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Childhood Development Initiative IT Tallaght 11 th March 2015
Contents: Overview of establishment of CDI; Overview of CDI programmes; Programme evaluations and link to policy; What works; Challenges; Questions.
Background to CDI: Consortium of 23 people established; One of three Prevention and Early Intervention Programmes funded by Government and The Atlantic Philanthropies; Needs Analysis “How Are Our Kids? ” (2004); 15 million granted for the design, implementation and evaluation of programmes; “How Are Our Families”, 2012 indicates ongoing disadvantage and social issues; CDI now funded under the Government’s Area Based Childhood Programme (ABC) – co-funded by AP.
CDI’s Guiding Principles: Identifying need; Developing a coherent, community informed, integrated response; Implementing and overseeing the quality delivery of evidence-based programmes; Supporting inter-agency collaboration and outcomes focused approaches; Evaluating evidence-informed programmes, to identify what works and what doesn’t; Sharing the learning regarding programmes and processes in order to inform future policy and practice.
CDI Governance Chart 2015: The Atlantic Philanthropies (AP) Pobal/CES CDI Board CDI Implementatio n Support Group (ISG) Restorative Practice Management Committee (RPC) Expert Advisory Committee (EAC) RP National Strategic Forum Children’s Services Committee (CSC) CDI Team Finance and Risk Sub-Committee Department of Children and Youth Affairs (DCYA) Local Community Development Committee (LCDC) Human Resources Sub-Committee Communications Sub-Committee Indicates an advisory/supporti ve relationship Indicates lines of accountability
CDI Seven Service Evaluations: Early Years Service; Speech and Language Service; Doodle Den: Literacy; Mate-Tricks: Pro-Social Behaviour; Healthy Schools Programme; Community Safety Initiative; Restorative Practice Programme.
Key Stages in Programme Design and Implementation: Research design; Logic modelling; Manualised approach; Delivery through local agencies; Supporting quality.
Logic Model: A logic model is a tool for programme planning, implementation and evaluation; It provides a rationale for delivering specific programmes; It clearly describes a programme’s goals, tasks, activities and anticipated outcomes, and links to evidence and best practice.
Logic Model: The current situation i. e. the situation that needs changing Research evidence i. e. what the research or best practice tells us Inputs i. e. the resources required to bring about change Activities i. e. the activities necessary to effect change Outputs i. e. what is expected to occur or be delivered Outcomes i. e. changes in attitudes, behaviour, knowledge and perceptions
Manualised Approach: Why use a manualised approach? To ensure the programme is: Delivered with consistency Delivered as intended Adheres to the Logic Model The role of fidelity and dosage • • Fidelity (i. e. where practitioners use all the core intervention components skillfully) Evidence-based programmes are most effective when they are implemented with fidelity; Fidelity helps us to attribute positive outcomes to the programme; The greater the fidelity, the more likely positive outcomes will be replicated; Dosage – where participants receive the intended amount of programme/ core intervention.
CDI Evaluations 2007 -2014: 3 Randomised Controlled Trials Community Safety Initiative – (NUIG) Restorative Practice – (NUIG) Early Years – (DIT) Doodle Den – (QUB) Mate Tricks – (QUB) 3 Process Evaluations Overall Process Evaluation – (NUIG) Quasi-Experimental Study Healthy School’s Programme – (TCD) Retrospective Impact Study Speech & Language Therapy
Mechanisms to Support Quality Delivery: Dedicated Quality Specialist role; Training; Communities of Practice (COP’s); Site / practice visits; Fidelity checks; Progress meetings; Programmatic / thematic steering committees.
Early Years Service: 2 year programme 2½-3 year olds; High. Scope Curriculum; 1: 5 staff: child ratio; Staff qualifications; Key worker system; Home visits; Parent/Carer Facilitator (PCF); Speech and Language Therapy (SLT); Communities of Practice (Co. P); Manager meetings; Onsite support.
Key Findings – Child Outcomes: Measures Child cognitive & language scores: Findings Overall - no statistically significant difference. Control groups scored higher on a Rhyme & Lower case recognition. Within intervention groups – between group differences on: rhyme; block building and vocabulary. Child Attendance: No great difference. However, Int. services had a better minimum attendance rate = better at supporting children prone to lower attendance. ECCE Environment: Int. services engaged significantly more often in some music/movement; nature/science and maths. Int. services had better planning and curricular quality. Int. services had a higher quality literacy environment. Int. staff maintained similar levels of sensitivity throughout evaluation. Home learning environment: Int. parents had a an improved home learning environment.
Parents/Process Outcomes: Measures Home Int. parents had Learning environment. Environment: Process: a Findings an improved home learning High. Scope training: “revolutionised their practice” e. g. conflict resolution: end of year two, children were able to solve problems and conflicts without adult intervention. Speech and Language training: better understanding of language development and how to support children with SL needs, e. g. greater awareness of the print rich environment. Communities of Practice (Co. P): opportunity to share ideas, information and ideas - impacted on their daily practice and would like to see them continued.
CSER, DIT Key Recommendations: Ø Ø Ø High staff: child ratios – as evident in children’s behaviour; Non–contact time to allow for planning and training – as evident in improved curricular and planning quality; Advisable to have training structures in place prior to programme implementation; Importance of a very specific and clear curriculum; In light of bedding-down effects, a longitudinal study/followup of parents, children and preschools would help to determine if these effects persist and strengthen over time; Delivery of parent training as part of a pre-school programme.
Speech and Language Service (S&L): Collaboration with HSE; 2 therapists employed; Three pronged approach; Onsite delivery; 11 early years services & 5 primary schools; Staff training – formal and informal.
Policy-Relevant Outcomes: 18% discharged within normal limits following intervention – TW has an over-representation of families at risk of experiencing multiple disadvantages (CDI, 2004 and 2005); 55 -66% not ‘picked up’ by HSE service – early identification and intervention; 25% referred to other specialist services - promotion of access to health services.
Policy-Relevant Outcomes Cont. : Changes in practice related to the support of speech and language development within the Early Years services and schools; Parents reported easier access and less stigmatisation highlights the need for other SLT and specialist services to give consideration to location and accessibility issues; Improved Therapists’ Wellbeing: ◦ Therapists fulfilled by working in an intensive manner with children. Made possible by short waiting lists and on-site therapy over the course of the school/Early Years service term; ◦ HSE counterparts reported frustration at having to deal with long waiting lists and block therapy delivery.
Healthy Schools programme (HSP): Manualised whole school approach – based on the WHO model of health promotion; Two Healthy Schools Coordinators (HSC) based in 5 schools; Supported schools to implement health and well being activities, both in and out of school; Supported schools to review and update school policies; Supported families to attend specialist appointments; Strengthened links with school and health services, through establishment of Care Teams.
Key Findings: Intervention schools showed significant difference in overweight and obesity: Increased from baseline. Children (older cohort) in intervention schools self reported a reduction in bullying from baseline. Health and Wellbeing: Both intervention and comparison were on average within international range from baseline through to final year. Autonomy + parent relations improved into year 2 (both groups). Child Depression: Intervention and comparison: baseline – within international range, improvements in year 2. However: schools have begun the process of change that is required to become a WHO defined ‘health promoting school.
4 th Year Evaluation Findings: BMI: Higher percentages of Control school children were underweight, overweight and obese compared to Int. schools; Int. schools showed significant improvement in social support and peer relations compared to C schools; No significant differences between I and C schools on breakfast uptake, children’s perception of weight and incidences of reported bullying; No significant differences between I and C schools on emotional and behavioural outcomes; No significant differences between I and C schools on the depression scale.
Policy Relevancy: An assessment of the readiness of a school or organisation for an intervention needs to be undertaken prior to the implementation; An expansion of the culture of joint working and collaboration is required from the Department of Education and Skills and the Department of Health in order to continue the development of children’s wellbeing in educational settings; A National Framework for Health Promoting Schools involving the Departments of Education and Health should be developed;
Policy Relevancy: The establishment of a Health Promoting Committee, with health and local authority participation, building on local inter -agency models of working; Health promotion and mechanisms to support inter-agency collaboration should be included in training for teachers and related professionals, and as part of continuous professional development; CDI recommends that all Government Departments commit to using evidence to inform planning and service delivery and that the implications are taken on board.
What is Doodle Den? Afterschool literacy programme aimed at children in Senior Infants An evidence based balanced literacy framework A manualised curriculum that teaches literacy through a variety of media
Programme Components; Child Component Parent Component Family Component • 32 weeks • 3 sessions per week • 90 minute duration • 6 sessions – 2 per term • Supports work done in Doodle Den session and equips parents with skills to support children’s literacy • Open door policy on all sessions • 3 per year • Parent and child working together • Variety of themes
Main Outcomes; 7 percentile point gain in overall literacy ability Particular gains seen in: Word Recognition (7 percentile point gain); Sentence Structure (12 percentile point gain); and child’s word choice (10 percentile point gain) Combined with teachers ratings, this increased to an 11 percentile point gain Teacher’s report indicate a 7 percentile point decrease in negative behaviours
Secondary Outcomes; Parent’s report increase in child's reading at home (10 percentile points) Increase in family library activity (15 percentile points) Improved school attendance Parental reported child literacy activity
Process Evaluation; Parents were: Positive about library session; Feeling informed about what their child was doing; and Had good relationships with everyone involved. Facilitators: Support from CDI and positive communication; Improved relationships with schools and parents; Improved parental involvement; Improved delivery over time, greater confidence and knowledge of the manual.
What is Mate-Tricks? Afterschool pro-social behaviour programme aimed at children in 4 th Class (9 -10 year olds) An evidence based programme using the Strengthening Families and Coping Power Programmes A manualised afterschool programme that encourages children to reflect on behaviour, emotions and interactions with peers
Programme Components; Child Component Parent Component Family Component • 59 sessions over the course of the year • 2 sessions per week • 90 minute duration • 6 sessions – 2 per term • Supports work done in Mate-Tricks sessions • 3 per year • Parent and child working together • Opportunity to develop and discuss their ideas around key family issues
The Findings: RCT Main Outcomes: No change in majority of the 21 outcomes investigated -16 showed no impact Two statistically significant adverse effects: ◦ Anti-social Behaviour (PSB Questionnaire) ◦ Authoritarian Parenting (APQ) Three effects approaching significance: ◦ Liberal parenting (adverse effect) ◦ Conflict tactics (positive effect) ◦ Improvement in relationships with mothers (positive effect)
Main Outcomes: Anti-Social Behaviour Predicted Post Test ASB Scores** 5 4 3 2 1 1. 21 1. 4 Control Intervention
Process Evaluation: Views and observations of the programme from the various stakeholders were generally very positive; Combined findings from the process evaluation and the outcomes data, provided by engaged parents and their children were more favourable towards the Mate-Tricks programme than the findings from the full sample of parents and children; The model of change or tools provided to facilitators (i. e. the Mate. Tricks programme) was not effective.
Policy Recommendations: After-school programmes focused on behavioural change should be rigorously piloted before roll out; All services for children should be evaluated. Programmes which have shown no demonstrable impact on outcomes should be incrementally removed and replaced with EBPs; All Government Departments commit to using evidence to inform planning; Serious consideration should be given to the implications of the MT evaluation for professional training, service planning and integration; Managers in all state funded organisations working with children receive training in logic modelling, utilising evidence to inform planning and assessing outcomes; Pre-service training involves mandatory modules on engaging parents.
What works: Support for parents of young children; On site, early intervention speech and language – 3 pronged approach; Ongoing professional development, focus on reflective practice, quality promotion; Afterschool, literacy rich, high activity curriculum; Collaboration to improve referrals and service gateways; Creating and supporting structures, systems and relationships which promote collaboration.
Challenges: Impacting on children’s behaviour through after school settings; Evaluating programmes without a ‘bedding down’ period; Process driven programmes (i. e. cultural change) is slow; Unanticipated training and support needs were identified, necessary for the delivery of quality services with fidelity. The tension between being “community-led” and “evidence-based”.
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