavement Services Questionnaire; 2) a measure of grief reaction (TRIG) and 3) a measure of religiosity (SCSORF). A total of 243 people (47%) returned completed questionnaires, most of whom were satisfied with the service, (although not all had attended all elements of the bereavement service). However, a number of improvements were emphasised. Several statistically significant differences (P < 0.05) also emerged between service attenders and non-attenders with respect to grief reaction and other key factors (e.g., the age and relationship to the deceased). The findings emphasise the needs and views of both attenders and non-attenders and provide important lessons for the implementation and development of hospice-based bereavement support services.

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.

Children's attitudes toward their peers with Down Syndrome in schools in rural Ireland: an exploratory study

Increasingly, children with Down Syndrome are attending mainstream schools, but evidence suggests that these children are more prone to peer rejection and other problems when compared with their non‐disabled counterparts. However, relatively little is known about childrens attitudes toward their peers with moderate to serious learning disabilities, including Down Syndrome. This study assessed the attitudes of non‐disabled primary school children (n = 118) in mainstream education toward their peers with Down Syndrome. A secondary aim was to assess whether exposure to audiovisual material promoting inclusion had any immediate effects on overall attitudes. A cross‐sectional, questionnaire‐based survey was administered in four rural‐based schools. The results showed that female participants over 10 were the most sociable. Overall attitudes toward inclusion were consistently and statistically significantly more negative than those toward sociability. Other factors, such as contact with peers with Down Syndrome, were not related to attitudes. Neither was there any change in overall attitudes following exposure to the promotional material. Further work is needed to identify factors underpinning the attitudes of non‐disabled children to their peers with Down Syndrome and how best to promote inclusion in mainstream schools.

Work, rehabilitation and mental health

This study was undertaken to evaluate a new employment initiative called ACCEPT - Assessment Counselling and Coaching in Employment Placement and Training for people with mental health problems. Pre- (T1) and post-training (T2) assessments of 63 ACCEPT trainees - based on the Lancashire Quality of Life Profile - indicated statistically significant improvements ( p <0.05) at T2 in satisfaction with employment status, religion and purpose in life, social relationships and overall wellbeing as well as a statistically significant increase in overall self-esteem scores. Minor psychiatric morbidity (GHQ) also decreased significantly ( p <0.05) after training. Trainees‘ own views about ACCEPT were positive. At the end of the study, approximately half (32/63) were in paid employment or in part/full-time voluntary work or work experience. Mental health professionals ( n =52) were generally in favour of the service, although some expressed concern about staffing, client placements and inter-agency communication. The findings highlight, among other things, the importance of ‗therapeutic outcomes‘ and the critical role of effective inter-agency working and support from mental health professionals in the success of work-orientated programmes of care.

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.