Research in Wales has demonstrated that the Incredible Years parenting programme, an evidence-based programme developed at the University of Washington, Seattle, is very effective in reducing the likelihood of children going on to develop behavioural problems in the UK.
The study is the first of its kind to demonstrate the effectiveness of the programme in a community setting.
Antisocial behaviour in young people is a growing problem. Around 5-10% of UK and US children aged 5-15 years present with clinically significant conduct disorders and the problem is highest in socially disadvantaged areas. Left untreated, up to 40% of children with early difficulties develop subsequent conduct disorder, including drug misuse, criminal and violent behaviour.
So researchers in North Wales set out to determine whether the Incredible Years programme, which teaches and develops parenting skills, could help prevent a child from developing conduct disorders.
The programme was delivered by existing Sure Start staff across North and Mid Wales. Sure Start is a government strategy aimed at providing parenting support for young children and their families in high-risk communities.
More than 150 parents from socially disadvantaged areas took part. All had children aged 3 and 4 years at risk of conduct disorder. Parents were either placed on the programme (12 weekly group sessions) or were put on a waiting list (controls).
Child behaviour and parenting skill were assessed at the start of the study and six months later both by parent report and by direct blind observation. Parents were also asked to self-rate their own feelings of depression, stress and ability to cope.
Children on the programme showed significantly reduced antisocial and hyperactive behaviour, and increased self-control, compared to control children. Parents reported a reduction in stress and depression levels and improved parenting skills.
The authors say this study holds "important lessons for the UK government because, unlike the disappointing results from the national evaluation of Sure Start, it shows that choosing an evidence-based programme ... can achieve remarkable outcomes in high risk children whose parents generally fail to engage with services."
They conclude: "It is important that Government commission effective services for high-risk conduct disordered children. They deserve evidence-based programmes, as do the public, who pay a high price for services and for the other costs of antisocial behaviour."
In a separate paper, the researchers looked at the cost-effectiveness of the programme. Costs were measured from a public sector perspective including health, special educational and social services, and these were considered against the outcome of improved child behaviour based on parent report using the Eyberg Child Behaviour Index (ECBI), a commonly used measure of child behaviour and the primary outcome measure reported in the main study.
They calculated that it would cost £1344 to bring the average child on the programme to below the clinical cut-off point and £5486 to bring the child with the highest ECBI score to below the clinical cut-off point. The programme also appeared to be more cost effective in children at highest risk of developing conduct disorder.
This parenting programme involves a modest additional cost and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending, they conclude.
Materials provided by British Medical Journal. Note: Content may be edited for style and length.
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