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Looking into Looked After Children (LILAC):Trialling the Incredible Years Parent Programme with Foster Carers. IYW Conference, Metropole Hotel, Llandrindod Wells 7th February 2008 Tracey Bywater, Judy Hutchings, Dave Daley Rhiannon Tudor Edwards, Ian Russell, Pat Linck

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Looking into Looked After Children (LILAC):Trialling the Incredible Years Parent Programme with Foster Carers

IYW Conference, Metropole Hotel, Llandrindod Wells

7th February 2008

Tracey Bywater, Judy Hutchings, Dave Daley

Rhiannon Tudor Edwards, Ian Russell, Pat Linck

Project funded by Wales Office of Research & Development for Health & Social Care (WORD)

overview of presentation
Overview of Presentation
  • Challenging child behaviour
  • What works
  • The trial
    • Aims
    • Methodology
    • What we hope to find
challenging behaviours childhood conduct disorder a growing political issue
Challenging behaviours: Childhood Conduct Disorder a growing political issue
  • increasing in numbers, between 5-10% of children in Britain and USA but as many as 35% in high risk disadvantaged areas & 42% in Welsh LAC
  • resistant to intervention if not treated early
  • if unresolved can predict delinquency, adult mental health problems and/or crime
  • costly to society - health, education & social service costs
lac in wales
LAC in Wales
  • Around 5000 LAC in Wales (up to 2500 with conduct problems)
  • 14% of these had 3 or more placements in one year
  • In 6 North Wales Authorities approx 750 LAC (53% boys)
  • Mike Lewis-Children in Wales- states,

“ care leavers are 50 times more likely to go to prison, 60 times more likely to be homeless and 88 times more likely to be involved in drug use than children and young people who have not been ‘looked after’ by local authorities”.

key findings of a research review of foster care in the uk sellick 2006
Key findings of a research review of foster care in the UK (Sellick, 2006):
  • Effective foster caring means good parenting irrespective of children’s ages
  • Good support and supervision of foster carers is likely to result in their feeling satisfied and staying on
essential components of effective parent programmes
Essential components of effective parent programmes
  • Specific factors (social learning theory that underpins effective child management)
    • new parenting skills must be modelled and rehearsed
    • (non-violent) sanctions for negative behaviour and relationship building, praise and rewards
  • home-based practice or ‘homework’

The Intervention: IY BASIC Parent Programme

  • Was developed by Professor Webster-Stratton at the University of Washington, Seattle. It focuses on strengthening parenting skills, with the intention of preventing, reducing and treating conduct problems among children aged 2 - 8 years and increasing their social competence
  • It consists of 12-14 weekly sessions that emphasise the importance of play, ways to help children learn, effective praise, use of incentives, limit setting and ways to deal effectively with misbehaviour. A collaborative approach is emphasised with skills developed through group discussion, videotape modeling and rehearsal

In The Pipeline:

Infant Toddler Programme, New video material for the basic parent programme

New video material for a fully revised school aged programme for 6 - 8 year olds and 8 - 12 year olds

The Incredible Years Programmes

Teacher Programme

6 full day sessions held monthly

Child Dinosaur Programme: Classroom

2 year curriculum, 2 sessions per week, 30 weeks

Child Dinosaur Programme:


18 - 22 weekly sessions

School Aged


17 sessions,

8 – 12 years

School Aged Programme:

12 sessions,

5 – 10 years

ADVANCED Parent Programme: 8 sessions helping adults problem solve

School Readiness Parent


4 sessions,

2 – 4 years

BASIC Parent Programme: 12 weekly sessions,

2 – 8 years


Evaluation Questions:

  • Is the programme effective in supporting carers, increasing the toolkits they have to deal with certain behaviours, and reducing child behaviour problems in looked after children?
  • How do carers and leaders respond to the programme and what, if any, difficulties are experienced in using the programme?
  • How many services do LAC and their carers access, and what is the cost?
  • 3 Authorities
  • 1 intervention groups & 1 control group in each area
  • 44 LAC (27 boys): 28 intervention, 16 control condition with age range 2-16 years
  • Baseline & 1 follow-up
  • Measures
  • At the two time points:
    • Demographics
    • Eyberg Child Behaviour Inventory - LAC & sibling
    • Strengths & Difficulties Questionnaire - LAC
    • Service use Questionnaire - LAC & carer
    • Health EQ5 - carer
    • Arnold & O’Leary Parenting Scale - carer
    • Beck Depression Inventory - carer
    • O’Leary-Porter Scale - carer
    • Strengths & Difficulties Questionnaire - teacher
    • Teacher Questionnaire - teacher
  • Over a six-month period:
    • A diary of service use - LAC & carer
costs of lac
Costs of LAC
  • Top down- service managers etc
  • Bottom-up - carer given information
    • In order to improve foster care services and the allocation of resources we need to know the full range of contacts that Looked After Children (and foster carers) have with health, social care and special education services.
    • Carers may use more services when looking after a particularly difficult child
the eyberg child behaviour inventory eyberg ross 1978
The Eyberg Child Behaviour Inventory (Eyberg & Ross, 1978)
  • 36 items, ages 2-16 years
  • Problem score has a minimum of 0, maximum of 36 (yes/no answers, problem or not)
  • Intensity scale - minimum score of 36, maximum 252 (scale of 1 – 7, where 1 = never and 7 = always)
  • Clinical cut-off scores, ≥127 intensity, or ≥11 problem
ecbi intensity results
ECBI Intensity results

For other short-term results see: Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., Eames, C., & Edwards, R.T. (2007). Parenting Intervention in Sure Start Services for Children at Risk of Developing Conduct Disorder: Pragmatic Randomised Controlled Trial. BMJ, doi:10.1136/bmj.39126.620799.55

cost effectiveness findings from sure start study
Cost-effectiveness findings from Sure Start study
  • A bootstrapped incremental cost-effectiveness ratio (ICER) point estimate of £60 was calculated per one point improvement on the intensity score of the ECBI. It would cost £4275 to bring the child with the highest ECBI score to below the clinical cut-off point and £995 for the average child.
  • With a Cost-Effectiveness Acceptability Curve (CEAC) cost ceiling set at £100 there is a 95.1% chance of the intervention being cost-effective.

Edwards, R.T., Ó Céilleachair, A., Bywater, T., Hughes, D.A., & Hutchings, J. (2007). Parenting Programme for Parents of Children at Risk of Developing Conduct Disorder: Cost-Effective Analysis. BMJ, doi:10.1136/bmj.39126.699421.55.

to conclude
To Conclude
  • We hope that foster carers find the programme useful and supportive in dealing with LAC difficult behaviour
  • That LAC behaviour improves
  • That in the future this will reduce number of placement breakdowns
  • Decrease in problem behaviour and breakdowns have societal cost benefits