Tracey Bywater

Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention.

We examined mediators and moderators of change in conduct problems, in a multiagency randomized trial of the Incredible Years parenting program. Preschoolers (n = 153) at risk for conduct problems were randomly assigned to intervention (n = 104) and wait-list (n = 49) groups. Boys and younger children, and those with more depressed mothers, tended to show greater improvement in conduct problems post-intervention. Other risk factors (i.e., teen or single parenthood, very low income, high initial levels of problem behavior) showed no predictive effects, implying intervention was at least as successful at helping the most disadvantaged families, compared to more advantaged. Mediator analyses found change in positive parenting skill predicted change in conduct problems.

Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis

Objective To investigate the cost effectiveness of a parenting programme. Design An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community. Setting Sure Start areas in north and mid Wales. Participants Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team. Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control. Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory. Results The bootstrapped incremental cost effectiveness ratio point estimate was �73 (€109,

Efficacy of the Incredible Years Programme as an early intervention for children with conduct problems and ADHD: long-term follow-up

142) per one point improvement on the intensity score (95% confidence interval �42 to �140). It would cost �5486 (€8190,

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

10 666) to bring the child with the highest intensity score to below the clinical cut-off point and �1344 (€2006,

Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder

2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of �100 (€149,

Treatment fidelity as a predictor of behaviour change in parents attending group-based parent training

194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was �1934 (€2887,

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

3760) for eight children and �1289 (€1924,

Early prevention of conduct disorder: how and why did the North and Mid Wales Sure Start study work?

2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder. Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.

Effective evidence-based interventions for emotional well-being: lessons for policy and practice

BACKGROUND This study examined the long-term efficacy of the Incredible Years (IY) BASIC Parenting Programme delivered as a preventive intervention with parents of pre-school children who display signs of attention deficit hyperactivity disorder (ADHD) and conduct problems. Families were followed up after the completion of a controlled trial with 11 Sure Start areas in North and Mid-Wales and North West England. METHODS Participants in the study were 50 pre-school children whose parents had received the intervention. Child ADHD symptoms were assessed at baseline, at follow-up one (6 months after baseline); at follow-up two (12 months after baseline); and at follow-up three (18 months after baseline). Families in the original waiting-list control group were not assessed after follow-up one as they had subsequently received the same intervention. RESULTS The significant post-intervention improvements in child ADHD symptoms evident at follow-up one were maintained over time, as demonstrated by statistical and clinical stability of measures. No significant differences were found for ADHD symptoms across each follow-up, indicating that the gains made post intervention were maintained for at least 12 months, with 57% of the sample maintaining scores below the clinical cut-off on the Conners. Eighty-six, 58, and 30 per cent respectively had maintained at least a modest, large, or very large improvement in ADHD symptoms at follow-up three. CONCLUSIONS Findings from this study suggest that the IY psychosocial treatment programme is a valuable intervention in the longer term for many pre-school children displaying early signs of ADHD.

Micro-Costing in Public Health Economics: Steps Towards a Standardized Framework, Using the Incredible Years Toddler Parenting Program as a Worked Example

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.