A Study to Assess the Acceptability of Adding Home Parent Support along with the Incredible Years[R] Parent Programme

There is an increase in the incidence and intensity of child conduct problems affecting 5-10% of children internationally (Boden, Fergusson, & Horwood, 2010; Church, 2003; Maughan, Rowe, Messer, Goodman, & Meltzer, 2004; Pilling, Gould, Whittington, Taylor, & Scott, 2013; Scott, 2007). Severe conduct and behavioural problems in young children are an important predictor of later chronic antisocial and criminal behaviour in adolescents (Blissett et al., 2009; Boden et al., 2010; Church, 2003; Fergusson, Boden, & Hayne, 2011) and are costly to individuals, families and communities (Bonin, Stevens, Beecham, Byford, & Parsonage, 2011; Church, 2003; M. Cohen, 2005; Scott, Knapp, Henderson, & Maughan, 2001). It is therefore, essential that evidence-based interventions are introduced early in the life of the child and are targeted at children with identified risk factors for developing serious conduct problems. The Incredible Years[R] parent management programme (IYP) is an evidence based parenting programme designed to address conduct problems in young children. International research on the efficacy of IYP consistently demonstrates positive outcomes in terms of fewer child externalising behaviours, improvements in parent-child relationships, child problem solving skills, emotional regulation, and parental confidence (Bywater et al., 2011; Kaminski, Valle, Filene, & Boyle, 2008; Webster-Stratton, 2000). The literature also demonstrates the effectiveness of IYP programmes in New Zealand (Berryman, Woller, & Glyn, 2009; Fergusson, Stanley, & Horwood, 2009; Lees & Ronan, 2008; Sturrock et al., 2013; Sturrock, Gray, Fergusson, Horwood, & Smits, 2014). While evidence based parent management programmes have good outcomes for most families, not all families make the same improvement. Follow-up studies show that up to one third of families still experience clinically significant child behaviour problems post-treatment, and this was a predictor of adolescent engagement in delinquent acts (Reyno & McGrath, 2006; Webster-Stratton, Rinaldi, & Reid, 2011). Identifying families vulnerable for poorer response to IYP and providing them with additional in home support is expected to improve outcomes. The factors predicting poor treatment outcomes can generally be identified as child factors (e.g. high levels of externalising behaviour); parent factors (e.g. mental health, parenting style); family demographics (e.g. single parent, family size, education/socioeconomic), and participation (attendance, barriers to participation). Families with several of these factors are more likely to drop out of treatment (Bagner & Graziano, 2012) and are therefore more vulnerable to poorer treatment response. It is these families who may benefit from extra support to address barriers for change and to maximise the benefits from attending a parenting programme. Having support in the home enables the therapist to personalise the parenting strategies for the particular needs of each family and to implement them effectively. Additionally, the therapist is able to observe participants in their homes and support them to address barriers preventing change such as; substance abuse, poor parental mental health, and domestic violence (Gomby, 2005). It is expected that combining an evidence based parent programme with a home visiting intervention would improve outcomes. Incredible Years[R] Parent Programme in New Zealand. The Child and Adolescent Mental Health Service in the Bay of Plenty District Health Board was the first hospital service in New Zealand to introduce IYP as a treatment pathway for parents of children with conduct problems. IYP was first delivered and evaluated in 2001, and results showed improvement in child behaviour and family functioning (Lees & Ronan, 2008) which reflected international outcomes (Jones, Daley, Hutchings, Bywater, & Eames, 2008; Kaminski et al. …