Our flagship ENRICH programme (EvaluatioN of wRaparound in Ireland for CHildren and families) is a five year, multi-component research programme designed to help promote child health and family wellbeing early in life.
ENRICH is funded by the Health Research Board and is being conducted by a team of researchers from Maynooth University and senior academics from Queen’s University Belfast, York University and the University of Ulster. The research team, led by Professor Sinead McGilloway, is working in close collaboration with a number of community-based organisations (including the Blue Skies Initiative (ABC) Programme, the Genesis (ABC) Programme, and the Deansrath Family Centre) and stakeholders involved in programme development, delivery and implementation. This brings together researchers and service providers from across child and family services, including social workers, Public Health Nurses, family support workers and community-based health and social care practitioners.
The research programme involves two in-depth evaluations designed to inform the development, implementation and evaluation of two new and innovative ‘wraparound-inspired’ models of care: the Up to 2/Parent and Baby Programme and the Children At Risk Model (ChARM).
The Up to 2/Parent and Baby Programme is being evaluated using a controlled trial, while a Randomised Controlled Trial is being conducted to examine the effectiveness of the ChARM. Two in-depth process evaluations are also being undertaken in parallel to explore the development and implementation of both models. In addition, the research will explore the cost-effectiveness of each programme and whether or not they represent value for money.
Research demonstrates that prevention and early intervention programmes can help to improve child well-being and family adjustment, and reduce the risks of long term maladaptive outcomes (NICE, 2007). However, individual programme interventions and stand-alone evidence-based treatments do not always meet the complex needs of many disadvantaged and marginalised children and families.
The wraparound process offers a team-based approach in order to meet the specific needs of the family. Wraparound brings together parents, families and service providers to provide a comprehensive system of services and supports in order to improve child development and family wellbeing. In particular, the wraparound-inspired service models that are being investigated by the ENRICH research team, incorporate existing evidence-based parenting and child interventions, such as the Incredible Years programmes (www.incredibleyears.com), and provide parents with additional community supports to best support them and their children in the early years.
To date, little evidence exists as to the effectiveness of these kinds of wraparound models of care. The ENRICH research programme will identify what community-based treatment options are of most benefit in improving child and family outcomes over the longer-term.
What are the aims of the research?
- To assess the implementation of two new early intervention/prevention wraparound-inspired service models (the Up to 2/Parent and Baby Programme and the Children At Risk Model);
- To evaluate the effectiveness and cost-effectiveness of each model; and
- To explore the use of research evidence in child health and social care in Ireland and the translation of evidence by managers and practitioners in routine service delivery.
Some of the kinds of research questions which we hope to answer are:
- Do the new models lead to improved parent and child outcomes when compared to parents who receive usual care or services?
- To what extent do the new Incredible Years programmes (Baby & Toddler) lead to positive parent and child outcomes when compared to the other model components and services as usual?
- To what extent are improvements (if any) maintained over time?
- What are the experiences of participants and service providers and what are the key barriers/challenges to successful implementation?
- How cost-effective are the models?
Information for Parents
What is the ENRICH Research Programme?
Two separate studies are being undertaken at Maynooth University – as part of the ENRICH research programme – to assess (1) the Up to 2/Parent and Baby service; and (2) a Children at Risk service. The research will investigate whether these new services and supports are beneficial for parents and their children. Both of these service models will be run in parallel in different sites within the Dublin area and also in the Dundalk/Drogheda area. Detailed information on the range of supports and services available to participants within each of these models is outlined below.
Study One In order to assess the effectiveness of the Up to 2/Parent and Baby Model, two groups have been recruited to take part in the research:
Intervention Group: This group will have access to services / supports such as: the Incredible Years Parent and Toddler Programmes, baby massage classes, stress and weaning workshops, paediatric first aid course, play and development programme and a ‘return to work’ programme.
Comparison Group: This group will have access to usual public health services such as: breastfeeding support, feeding support/advice and developmental check-ups. Both groups are being assessed on four occasions over a two-year period. By comparing data over the course of two years, the research team will assess what services and supports can best help parents in promoting positive parenting, parent-child relationships and child and parent mental health and wellbeing from birth up to two years of age.
Study Two For participants who take part in Study Two (the Children at Risk Model) a Randomised Controlled Trial (RCT) is being undertaken. An RCT is a bias-free method of assigning participants fairly and randomly to either an ‘intervention’, or ‘control’ group. This ensures that both groups are equivalent and allows the research team to determine whether the additional services offered to the intervention group are beneficial over and above usual services. In the design, all participants will, at some stage, receive the service – it’s just that those assigned randomly to the intervention group will receive the service first.
Intervention Group: This group will have access to a life skills programme, the Incredible Years BASIC Parenting programme and the Incredible Years Home Visiting Coach.
Control Group: This group will be offered services as usual, but will be offered the above programmes at a later stage. Participants assigned to the Intervention group are assessed at baseline (before any intervention) and then again at 6-8 months and 12 months later. Those participants allocated to the Control Group are assessed at baseline and 6-8 months later. Participants are then offered the intervention programmes shortly after completing their final assessment. By comparing data over time, the research team will be able to assess whether or not the new service improves parent child relationships and child behaviour as well as overall family functioning and well-being.
Who can take part?
For the Up to 2/Parent and Baby Programme: anyone who is expecting a child or who has recently given birth living within the targeted areas (see next section for list of areas). For the Children at Risk Model: anyone who needs help to better manage their child’s behaviour (aged 3-10 years) and who is living within the targeted areas listed below.
Where are the services being delivered?
South Dublin County and West Dublin including Dublin 10 (Ballyfermot), Dublin 22 (Clondalkin, Neilstown, Palmerstown), Dublin 24 (Tallaght) and Co. Dublin (Lucan) Dundalk and Drogheda.
What do you have to do?
Participants are required to complete (with help where required) a number of questionnaires at baseline (i.e. before any programmes commence) and then a number of follow up assessments will be undertaken thereafter. The number of follow-up assessments will vary according to which study and group to which you are assigned. Each visit takes approximately one hour and you will receive a voucher each time you complete these questionnaires as a ‘thank you’ for your time and contribution to our research programme. A team of highly trained researchers, based at Maynooth University, are conducting the data collection. Your involvement in the research is very important to us and will help us find out whether or not the services / supports are useful to you and your child and therefore, if they should be provided in the future to other parents and families.
What will happen to the results of the research?
The research will be written up in report format and may be published in journals and presented at conferences. A copy of the research will be available upon completion.
Will the research be kept confidential?
Yes, all information that is collected during the course of the research will be kept strictly confidential. No names will be identified at any time. All information will be securely held at Maynooth University and is not available to anyone outside the research project.
Who has approved this study?
The study has received ethical approval from the NUI Maynooth Social Research Ethics Sub-Committee and from Tusla.
What use will this study be to me and my child?
We hope that this research will help us to identify, and improve upon, the needs of parents of babies / young children and also inform and develop new services and supports for families living in Ireland and elsewhere.
Who do I contact for more information on the research?
Please contact Yvonne Leckey, Researcher and Fieldwork Manager, on (01) 708 6657.
Who do I contact for more information on services/supports available to parents?
For those taking part in Study One (the Up to 2/Parent and Baby Programme), please contact Archways on (01) 456 8734/ www.archways.ie. For those taking part in Study Two (the Children At Risk programme), please contact your local Child Welfare Team.
Incredible Years Training Programmes
There are a number of programmes within the Incredible Years series aimed at parents (and teachers) of children of different ages (see Figure below from www.incredibleyears.com).
Both models being evaluated incorporate Incredible Years programmes supplemented by additional community-delivered supports and services depending on which trial participants are involved.
Parent and Baby Programme (available to participants in Study One)
In the Parent and Baby Programme, parents learn how to help their babies feel loved, safe, and secure. They learn how to encourage their new baby’s physical and language development. The parenting group format fosters peer support networks and shared learning. Trained Incredible Years facilitators use video clips of real-life situational vignettes to support the training and stimulate parenting group discussions and practice exercises with their babies. Topics covered include learning how to read babies’ cues and signals, coping with babies’ crying and fussy periods and sleep habits, learning about feeding, providing visual, tactile and auditory stimulation, understanding the importance of parental communication, understanding how babies learn and learning how to get support from others.
Parent and Toddler Programme (available to participants in Study One)
In the Parents and Toddler Basic Programme, parents learn how to help their toddlers feel loved and secure and how to encourage their toddler’s language, social, and emotional development. They learn how to establish clear and predictable routines, handle separations and reunions, and use positive discipline to manage misbehaviour. The parenting group format fosters peer support networks and shared learning. Trained Incredible Years facilitators use video clips of real-life situational vignettes to support the training and stimulate parenting group discussions and problem solving practices. Topics covered include: building toddlers’ language skills; promoting positive play; encouraging children’s self-esteem and expression of feelings; promoting praise; identifying positive behaviour; and establishing clear and predictable routines.
BASIC Parent Training programme (available to participants in Study Two)
The BASIC Parenting Programme strengthens parent-child interactions and attachment, reducing harsh discipline and fostering parents’ ability to promote children’s social, emotional, and academic development. Parents learn the importance of monitoring children and how to set rules regarding TV and computers. Parents also learn how to support and promote children’s academic, social, and emotional skills. In the parenting groups, trained Incredible Years facilitators use video clips of real-life situational vignettes to support the training and stimulate parenting group discussions, problem solving, and practice exercises. Parent competences are developed in the area of positive communication (e.g. using praise instead of criticism), limit-setting, problem-solving and anger-management. Topics include the importance of parental attention, understanding the importance of encouraging social and emotional skills, effective use of praise and encouragement, establishing clear routines as well as respectful limit setting, understanding the importance of parental monitoring, helping children to be more compliant and strengthening positive behaviours.
The Home Visiting Coach (available to participants in Study Two)
The Home-Visiting coaching programme is a one-on-one 12-18 week parent-coach model designed for use with parents who are receiving the IY-Basic Parent Training Programme intervention, but who need some additional coaching to help them with their children. These home visits will be carried out by “home visitor coaches” (e.g. Family Support Workers) who are trained in the IY concepts and principles and receive ongoing supervision from an IY mentor. During these home visits, coaches help biological parents to practise targeted parenting strategies with which they are having difficulty. Coaches also show some additional video vignettes not covered in the groups to reinforce parental learning whilst additional parent manuals cover basic life skills training. For more information on the Incredible Years programmes see: www.incredibleyears.com.
The Project Team (Maynooth University)
Current and recent community-based collaborators/partners include:
- Archways, Dublin and the Blue Skies Area-Based Child poverty (ABC) Programme (www.archways.ie)
- The HSE/Public Health Nurses, Dublin South West and County Louth
- The Genesis (ABC) Programme, County Louth (www.genesislouth.ie)
- Clondalkin Community Healthy Living Initiative, Dublin.
- Deansrath Family Centre, Dublin (www.deansrathfamily.ie)
- Tusla (Child and Family Agency) (www.tusla.ie) (Dublin South West/Kildare/West Wicklow) (Dublin South Central)
- The Social Work Department, Dublin South Central and Cherry Orchard Hospital
- Familibase, Ballyfermot, Dublin
Other Academic Team Members
Senior academics from other institutions who are supporting the project team include:
- Professor Michael Donnelly (Queen’s University, Belfast)
- Professor Tracey Bywater (University of York, England)
- Dr Chris Cardwell (Queen’s University, Belfast)
- Professor Ciaran O’Neill (Queen’s University Belfast)
- Professor Brian Taylor (University of Ulster)
- Dr Evie Gardner (The Northern Ireland Clinical Trials Unit)
- Dr Melanie Barwick (SickKids Hospital, Toronto)