Most common childhood mental health disorder

Most common childhood mental health disorder (Polanczyk et al., 2015)

• Most common childhood mental health disorder (Polanczyk et al., 2015)

• Increasing levels over the last decade (BMA, 2013; Hutchings et al., 2011)

• Most common reason for referral to CAMHS (NCCMH, 2013)

• Predict poor outcomes into adolescence and adulthood (Colman et al., 2009; Reef et al., 2009)

Most effective interventions (NCCMH, 2013)

• Most effective interventions (NCCMH, 2013)

• Different formats of delivery

• Group programmes highly effective (Furlong et al., 2012)

• Barriers to access for disadvantaged families

May be more appropriate (Lundahl et al., 2006)

• May be more appropriate (Lundahl et al., 2006)

• Eliminate barriers

• Tailored to family needs (Fettig & Ostrosky, 2011)

Developed in 1990s

• Developed in 1990s

• Individually delivered

• Three core components

Intensive Treatment trial (Hutchings et al., 2002, 2004)

• Intensive Treatment trial (Hutchings et al., 2002, 2004)

• Significant improvements compared to standard CAMHS, maintained at 4-years

• Health visitor trial (Lane & Hutchings, 2002)

• Significant improvements but small sample and no randomisation

• Waterloo trial (Hutchings & Williams, 2013)

• Significant improvements but small sample and no control group

Aim to address limitations

• Aim to address limitations

• Course re-designed

• Day 1 – Structured Assessment
• Day 2 – Case Analysis
• Day 3 – Intervention Strategies

• Tailored to support health visitors

• See Williams & Hutchings (2015)

Multi-centre pragmatic randomised controlled trial

• Multi-centre pragmatic randomised controlled trial

• North West Wales
• Central North Wales
• North East Wales
• Shropshire

Health visitors recruit 2 families

• Health visitors recruit 2 families

• Families randomised to intervention or TAU

• Weekly visits for for up to 12 weeks

• Data collection at baseline and 6-months

• Child behaviour
• Parenting skills
• Parental depression
• Observation of parent-child interaction

37 attended training

• 37 attended training

Two types of analyses:

• Two types of analyses:

• Complete case – families with baseline and follow-up data (Intervention n = 19; control n = 17)
• Per-protocol – families who completed all 3 stages of EPaS (Intervention n = 13; control n = 17)

Health visitors working with highly challenged families

• Health visitors working with highly challenged families

• High levels of satisfaction (HV and parents)

• Promising results

• Potentially useful tool for working with disadvantaged families

British Medical Association [BMA] Board of Science (2013). Growing up in the UK: ensuring a healthy future for our children. Retrieved from: http://www.bma.org.uk/working-for-change/improving-and-protecting-health/child-health/growing-up-in-the-uk

• British Medical Association [BMA] Board of Science (2013). Growing up in the UK: ensuring a healthy future for our children. Retrieved from: http://www.bma.org.uk/working-for-change/improving-and-protecting-health/child-health/growing-up-in-the-uk

• Colman, I., Murray, J., Abbott, R.A., Maughan, B., Kuh, D., Croudace, T.J., & Jones, P.B. (2009). Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. British Medical Journal, 338, a2981-a2989.

• Fettig, A., & Ostrosky, M.M. (2011). Collaborating with parents in reducing children’s challenging behaviors: Linking functional assessment to intervention. Child Development Research, doi: 10.1155/2011/835941

• Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S.M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Cochrane review). Cochrane Database for Systematic Reviews, 2, 1-362. doi: 10.1002/14651858.CD008225.pub2

• Hutchings, J., & Williams, M.E. (2013). Report on the staff training project to support children with developmental challenges funded by the Waterloo Foundation. Bangor University: Children’s Early Intervention Trust

• Hutchings, J., Lane, E., & Kelly, J. (2004). Comparison of two treatments for children with severely disruptive behaviours: A four-year follow-up. Behavioural and Cognitive Psychotherapy, 32, 15-30. doi:10.1017/S1352465804001018

• Hutchings, J., Williams, M. E., Martin, P., & Pritchard, R. O. (2011). Levels of behavioural difficulties in young welsh school children. Welsh Journal of Education, 15(1), 103-115.

• Hutchings, J., Appleton, P., Smith, M., Lane, E., & Nash, S. (2002). Evaluation of two treatments for children with severe behaviour problems: Child behaviour and maternal mental health outcomes. Behavioural and Cognitive Psychotherapy, 30, 279-295. doi:10.1017/S1352465802003041

• Lane, E., & Hutchings, J. (2002). Benefits of a course in behavioural analysis for health visitors. British Journal of Nursing, 11, 702-714

• Lundahl, B., Risser, H.J., & Lovejoy, M.C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26, 86-104.

• National Collaborating Centre for Mental Health (2013). Antisocial behaviour and conduct disorders in children and young people: The NICE guideline on recognition, intervention, and management (No. 158). Leicester, UK: RCPsych Publications

• Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry. Advance online publication. doi:10.1111/jcpp.12381

• Reef, J., Diamantopoulou, S., van Meurs, I., Verhulst, F., & van der Ende, J. (2009). Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatrica Scandinavica, 120, 230-238. doi:10.1111/j.1600-0447.2009.01422.x

• Williams, M. E., & Hutchings, J. (2015). A pilot effectiveness study of the Enhancing Parenting Skills (EPaS) 2014 programme for parents of children with behaviour problems: Study protocol for a randomised controlled trial. Trials, 16, 221-229. doi:10.1186/s13063-015-0741-y

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