Shared learning database

 
Organisation:
The Ministry of Parenting CIC
Published date:
April 2014

The implementation of The Incredible Years (IY) group programmes with the IY home-coaching programme and information workshops. Provision of this programme is delivery by experienced practitioners who have reviewed the evidence base; looked at NICE guidance, quality standards and examples of best practice. The programmes are relevant to CG158 reccomendations:
1.5.1 Offer a group parent training programme to the parents of children and young people aged between 3 and 11 years who: have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder.

1.5.5 Offer individual parent and child training programmes to children and young people aged between 3 and 11 years if their problems are severe and complex and they have been identified as being at high risk of developing oppositional defiant disorder or conduct disorder or have oppositional defiant disorder or conduct disorder.

Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes

Example

Aims and objectives

Aim; to provide a range of evidence-based parenting programmes for parents of children with ADHD or ADHD traits/behaviour problems living in Colchester.

Key objective: Delivery of the IY pre-school (3-5 years), school age children (6-12 years) and Advanced Parenting Programmes.

The parent programmes focus on strengthening parent-child interactions and attachment, reducing harsh discipline and fostering parents' ability to promote children's social, emotional, and language development. In the early years and school-age programmes parents also learn how to encourage school readiness skills and are encouraged to partner with teachers so that they can promote children's academic, as well as social skills and emotional literacy. The programmes have protocols for use as a prevention programme or treatment for children with conduct problems and ADHD. The long term goal is ultimately to reduce school drop-out, delinquent behaviours, and to promote academic success Intervention:
1) Parental engagement; to ensure appropriate support is provided/to ensure access to the programmes to parents who may find commitment to professional support uncomfortable due to stigma, past experience with services, or low self-esteem
2) Focused workshops; To increase parental and professional understanding of ADHD and issues related to ADHD
3) IY School Aged programme; To strengthen parenting skills, competencies, nurturing and support networks. Prevent and reduce aggression in young children. Strengthen children's social and emotional competence, problem solving and academic readiness
4) Advanced IY for parents who have attended the school-aged ADHD group; this will support parents to communicate effectively with adults (including schools) and children, give parents problem solving skills for themselves and their young children. To improve and maintain healthier family life/relationships. Improve parent to teacher relationship and communication. Raised self-esteem to whole family

Reasons for implementing your project

In the year ending 2013, the crime rate in Colchester was higher than the average crime rate across similar areas. Locally, the district health profile of Colchester indicates that 36% of secondary aged young people said that they often lose their temper or get angry. ADHD is currently one of the most common reasons for referral to child mental health services with prevalence estimated to range from 3% to 6% in school-aged children. That means that in the Colchester area approximately 1,749 to 3,498 children aged 0-16 will have been diagnosed with the condition. We are aware that families with children with ADHD or ADHD traits struggle with managing and following through with behavioural boundaries, managing conflict and communication. They report pressure placed on adult-to-adult relationships resulting in marital and partnership breakdown and external family conflict. Our hypothesis is that by strengthening protective factors such as positive parenting skills, family communication and effective behavioural management support for these parents, we will be able to reduce risk factors such as neglect, abuse, isolation and will therefore increase family harmony and functioning.

Due to changes in funding pathways and concerns around reducing funding levels for early intervention, the Ministry of Parenting was created as a pathway to provide early intervention, alongside more specialised programmes. Based on;1) company staff past involvement, experience and knowledge 2) views and experiences of users 3) Review of the clinical evidence 4) Feedback from other providers, we felt IY was most effective positive solution for our initiative.

The IY programmes have over 30 years evidenced research showing the effectiveness of working with children with conduct disorders. The author has also adapted specifics of the programme to support the parents of children with ADHD. This will target specific video-clips and video-tape modelling techniques for these parents to help support them in managing their children with these difficulties.We were aware that effective targeting of the project for children with behavioural problems is critical. Without it, the most vulnerable children risk missing vital opportunities to improve their outcomes (Social Research Unit, 2011a).

How did you implement the project

We believe in the importance of effective partnership working as the foundation for successful identification and referral of parents and children most likely to benefit from the project. We built on our current multi-agency network, undertook systematic networking and promotional work with potential referrers to support the referral process, used a clear and user friendly referral system and attended local relevant forums. Our target population was parents of children aged 5-12 yrs where there is one or more of the following:
- Concern by one or more services on the child's behavioural presentation
- Child in assessment process or recent diagnosis i.e. ADHD, High functioning Autism, Asperger's
- Child on school action plan or statement
- Parents own mental health is effecting the child's behaviour
Number of users

- 2010-13; 132 parents offered the IY School aged programme, 23 the school readiness programme and 165 information workshops.
- 2013-14; 108 parents offered IY School aged group/ IY home coaching/combination of group and home coaching
- 2014-15; 12 parents per programme, 6 programmes per year totalling 72 places. 6 workshops totally 84 places. 58 parents will undertake both the School-aged and Advanced programme We then estimate that we will be able to offer the whole of North-East Essex the additional workshops of ADHD information to a further 40 individuals.
Process:
- Referral forms accessed by email, web site and phone - Multi-agency referral pathway - Self-referral pathway Pre intervention:
- Telephone contact
- Introduction session
- Pre assessment visit/form
Post intervention:
- Letter to referrer
- Recommendation of further support
- Option to repeat intervention
- Phone support through project life

The funding to deliver the programmes has come from a range of local and county grants. Our predicted costs for the IY initiative for 2014-15 is £ 221.44 per person in the initiative (based on 112 people). Current costs; 2014-15 is £24,801. The funding trajectory for the programmes implementation and development has been sporadic so we have widened our income pathway and developed the commercial side of the business by providing IY programme trainings and are currently considering a more in-depth contingency plan against public-sector funding cuts and limited grant opportunities.

Key findings

Effectiveness of impact; Data processed by Warwick University continues to show our IY Groups rating highly for parents feeling respected and understood, 79% of case improvement in parent's mental well-being and a reduction in parenting laxness and parent over-reactivity. 100% of parents stating that they had fewer problems after the group programmes. Outcomes for parents; 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. Outcomes for children; 1) Raised self-esteem 2) Reduced behavioural problems 3) Improved relationships within the home 4) Reduced conduct problems in children's interactions 5) increases in their positive affect and compliance to parental commands. Outcomes for funder: to provide outcomes for beneficiaries and quantify value for money; 2012-13 108 people benefited from the IY interventions - £274.94 per family.

Parent's comments 2012-13; What message would you like to give to funders about the group?

"This course is really good for parents who feel insecure about their parenting skills/ Please continue to fund it, it has helped me and my family tremendously and I am really grateful to have been able to have been a part of the programme/If it wasn't funded I wouldn't have been able to have afforded to attend/I've had great time with laughter and lots of family learning /Very useful, I've learnt how to do with my child more appropriately in difficult situations and realised other parents not just me have problems with their children/Thank you so much for all your help/Fantastic group, really worth it- well appreciated by parents/Fantastic course loved so much and helped so much that I have attended twice, the people running the groups are amazing and truly do a wonderful job helping and supporting as much as they can".

Key learning points

We credit our strong evidence base of success to the implementation of the IY groups with fidelity. This involves:
- Collective actions through a project lead to ensure individual responsibility and a sense of obligation.
- Feedback: we have been so lucky to have rich feedback from the parents we have worked with who have guided us in ensuring we have a practical, functional and realistic vision. We are involved with our Parents Advisory Group (users group) to develop information to parents including self-referring to the intervention.
- Following programme training, coaching and support 
infrastructure e.g. attending accredited IY training with regular and robust supervision, this includes recording sessions, regular
 peer
 review 
and 
self-reflection 
on 
recording, of
 weekly
 sessions, meeting
 with
 IY mentor
 for
 review
 of 
group
 sessions
 with goals
 defined and attending
 consultation 
days
 with 
peer mentors and programme author.
- Maintaining programme protocols i.e. delivery of author recommended number of sessions and appropriate planning infrastructure.
- Accessible to the local community. Sessions are offered day or evenings depending on demand so we can cater to fathers and working parents. For families with literacy, communication or cultural barriers we use friendly technology and alternative methods of capturing feedback. We provide high quality refreshments, course hand-outs and provide each family with the IY book.
Challenges:
- Networking, we have had a number of inappropriate referrals so have increased time allocation of networking.
- We had to improve our assessment forms to include genogram/ego map and re-designed our pre and post evaluation forms to ensure appropriate data for funders.
- The NICE guidelines gave supportive evidence for the continuation of the group programmes and supported maintaining the fidelity of the programme. This is very helpful in obtaining ongoing funding.

Contact details

Name:
Jeannie Gordon
Job:
Director
Organisation:
The Ministry of Parenting CIC
Email:
jeannie.gordon@theministryofparenting.com

Sector:
Please select
Is the example industry-sponsored in any way?
No