Bywater T, Hutchings J, Linck P, Whitaker C, Daley D, Yeo S T, Edwards R T
College of Health and Behavioural Science, School of Psychology, Bangor University, Gwynedd, UK.
Child Care Health Dev. 2011 Mar;37(2):233-43. doi: 10.1111/j.1365-2214.2010.01155.x. Epub 2010 Sep 21.
the incidence of conduct disorder in young children is 10% in the general population and 37% among fostered children. Up to 40% of untreated children diagnosed with conduct disorder develop problems later in life including drug misuse, criminal and violent behaviour. There are more than 80,000 looked after children in the UK, with 5000 in Wales. Challenging child behaviour is the main reason for placement breakdown and has huge cost implications as challenging children cost up to 10 times more in service use than children without conduct disorder. The Incredible Years (IY) evidence-based parenting programme is an effective, low cost solution in improving child behaviour and social competence in 'conventional' families and thus has the potential to support foster carers in managing difficult behaviours. Our main aims were to establish: • The feasibility of delivery and the effectiveness of the IY parenting programme in supporting carers in managing difficult behaviour in looked after children. • Service use costs for foster carers and looked after child.
This was a 12-month trial platform study with 46 foster carers in three authorities in Wales. Carers were allocated 2:1 intervention to waiting-list control. Validated measures were used to assess 'parenting' competency, carers' depression levels, child behaviour and service use. Measures were administered at baseline and 6-month follow-up. Intervention carers received the programme between baseline and follow-up.
Analyses showed a significant reduction in child problem behaviour and improvement in carers' depression levels for intervention families at follow-up, compared with control. Unexpectedly, there was a significant improvement in control carers' self-reported 'parenting' strategies. Special education was the greatest service cost for looked after children.
Initial foster carer training could incorporate the IY programme to support carers in establishing positive relationships and managing difficult child behaviour. Programme participation may lead to reduced service use and improved placement stability.
在普通人群中,幼儿品行障碍的发病率为10%,而在寄养儿童中这一比例为37%。在未经治疗的品行障碍儿童中,高达40%的儿童在日后生活中会出现问题,包括药物滥用、犯罪和暴力行为。英国有超过8万名被照料儿童,其中威尔士有5000名。具有挑战性的儿童行为是安置失败的主要原因,并且成本高昂,因为有挑战性的儿童在服务使用方面的花费比没有品行障碍的儿童高出多达10倍。“不可思议的岁月”(IY)循证育儿计划是一种有效且低成本的解决方案,可改善“传统”家庭中儿童的行为和社交能力,因此有潜力支持寄养照顾者管理困难行为。我们的主要目标是确定:• 在支持寄养照顾者管理被照料儿童的困难行为方面,实施IY育儿计划的可行性和有效性。• 寄养照顾者和被照料儿童的服务使用成本。
这是一项为期12个月的试验性平台研究,涉及威尔士三个地区的46名寄养照顾者。照顾者被以2:1的比例分配到干预组和等待名单对照组。使用经过验证的测量方法来评估“育儿”能力、照顾者的抑郁水平、儿童行为和服务使用情况。在基线和6个月随访时进行测量。干预组照顾者在基线和随访之间接受该计划。
分析表明,与对照组相比,随访时干预组家庭的儿童问题行为显著减少,照顾者的抑郁水平有所改善。出乎意料的是,对照组照顾者自我报告的“育儿”策略有显著改善。特殊教育是被照料儿童最大的服务成本。
最初的寄养照顾者培训可以纳入IY计划,以支持照顾者建立积极的关系并管理儿童的困难行为。参与该计划可能会减少服务使用并提高安置稳定性。