A Meta-Analysis of the Current State of Evidence of the Incredible Years Teacher-Classroom Management Program

This meta-analysis evaluated the current state of evidence and identified potential treatment moderators of the Incredible Years Teacher Classroom Management (IYTCM) program used to reduce externalizing and internalizing behaviors in school-aged children. Inclusion criteria involved published studies between 1984–2018 and examining the effects of IYTCM as a standalone program on teacher and/or child behavioral outcomes. We identified and narratively summarized potential moderators, which included the severity of child behavior, dosage, study design, and reporting methods. Overall, effect sizes revealed IYTCM had moderate positive effects on teachers and small positive effects on children. Narrative summaries indicated larger effect sizes in higher dosage studies and higher risk children. The results align with previous systematic reviews on the Incredible Years Parent Training (IYPT) program but this is the first study to look at the teacher training program. Overall, IYTCM seems to be an effective intervention; however, what components of this program work best, for whom, and under what conditions require further empirical investigation.

Pilot Randomized Controlled Trial Protocol Evaluating an Evidence-based Parenting Intervention among Filipino Parents (Preprint)

BACKGROUND Filipino Americans underutilize mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse and teen pregnancy, while adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years® (IY) Parent Training Program improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE The aims of this manuscript are to 1) describe the design and rationale of a randomized controlled trial evaluating the effects of the on-line IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and 2) describe the impact of COVID-19 on our study protocols. METHODS This study uses a randomized controlled two-arm individually randomized group treatment pretest posttest design for 180 parent-child dyads. Individuals are eligible if they are 18 years or older, live in California, and have at least one Filipino child aged 8-12 years old. Consenting participants are randomly allocated to receive: (1) the 12-week Incredible Years parenting intervention (intervention arm), or (2) American Academy of Pediatrics’ Bright Future handouts and placed on a waitlist to receive IY post-trial (waitlist control arm). Primary outcomes include the Parent Practices Interview (PPI) and Parenting Stress Index (PSI). Secondary outcomes will be measured by the Child Behavior Checklist (CBCL, completed by Parent and Child) and will include child externalizing and externalizing behaviors, and total problems. Data is collected at baseline, 3-month and 6-month follow-ups. RESULTS Recruitment is currently ongoing. Changes made to the protocol due to COVID-19 include administration of surveys remotely and implementation of the intervention online. The pandemic has provided an opportunity to evaluate the effectiveness of an online version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed in one year. CONCLUSIONS Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors among Filipino families with children ages 8-12 years old. It will also uplift cultural narratives and add to the evidence based supporting online parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk ethnic minority communities. CLINICALTRIAL ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170

Parenting interventions for families with refugee backgrounds: a randomized factorial, mixed-methods design study protocol

Background Raising children in new social and cultural contexts can be challenging for parents. In order to help parents address these challenges, the Norwegian government has instituted a policy of mandatory parent training for families who settle in Norway as refugees. The Incredible Years (IY) and The International Child Development Programme (ICDP) have been widely adopted throughout Norway. They have similar aims: to improve parenting through positive parenting practices and development of attachment behaviors. We will evaluate the use of these programs and a measurement feedback system (MFS) to give regular feedback to interventionists about parents’ progress during the course of the parenting intervention. Methods The study is a mixed method, randomized factorial design aimed at evaluating the effect of parenting interventions and the use of feedback to address parental stress, child behavior, resilience, and parents’ mental health. Factor 1 is based on random assignment to one of the parenting interventions IY or ICDP. The parenting interventions are delivered over 15 weeks (IY) or 12 weeks (ICDP) in group-based settings. Factor 2 is based on random assignment of the parenting groups to the (a) with MFS or (b) without MFS condition. The MFS is answered weekly via a phone app, MittEcho, and results are sent to group leaders in the MFS condition. Additionally, the study explores the experiences of families settling in a new cultural context and participating with parenting programs via qualitative interviews. Participants will be recruited from a population of parents with children between the age of 6 and 12 years who settled in Norway as refugees within the previous 9 years. The target sample size is N = 360; n (IY) = 180, n (ICDP) = 180 families. This study is a collaboration between first-line, municipal services; their national governing agencies; family representatives; and a national network of research organizations. Discussion This study endeavors to provide information about what helps families with refugee background integrate successfully into new cultural contexts with different laws, norms, and expectations. Whether or not these interventions can help to normalize this experience, reduce stress, and provide parents with new tools to improve their parenting and the lives of their children are important questions which we address. These findings can lead to the further establishment of evidence-based practices in Norway. Trial registration ISRCTN35008070. Registered on February 24, 2020

“Sometimes I think my frustration is the real issue”: A qualitative study of parents’ experiences of transformation after a parenting programme

Introduction Parenting programmes help to alleviate conduct problems in children, but ensuring that all parents feel supported to attend, complete and learn from these programmes has proven difficult. Parents can feel overwhelmed and struggle to change their parenting. This article aims to inform the future refinement of parenting programmes by examining parents’ narratives of how programmes motivated them to change and enabled them to put changes into practice. Method and results Forty-two parents, most of whom had attended Incredible Years group sessions, were interviewed about their views and experiences of parenting programmes that focused on positive parenting practices. Analysis of interview transcripts drew on thematic approaches. Parents perceived that parenting programmes helped them to better understand their child and themselves and to let go of anxieties surrounding their child’s behaviour. Better understanding included greater awareness of emotions and of behaviours their child could and could not control. Parents believed this awareness helped them to change the ways that they interacted with their child, which, in turn, helped them and their child to feel calmer. With greater understanding and calmness parents believed they became more able to see for themselves the changes that they could make in their parenting and everyday lives, and to feel more confident in putting these into practice. Discussion By supporting parents to reflect on their own and their child’s situation, parents perceived that programmes enabled them to improve interactions with their children without getting stuck in self-blame or feeling overwhelmed. Parents of children whose behaviour remained challenging believed that programmes led to beneficial changes in the way they felt about their child’s behaviours. Enhanced support for reflection by parents could potentially help more families to benefit from parenting programmes.

Creating a Culture of Mental Health in Filipino Immigrant Communities through Community Partnerships

One out of five children in the United States has a mental, emotional, or behavioral health diagnosis. Behavioral health issues cost America $247 billion per year and those with mental health disorders have poorer health and shorter lives. Evidence-based parenting interventions provided in childhood have proven to be effective in helping parents to prevent disruptive, oppositional and defiant behaviors, anxiety and depressive symptoms, tobacco, alcohol, and drug misuse, aggression, delinquency, and violence. Yet, few parents participate in such programs, especially hard-to-reach, underserved minority and immigrant populations. The Robert Wood Johnson Foundation has identified a culture of health action framework that mobilizes individuals, communities, and organizations in order to examine ways to improve systems of prevention, invest in building the evidence base for such systems, and provide evidence-based information to decision makers. The overarching goal of this effort was to create a culture of mental health among Filipinos, a large, yet understudied immigrant community that is affected by alarming mental health disparities, including high rates of adolescent suicide ideation and attempts. Our impact project focused on increasing the reach of the Incredible Years® because maximizing the participation of high-risk, hard-to-engage populations may be one of the most important ways to increase the population-level impact of evidence-based parenting programs. If the approach succeeded with Filipinos, comparable strategies could be used to effectively reach other underserved populations in the U.S., many of whom are reluctant to seek behavioral health services. In this chapter we discuss 1) the state of the literature on the topic of Filipino adolescent mental health disparities; 2) our wicked problem and the impact project aimed at ameliorating this issue; 3) how our team formed and implemented our impact project; 4) outcomes and results of our efforts; 5) challenges we faced and how they were overcome; 6) the leadership and health equity skills that were most helpful in addressing our problem; and 7) a toolkit that could assist other communities addressing youth mental health and prevention of suicide and depression.

Enhancing Social-Emotional Outcomes in Early Years (E-SEE): Randomized Pilot Study of Incredible Years Infant and Toddler Programs

Social emotional development in infancy is a predictor of outcomes in later life, yet there is little evidence of effectiveness for parenting interventions designed to enhance social emotional wellbeing in infancy. An 18-month two-arm randomized controlled pilot trial evaluated the feasibility of a definitive trial of Incredible Years (IY) Infant and Toddler parent programs delivered in a proportionate universal model, called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. Intervention families received an IY Babies book (universal dose), followed by the IY Infant and/or the Toddler group-based programs, based on parent depression (PHQ-9) and/or child social emotional development (ASQ:SE-2) scores. Control parents received services as usual. Parents from two English local authorities with a child eight-weeks-old or younger participated, and were block randomized using a web-based system. Primary endpoints for the study were feasibility parameters relating to recruitment, retention, intervention fidelity and appropriateness of measures. 205 participants were randomized (152:53, intervention:control). Our target was 288 parents. Trial retention rate was higher than expected, with a completion rate of 88% (n = 181, 137:44) at follow-up 3; equating to 94% of 192 expected participants. Intervention uptake was lower than expected. Fidelity of delivery was acceptable and measures were deemed appropriate. A definitive trial is feasible with design amendments to include: introduction of a child screener for intervention eligibility; enhanced intervention material; revised sample size and random allocation ratio. Our internal pilot became an external pilot due to these changes.

Características de los estudios de evaluación de programas grupales de educación parental. Una revisión de alcance

Se ejecutó una revisión de alcance de las características de los estudios de evaluación de programas grupales de educación para progenitores con hijos de cero a dieciocho años, extraídos de ocho bases de datos, entre los años 2006 y 2019 y pertenecientes a revistas científi cas. De los 114 artículos revisados, la mayoría estaban publicados en Norteamérica o Europa, eran ensayos controlados aleatorizados, contaban con muestras pequeñas (inferiores a 100 sujetos), se implementaron en contextos escolares y estaban destinados a progenitores con hijos de hasta seis años o necesidades específi cas de apoyo educativo. Un amplio porcentaje (49.5%) no incluía pruebas de seguimiento post-intervención. Habitualmente el número de sesiones oscilaba entre seis y ocho (30.2%), con una duración promedio de dos horas y una perioricidad de una a la semana. Las intervenciones más evaluadas fueron Triple-P, Incredible Years, Strengthening Families y el Programa-Guía. Los contenidos más abordados fueron la comunicación, las emociones y las estrategias para manejar las conductas. Las principales variables medidas fueron los problemas de comportamiento, las prácticas de crianza y la autoefi cacia parental. Se detectó un interés creciente y global en el tópico analizado; se proporcionan datos actualizados que pueden ser útiles a profesionales e investigadores del área y guiar los procesos de diseño de nuevas intervenciones.