Incredible Years Preschool

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Evidence rating: 4+

Cost rating: 2

The Incredible Years (IY) Preschool basic programme is for parents with concerns about the behaviour of a child between the ages of three and six.

Parents attend 18 to 20 weekly group sessions where they learn strategies for interacting positively with their child and discouraging unwanted behaviour. Two facilitators (QCF-7/8) lead parents in weekly two-hour group discussions of mediated video vignettes, problem-solving exercises and structured practice activities addressing parents’ personal goals.

The Advanced add-on to Incredible Years Preschool includes a component that seeks to improve children’s outcomes by improving the quality of interparental relationships (IPR).

EIF Programme Assessment

Evidence rating: 4+

Level 4 indicates evidence of effectiveness. This means the programme can be described as evidence-based: it has evidence from at least two rigorously conducted evaluations (RCT/QED) demonstrating positive impacts across populations and environments lasting a year or longer.

Cost rating: 2

A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of €125 - €599. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that a programme’s best evidence is level 4 standard, and there is at least one other study at level 3, and at least one of the level 3 studies has been conducted independently of the programme provider.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Preventing obesity and promoting healthy physical development

Improved independent play

based on study 3

Statement: 1.90-point improvement on an observed child independent play scale
Score: 28
Timeframe: Immediately after the intervention

Enhancing school achievement & employment

Improved reading ability

based on study 2

Statement: 9.18-point improvement on the Weschler Objective Reading Dimensions age-standardised score
Score: 16
Timeframe: 10 years later
Long term: 1

Preventing crime, violence and antisocial behaviour

Reduced frequency of behaviour problems

based on study 1

Statement: 29.19-point improvement on the Eyberg Child Behaviour Inventory (Intensity Scale)
Score: 35
Timeframe: Immediately after the intervention

based on study 3

Statement: 17.8-point improvement on the Eyberg Child Behaviour Inventory (Intensity Scale)
Score: 21
Timeframe: Immediately after the intervention

Reduced number of behaviour problems

based on study 1

Statement: 4.99-point improvement on the Eyberg Child Behaviour Inventory (Problem Scale)
Score: 26
Timeframe: Immediately after the intervention

based on study 3

Statement: 3.90-point improvement on the Eyberg Child Behaviour Inventory (Problem Scale)
Score: 18
Timeframe: Immediately after the intervention

Reduced child deviance

based on study 2

Statement: 2.12-point improvement on the Strengths and Difficulties Questionnaire (Deviance Scale)
Score: 14
Timeframe: Immediately after the intervention

based on study 1

Statement: 1.92-point improvement on the Strengths and Difficulties Questionnaire (Deviance Scale)
Score: 14
Timeframe: Immediately after the intervention

Reduced externalising behaviours

based on study 2

Statement: 5.23-point improvement on the Child Behaviour Checklist (Externalising Scale)
Score: 21
Timeframe: Immediately after the intervention

Improved behaviour

based on study 2

Statement: 9.98-point improvement on the Child Behaviour Checklist
Score: 17
Timeframe: Immediately after the intervention

Reduced parent defined problems

based on study 2

Statement: 1.41-point improvement on the Parent Defined Problems Questionnaire
Score: 32
Timeframe: Immediately after the intervention

Reduced total problems

based on study 2

Statement: 3.94-point improvement on the Parent Daily Report
Score: 27
Timeframe: Immediately after the intervention

Reduced oppositional defiant disorder

based on study 2

Statement: 0.22-point improvement on a coded observational measure of structured play
Score: 0
Timeframe: Immediately after the intervention

based on study 2

Statement: 1.61-point improvement on the Child and Adolescent Psychiatric Assessment
Score: 33
Timeframe: 10 years later
Long term: 1

Reduced oppositional defiant symptoms

based on study 2

Statement: 1.58-point improvement on the Child and Adolescent Psychiatric Assessment
Score: 32
Timeframe: 10 years later
Long term: 1

Reduced antisocial personality traits

based on study 2

Statement: 4.41-point improvement on the Antisocial Process Screening Device
Score: 26
Timeframe: 10 years later
Long term: 1

Reduced antisocial behaviour

based on study 2

Statement: 1.79-point improvement on the Strengths and Difficulties Questionnaire (Conduct Problems Scale)
Score: 29
Timeframe: 10 years later
Long term: 1

Reduced child hyperactivity

based on study 1

Statement: 4.32-point improvement on the Conners Parent Rating Scale (Parent Report)
Score: 28
Timeframe: Immediately after the intervention

based on study 1

Statement: 1.07-point improvement on the Strengths and Difficulties Questionnaire (Hyperactivity Scale - Self-Report)
Score: 18
Timeframe: Immediately after the intervention

based on study 2

Statement: 0.21 point-improvement on the Parent Account of Child Symptoms Interview
Score: 12
Timeframe: Immediately after the intervention

Reduced negative behaviour

based on study 3

Statement: 5.00-point improvement on an observed child negative behaviour scale
Score: 28
Timeframe: Immediately after the intervention

Reduced conduct problems

based on study 1

Statement: 0.82-point improvement on the Strengths and Difficulties Questionnaire (Problems Scale)
Score: 17
Timeframe: Immediately after the intervention

based on study 2

Statement: 0.40-point improvement on the Parent Account of Child Symptoms Interview (Parent-Report)
Score: 31
Timeframe: Immediately after the intervention

based on study 2

Statement: 1.05-point improvement on the Strengths and Difficulties Questionnaire (Conduct Problems Scale - Self-Report)
Score: 19
Timeframe: Immediately after the intervention

Reduced frequency of behaviour problems in siblings

based on study 1

Statement: 21.35-point improvement on the Eyberg Child Behaviour Inventory (Intensity Scale)
Score: 27
Timeframe: Immediately after the intervention

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Preschool

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

Group

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

Home
Children's centre or early-years setting
Primary school
Community centre
Out-patient health setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

Targeted indicated

Where has it been implemented?

United Kingdom
United States
Ireland

Ireland provision

This programme has been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

Incredible Years Preschool is delivered by two IY co-leaders to groups of approximately 12 families in 20 sessions of around two hours each.

What happens during the intervention?

During the sessions, parents practise child-directed play skills that build positive relationships and attachment; strengthen more nurturing parenting using social, emotion and persistence coaching methods; encourage school readiness skills and early problem-solving skills; establish predictable routines and rules; provide incentives for positive behaviour; and reduce behaviour problems.
Parental social support is strengthened by weekly facilitator calls, parent-buddy calls and group process methods.
IY Preschool can be combined with Incredible Years Advanced for families with more complex issues. Advanced is a 10 to 12-week add-on component that covers anger and depression management, building support networks, effective problem-solving for couples and has teacher and family meetings.

What are the implementation requirements?

Who can deliver it?

It is delivered by two IY co-leaders with NFQ-9/10 qualifications who may be a psychologist, social worker, nurse or physician.

What are the training requirements?

The practitioners have 24 hours of training each. Booster training of practitioners is recommended.

How are the practitioners supervised?

Supervision is shared between the host agency and the programme developer and is provided by two supervisors with NFQ-9/10 qualifications.

What are the systems for maintaining fidelity?

Fidelity monitoring
Face-to-face training
Accreditation or certification process
Supervision

Is there a licensing requirement?

There is a licence required to run this programme.

How does it work? (Theory of Change)

How does it work?

The Incredible Years model assumes that some parenting behaviours inadvertently encourage unwanted child behaviour.
Parents will learn more effective strategies for dealing with unwanted child behaviour when they have opportunities to practise and perceive themselves as effective in using them.
Effective parenting strategies help the child learn how to better manage his or her emotions and behaviour.
In the longer term, the child will get along better with others and there will be a reduced likelihood of antisocial or criminal behaviour.

Intended outcomes

Contact details

Lisa St George
lisastgeorge@comcast.net

Carolyn Webster-Stratton (US Programme Developer)
cwebsterstratton1@icloud.com

http://www.incredibleyears.com/
https://www.crimesolutions.gov/ProgramDetails.aspx?ID=194
http://www.promisingpractices.net/program.asp?programid=134
http://www.cebc4cw.org/program/the-incredible-years/

About the evidence

The Incredible Years (IY) Preschool Basic Programme’s most rigorous evidence comes from three RCTs which were conducted in the UK.

This study identified statistically significant positive impact on a number of child and parent outcomes.

This programme has evidence from three rigorously conducted RCTs, with at least one study demonstrating long-term impact, and impact on assessment measures independent of study participants (not self-reports). In addition, at least one study has been conducted independently of the programme developer. Consequently, the programme receives a 4+ rating overall.

Study 1

Citation:	Hutchings et al (2007)
Design:	RCT
Country:	United Kingdom
Sample:	153 families attending Sure Start centres in Wales
Timing:	Post-test
Child outcomes:	Reduced frequency of behaviour problems Reduced number of behaviour problems Reduced child hyperactivity Reduced conduct problems Reduced child deviance Reduced frequency of behaviour problems in siblings
Other outcomes:	Reduced symptoms of depression Reduced levels of stress Reduced critical parenting Increased positive parenting
Study rating:	3

Study 2

Citation:	Scott et al (2001) and Scott et al (2014)
Design:	RCT
Country:	United Kingdom
Sample:	141 families referred to CAMHS for child behavioural problems and 94 participants from the original study
Timing:	Post-test; 10-year follow-up
Child outcomes:	Improved reading ability Reduced child deviance Reduced externalising behaviours Improved behaviour Reduced parent defined problems Reduced total problems Reduced oppositional defiant disorder Reduced oppositional defiant symptoms Reduced antisocial personality traits Reduced antisocial behaviour Reduced conduct problems Reduced child hyperactivity
Other outcomes:	Reduced inappropriate commands Warmer expressed emotion
Study rating:	3

Scott, S., Spender, Q., Doolan, M., Jacobs, B., & Aspland, H. (2001). Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice. BMJ, 323, 1-7.

Scott, S., Briskman, J., & O’Connor, T. (2014). Early Prevention of Antisocial Personality: Long-Term Follow-Up of Two Randomized Controlled Trials Comparing Indicated and Selective Approaches. American Journal of Psychiatry, 171, 649- 657.

Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35270/
https://www.ncbi.nlm.nih.gov/pubmed/24626738

Study design and sample

The second study is a rigorously conducted RCT.

This study involved random assignment of families to an IY treatment group, a waitlist control group, and a standard treatment group.

This study was conducted in the UK, with a sample of 141 families referred to CAMHS for child behavioural problems. On average, the children were 5.7 years of age with almost half (46.8%) eligible for free school meals. Sixteen percent of the parents were in ethnic minority.

Measures

Child antisocial behaviour and hyperactivity were measured using parent account of child symptoms (parent report) and clinical interviews (diagnostic interview). Child conduct problems were measured using the Strengths and Difficulties Questionnaire (SDQ) (conduct problems, total deviance) (parent report), the Child Behaviour Checklist (externalising problems, total) (parent report), the parent daily report questionnaire (parent report), the parent defined problems questionnaire (parent report), and the ICD—10 diagnosis of conduct disorder (oppositional defiant type) (diagnostic interview). Child reading was measured using the Wechsler Objective Reading Dimension (direct assessment). Adolescent oppositional symptoms and diagnosis were measured using the Child and Adolescent Psychiatric Assessment (diagnostic interview). Adolescent antisocial personality traits were measured using the Antisocial Process Screening Device (parent report). Adolescent antisocial behaviour was measured using the SDQ conduct problems scale (parent report) (teacher report) and the Self-Report Delinquency instrument (child self-report). Parent-child relationship quality was assessed through a five-minute parent-child conversation audio sample (expert observation of behaviour) and a 20-minute videotape of parent-adolescent interaction (expert observation of behaviour).

Parental inappropriate commands were measured using observations of an 18-minute structured play task (expert observation of behaviour).

Findings

This study identified statistically significant positive impact on a number of child and parent outcomes.

Child outcomes include:

Reduced conduct problems
Reduced child hyperactivity
Reduced child deviance
Reduced externalising behaviours
Improved behaviour
Reduced parent defined problems
Reduced total problems
Reduced oppositional defiant disorder
Reduced oppositional defiant symptoms
Reduced antisocial personality traits
Reduced antisocial behaviour
Improved reading ability

Study 3

Citation:	Gardner et al (2006)
Design:	RCT
Country:	United Kingdom
Sample:	76 families with a child aged six or younger
Timing:	Post-test
Child outcomes:	Improved independent play Reduced number of behaviour problems Reduced frequency of behaviour problems Reduced negative behaviour
Other outcomes:	Increased sense of competence Increased positive parenting strategies Decreased negative parenting strategies
Study rating:	3