Incredible Years Parent Training Success in Essex

Jeannie Gordon (Parenting, Clinical Nurse Specialist) & Jenna Richards (Assistant Clinical Psychologist).

North Essex Partnership Foundation Trust NHS

1st Floor Holmer Court

Essex Stress (off Headgate Street)

Colchester

C03 3BT

01206 287513

Abstract

This article is an evaluation of The Incredible Years Parent Training Programmes that have run in Essex from 1997 to 2008. The programme developed by Professor Caroline Webster-Stratton had produced a significant level of research to suggest that it is the best way to treat early onset conduct disorders by teaching parent’s to change their behaviour which in turn changes their child’s behaviour (social learning theory). In Essex 296 parents have taken part in groups and self completed questionnaires have shown an improvement in all the following areas; family life, parent-child relationship, level child problem behaviours, frequency of child problem behaviours, strengths and difficulties, parental stress and general health. This shows that the Incredible Years Parent Training Program is a success.

Introduction

A parenting program is a complex process of raising awareness about parenting by participating in a series of group sessions, run by a facilitator, including group discussions, feedback, videos, role play and homework, to help parents find ways to improve their parenting or to affirm their own parenting methods.

Research in this area is of high interest and there is a lot of evidence which suggests that these parenting programs are a great success. Research has shown that in early childhood the most effect way to promote mental wellbeing and reduce the risk of abuse for children is good parenting skills. Parental skills and parental education lead to long term benefits in reducing neglect, abuse, criminal and anti-social behaviour in young adults, as well as improving maternal mental health, education and employment outcomes. Professionals, especially from the mental health sector, have recommended group-based parent training programmes are the best way to manage children with conduct disorders.

A conduct disorder is an age inappropriate disruptive and antisocial behaviour, including high rates of oppositionality, defiance and aggression. In school years it includes violations of classroom rules and adult authority, including lying and cheating and in adult years it includes violations of the law or community authority. Family and contextual factors influence the rates of conduct disorders, higher rates are found in families with a single parent, frequent changes in parental figures, parental psychopathology, parental substance abuse, family criminal activity, marital problems, socio-economic disadvantage, school experiences and poor parenting skills. Left untreated conduct disorders can have a poor prognosis both for the short term (unhappiness, low self esteem, poor academic performance, lack of social skills and rejection from peers) and the long term (aggression leading to antisocial and criminal behaviour, violent offending, drug abuse and depression). Conduct disorders have huge financial implications for families, individuals and society, and these disorders are on the increase. The poor parenting skills linked to the development of conduct disorders include, nagging, ineffective commands and punishments. However, these could be eliminated with the use of parent training interventions and these have been found to be the most available treatment and prevention for conduct disorders.

These parent training programs are of high importance as recent figure have shown that antisocial behaviour is on the increase. There are more problems in the home, where parental stress levels and child behaviours are linked, in the community and in schools, as higher levels of conduct disorders have lead to an increase in drug and alcohol abuse and negative behaviours that impact on society as a whole.

The aim of these parent training interventions is to reduce conduct problems by strengthening parent management skills and improving timing of parental skills by modifying parent-child interactions, this in turn, will increase children’s pro-social behaviour and decrease child oppositional or antisocial behaviour. The main aim of the program is to teach the parents to change their behaviour, which in turn changes their children’s behaviours.

Over the last 20 years The Incredible Years programmes is one of these parent training groups that have developed much research. It has produced extensive research that shows the programme is both highly effective and acceptable to children’s carers. Success is thought to be achieved due to best results being gained when services are provided in local community settings (which The Incredible Years Programme is), increasing the likelihood of reaching families.

The Incredible Years Parent Training Programme focuses on strengthening parenting skills (monitoring, positive discipline and confidence) and fostering parent’s involvement in children’s school and home experiences in order to increase children’s academic and social skills and reduce conduct problems. Research has shown improvements in parent-child interaction, parental discipline strategies, parent’s involvement in child’s education, child conduct problems (at home and in school) and child social competence, which is even maintained overtime.

Additional research has also suggested that conduct disorders and ADHD may develop due to the interaction between the child’s emotional deregulation, parent’s rejecting and coercive parenting. This shows how important these parent training programmes are and how important it is that they are implemented.

The Incredible Years Series was developed by Professor Caroline Webster-Stratton over the last 30 years. The whole series is aimed at parents, teachers and children; however this report will focus on The Incredible Years BASIC Parent Training Programme as this is the programme that has been introduced in Essex.

The Incredible Years Program is based on the principles of social learning theory, the idea that people learn by observing others. It hypothesises that negative reinforcement develops and maintains children’s deviant behaviours, so changing parent’s negative behaviours by teaching them more appropriate and positive problem solving discipline strategies will lead to the parent’s children developing more positive social interaction, more social competence and a reduction in aggressive behaviour, both at home and in the school setting.

The Incredible Years BASIC Parent Training Programme is a group based intervention running for a total of 12-14 weeks, with a two hour session per week. The sessions are attended by 12-15 parents and run by a group facilitator, who needs to build up a reciprocal relationship, equally using their own knowledge and the group’s strengths and perspectives. The target population is for parents with children aged 2-10 years old showing signs of conduct problems. The Incredible Years BASIC Parent Training Program focuses on play, relationship building, praise, rewarding positive behaviour, instruction giving, problem solving and effect limit setting strategies for handling misbehaviour including ignoring, time out and natural and logical consequences.

The outcomes of The Incredible Years Program has resulted in a reduction in antisocial behaviour and education problems in the children themselves, and has fosters access to more satisfying relationships between the parent and child.

Evidence has found that The Incredible Years Parent training Programme has a positive effect both for the family and the child, this includes;

(1)  Increases in parent’s positive effect such as praise and reduced use of criticism and negative commands.

(2)  Increases in parent’s use of effective limit setting by replacing spanking and harsh discipline with non violent techniques and increased monitoring of children.

(3)  Reduction in parental depression and increases in parental confidence.

(4)  Increase in positive family communication and problem solving.

(5)  Reduced conduct problems in children’s interactions and increases in their positive affect and compliance to parental commands.

Due to this success The Incredible Years Parent Training Programme is viewed as an essential component to early intervention and the reduction of conduct disorders.

From 1997 to 2008 the Incredible Years BASIC Parent Training Program has been brought to Essex and has been delivered every academic term, to all tiers. Over these last 11 years the project has regularly supported hungered of families and many more families have been supported indirectly. In Essex the parenting groups have been very much in demand and this very positive, however this report aims to investigate whether the groups have statistically been a success or not.

Aims

The Incredible Years Parent Training Series has two long-range aims;

(1)  To provide cost-effective, early prevention programs that all families and teachers of young children can use to promote social, emotional and academic competence and to prevent children from developing conduct problems.

(2)  To provide comprehensive interventions for teachers and parents that are targeted at treating and reducing the early onset of conduct problems in young children (ages two to eight years).

Aims of the Incredible Years Parenting Training Groups in Essex;

(1)  Programs are based on the principles of social learning theory (learning by observing other peoples behaviours).

(2)  Programmes include ways of improving family relationships.

(3)  Programmes include enough sessions to help those taking part.

(4)  Programmes help parents to identify their own parenting goals.

(5)  Programmes include role play and homework between sessions so parent get used to practicing the techniques.

(6)  Group facilitators are suitably trained, skilled and supervised, have access to further training and work successfully with parents.

(7)  Program instruction manual and resources are followed to make sure that the program is consistent.

(8)  Create a good independent evidence base for each program to show that they work well.

These aims are achieved by increasing positive and nurturing parenting, creating family support networks and school involvement, involving parents’ in children’s academic-related activates at home, improving parents’ problem-solving skills, teaching anger management strategies, parenting skills, and communication skills, helping parents work collaboratively to ensure consistency across settings and to reduce critical and violent discipline approaches.

Aim of this article is to evaluate the success of The Incredible Years Parent Training Groups that have been running in Essex since 2004 to date. Incredible Years Parent Training Groups have run in Essex since 1997 but due to insufficient evaluations only the group run form 2004 can be analysed.

Method

Participants

Below figure 1 gives a snap shot of The Incredible Years Group population

Figure 1

No. of parents / 296 / Trust Accommodation / 5 / Self employed full time / 1
No. of male parents / 30 / Owner occupier (no mortgaged) / 14 / Full time family carer / 132
No. of female parents / 268 / Owner occupier (mortgaged) / 122 / Not in paid employment / 39
Married / 133 / Living with parents / 4 / Employed outside the home part time / 72
Divorced / 32 / Temporary accommodation / 4 / Self employed part time / 17
Single / 41 / White / 271 / Retired / 2
Living with partner / 51 / Black African / 1 / No. of children / 652
Separated / 18 / Chinese / 1 / No. of male children / 371
Rented council house / 71 / Mixed / 3 / No. of female children / 287
Private rented house / 47 / Employed outside the home full time / 30

Design

All information was collect by self completion questionnaires. All families were asked to provide information about themselves and family life, to illustrate the similarities and differences in the backgrounds of the families within the group. Self evaluations questionnaires were administered pre and post the group and included measures of parental stress (the Parental Stress Index, PSI), general health (the General Health Questionnaire, GHQ), parents reports on their child’s difficult behaviours measured using an intensity and level of problem scale (the Eyberg Child Behaviour Inventory, ECBI), and the parents report on the child’s strengths and difficulties (the Strengths and Difficulties, SDQ). The questionnaire also included information about the parent’s attitudes and feeling about the group, family life, relationships and parenting itself. The form was designed to asses whether the parenting group had an impact on parents’ views of themselves and their children, their relationship with their children and the behaviour of the children.

The family life and relationship questionnaire was a pre and post pictorial questionnaire asking the following two questions, where parents could give any of the following responses; my family life is? Happy, relaxed, soap opera, getting there, great fun, uphill struggle, unhappy, harmonious, confusing, time bomb, frustrating and rewarding. Which describe how you feel about your relationship with your child(ren)? Happy, juggling act, under attack, hanging on, challenged, angry, and can’t say.

The Eyberg Child Behaviour Inventory (ECBI) is a tool used to assess parental reports of conduct behaviour problems in children and adolescents aged 2-16. It is a 36 item questionnaire that represents common behaviours found in all children and measures them in two scales, a seven point intensity scale used to identify how often the problem occurs and a yes/no problem scale that identifies whether the behaviour is problematic for the parent. The variety and frequency of the results determine normal behaviour from conduct disorder behaviours.

The Parental Stress Index (PSI) identifies stressful areas in a parent child interaction, based on the theory that parental stress is a function of child characteristic, parental characteristic and situations related to the role of being a parent. It is a 36 item scale consisting of three subscales, parental distress, parent child dysfunction and difficult child. It identifies dysfunctional parenting and predicts the potential for parental behaviour problems and child adjustment difficulties within a family.

The General Health Questionnaire (GHQ) is a screening tool designed to gauge adult mental health and recognise ‘psychological distress’. It is a 12 item scale that measures the parent’s inability to carry out normal functions and the appearance of distressing events. It enables us to identify parents whose mental health may indicate an impact on their ability to parent consistently and implement suggested strategies.
The Strengths and Difficulties Questionnaire (SDQ) consist of 25 attributes that divide into five subscales, emotional problem, conduct problem, hyperactivity, peer relationship problems, and pro-social behaviour. It measures the difficulties that parent’s think their child/children is having at the time. Included in this questionnaire is the Diagnostic SDQ, these scores are produced when the results of the SDQ are coded and analysed. It predicts the likelihood of the child being diagnosed with one of the following disorders; psychiatric, emotional, conduct or a hyperactivity disorder.