the early home learning study: collaboration with...
TRANSCRIPT
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The Early Home Learning Study:
Collaboration with government and providers to develop and evaluate a parenting approach that improves learning outcomes for young children experiencing disadvantage.
Presentation to Brotherhood of St Laurence 28th August, 2014
Presenter: Jan Matthews
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Aims of the Early Home Learning Study
Funded by Victorian Government Department of Education and Early Childhood Development
(DEECD)
1. Improve early learning and development foundations for children in over 2,000 families living in vulnerable circumstances
2. Find out how best, in the Victorian early childhood context, to support parents to provide positive home learning environments to their children (focus on 0 – 3 years)
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Our Brief
Build capacity in existing service sector
Embed new evidence based strategies in existing service platforms
Provide practitioner training and site support
Build positive home learning environments in families
Parents increase quantity & quality of parent-child interactions &
Provide stimulating learning environments
Children’s learning and development
AddressVictorian
Early Years Learning &
Development Framework
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Acknowledgements
Principal Investigators
Jan Nicholson
Naomi Hackworth
Jan Matthews
Warren Cann
Donna Berthelsen
Advisors
Obe Ukoumunne(statistics, randomisation)
Lisa Gold (economics)
Jay Buzhardt & Kathleen Baggett (observational methods)
EHLS Team
Victoria Hamilton
Elizabeth Westrupp
Amanda Sicluna
Misel Trajanovska
Shannon Bennetts
Jane Bennetto
Kim Campbell
Emily Gutierrez
Nicola Johnson
Tracey Phan
Durga Shrestha
Maggie Yu, Olivia Clayton
Eloise Cameron
Hilary Davis, Simon Fox
Tessa Hillgrove, Laurel Johnson
Monique Seymour
Site Coordinators/Managers
Lauren BeecroftNatacha BuchananAnn BurkeIris CrookDonna FeoreVanessa FrogleyJacquie GilmourBarbara HayesAnnita KeeversBeth KershawDaniel Leach-McGillJulie McKenzieTanya McMaster-ThieleKaren MitchellAnne Monichon
Joanne NovakLuisa PerezMargaret PhillipsCarmel PillingerJenny RukuwaiDanielle SchofieldSally ThomsonKristy WaltonKaren WheelerKay Widdicombe
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Framework for enhancing early learning
Quality everyday interactions• tuning in • following the child’s lead • listening and talking more• using teachable moments• being warm and gentle
Stimulating home learning environment
• shared reading at home• learning through everyday routines• supporting children’s play at home • using community resources• monitoring use of media at home.
accessing needed services supported by and contributing to their community
Developing self-efficacy and self-sufficiency, self-monitoring & personal agency
Parent wellbeing stress
management
Quality everyday
interactions
Stimulating environment
Parent self-careParenting
confidence
Community and service connectedness
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The smalltalk intervention
Two levels of intensity • smalltalk – group only• smalltalk plus – group plus home coaching (6 home visits)
Two service platforms: MCH SPG
Parents of:Infants
6 – 12 months
Toddlers
12- 36 months
No. weekly group
sessions:6 10
Compared to ‘usual care’• Standard parenting or playgroups
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Study questions
The Service
• Was the intervention provided to the families it was designed for?
• Was it delivered the way it was intended?
• Did the families and the service providers like it?
• Did families remain engaged over time?
The Outcomes
• Did smalltalk families show greater gains over time compared to families attending standard groups?
• How effective was smalltalk compared to smalltalk plus?
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Cluster RCT Design
PLATFORM
SITE
LOCATION
smalltalkplus
Families
smalltalk
Families
‘usual care’
Families
2 Platforms (infant & toddler)
20 sites: Local Government Areas(10 infant ; 10 toddler)
101 locations: physical place where the groups were run = UNIT OF RANDOMISATION
Families received the variant offered in their local area
Each location ran 1 type of research condition
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Metropolitan sites (n=13)
Melton
(44 km)
Mornington Peninsula
(90 km)
Yarra Ranges
(30-110 km)
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Regional sites (n=7)
Bendigo
(153 km)
Shepparton
(191 km)
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Engaging parents & practitioners in intervention development
through consultation and collaboration:
Impact on engagement and process.
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Contextually mediated practice
“An approach to early childhood intervention that
uses everyday family and community activities as the
contexts for children’s learning, and child interests as the
foundation for involving children in everyday learning
activities “ (Dunst, 2006)
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Collaborative-consultative approach to intervention development
• Dissemination failure - attributed to inadequate early attention to critical aspects of program design and planning
(Dunst et al., 2008; Durlak & DuPre, 2008)
• Importance of consumer engagement (e.g. Boyd, Diamond & Bourjolly, 2006; Goodare & Smith, 1995; Greenhalgh et al, 2004; Nilsen et al 2013; Sanders & Kirby 2012)
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Factors influencing intervention design
Ease of Implementation• Fit with existing, widely accessed, services
• Modelled around Maternal and Child Health parenting groups & supported playgroups
• Fit with the funding models: Low intensity/light touch
Narrow Focus• Focus on fairly narrow range of parenting skills
Fidelity• Build on existing staff competencies
• Keep core elements simple and within staff capacity
• Provision of training, detailed manuals & resources
• Trained in ONE variant only
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How did we develop smalltalk?
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Development Process
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smalltalk materials
Practitioner manuals
Advertising
Practitioner resources to use with parents
Parent workbooks
DVD examples of the smalltalk strategies
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Conversation cards
Materials to support change
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Parenting intervention - triadic
model
19
PRACTITIONER
Facilitate groups
Conduct home coaching
PARENT
Implement smalltalkstrategies
CHILD
Enhance learning & communication
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Principles
•Partnership with parents
•Implementable – ‘light touch’
•Ensuring ‘fit’ with existing service delivery
•Building on approaches and strategies already in use
•Providing tools/resources appropriate for services and families
•Focus on skill development using methods known to bring about change
•Practice model emphasis on building parent’s self-efficacy
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Primary parent change mechanism
Coaching*Joint planning
Observation – live and filmed modeling (Parent dvd)
Action/practice
Reflection
Feedback
*Practice characteristics of coaching (Rush & Shelden, 2005)
Plus
Written/pictorial information
Group discussion
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Practitioner role – introduce & coach
MCH groups – smalltalk strategies introduced via cooperative learning
activities & practice in group.
SP groups – strategies introduced informally during brief ‘one on one’
or ‘one on two’ conversations + practice in group
Both platforms - Between session practice at home
Home coaching
DVD based – DVD = ‘3rd party’
Coach works with parent on DVD content
Facilitates parent practice with video feedback
Collaborative relationship between parent/practitioner –parent expert on their own child
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Results: Process data
Reach, retention, participation
Program fidelity
Exposure (quantity): Were the components of the intervention covered sufficiently?
Adherence: Did parents use the strategies in session and at home?
Exposure (quality): Were the parents and facilitators satisfied with the content and delivery
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Process measures
Site & facilitator/coach reportsParent recruitment/Attendance
Post – session ratings of parent participation, content covered & session conduct
Post–intervention ratings – satisfaction, benefit
Parent reportssmalltalk strategy use in home/other setting –weekly verbal report
Post intervention telephone interview –satisfaction, benefit
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Reach and retention
Recruitment 2,661 expressed interest
2,228 (84%) were eligible, contactable and
consented to participate
Reach Successful in recruiting targeted families:
84% at least 1 risk factor
20% had 4+ risk factors
Retention 83% retained to post-intervention
78% retained to 5-month follow-up
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26
Baseline risk factors for less than optimal child development
Clin
≤ 36,400
<Year 12
<<20
Sympt
< 52,000
Year 12 or Equivalent
<=25
0 20 40 60 80 100
Par. psychological distress
Low parent self efficacy
No parent employed
Govt pension/benefits
Low family income
Low par. education
Language other than English
Single parent
Young parent (<20; <=25)
Proportion
1111
N=2187
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Participation: Average proportion of sessions attended
0
20
40
60
80
100
MCH SPG
% s
essi
ons
atte
nded
standard
smalltalk
smalltalk plus
home coaching
59-64% of group sessions (first 3 bars)78-81% of home coaching (4th bar) 67% attended all
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0
20
40
60
80
100
Warm and gentle
Tuning in Follow child’s lead
Listening & talking more
Teachable moments
Reading
Par
tici
pan
ts (
%)
smalltalk strategy
Discussed at group
Practiced at group
Used at home
Data for the MCH (infant) platform
Same pattern for Supported Playgroups (toddler)
platform
Exposure to and use of strategies
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Parent satisfaction with intervention, facilitator & home coach
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Parent satisfaction with intervention, facilitator & home coach
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Parent satisfaction with intervention, facilitator & home coach
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Impact on knowledge – parent report
0 20 40 60 80 100
smalltalk plus
smalltalk
standard
smalltalk plus
smalltalk
standard
smalltalk plus
smalltalk
standard
smalltalk plus
smalltalk
standard
Met
oth
er
par
ents
Fou
nd
ou
t ab
ou
t o
ther
se
rvic
es
Un
der
stan
din
g o
f ch
ild
dev
elo
pm
ent
New
way
s to
te
ach
ch
ild
Proportion of parents (%)
A little
A lot
Data for the MCH (infant) platform
Similar, but stronger differences for SP (toddler)
platform
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Facilitator satisfaction
Rated as going “well” or “very well”
Standard smalltalk smalltalk plus
MCH (infant)70% 92% 81%
Supported
playgroups (toddler) 77% 80% 90%
Home coaching
sessionsn/a n/a 85%
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Outcomes of CRCT
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Research Questions
Did families show greater improvements:
1. For smalltalk vs. usual care?
2. For smalltalk plus home coaching vs smalltalk
group only?
Outcomes: parenting behaviours and the quality of
the home learning environment
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Design
Two parallel cRCTs
• Infants – 6 week MCH parent groups
• Toddlers – 10 week supported playgroups
Three conditions
• Standard
• smalltalk (group only)
• smalltalk plus (group + 6 home coaching sessions)
Three time-points
• Pre, post, 5-month follow-up
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Outcome measures – self-report
Parenting
• Warmth*
• Irritability*
• Verbal responsivity
Home environment
• Activities with child*
• Literacy environment
• Household confusion
Computer-assisted telephone interview (CATI)
Collected and analysed for full sample
*Reliable, validated measures from the
Longitudinal Study of Australian Children
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Outcomes measures – observational
Individual Growth & Development Indicators
Indicator of Parent-Child Interaction: Parent ‘facilitator’ behaviours
• Acceptance and warmth
• Descriptive language
• Follow child’s lead
• Maintains child’s interest(Carta, Greenwood, Walker & Buzhardt, 2010)
Four videotaped, structured parent-child play & tasks (8-10mins)
Collected for full sample; pre, post & 5-mthsCoded and analysed for random subsampleTrained coders, blind to intervention and time-point20% checked for coder agreement (87% agreement)
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Analyses
Within platform (i.e. separately for infant and toddler)
1. Participant characteristics
• Was randomisation successful?
• Was there selective attrition?
2. Adjusted regression analyses
• Pre to post; pre to follow-up
• Presented estimates are Effect Sizes (ES) for continuous data & Odds Ratios (OR) for categorical data
Adjusted for: child age, single parent family, language other than English, young parent (<25yrs), low parent education, parent unemployment, low income, government benefits
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Interpretation
Effect Sizes (ES) – summary of the magnitude of difference between the groups. For a community samples and a preventive intervention, we interpret these as:
Large: >0.50
Medium: 0.25 - 0.50
Small: <0.25
Odds Ratio (OR) – likelihood of the outcome cf. reference group
= 1.0 equal probability of the outcome
< 1.0 reduced probability of the outcome
> 1.0 increased probability of the outcome
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Analyses
3. Adjusted regression: Reliable change*
• Summary statistic, applied to the self-report data only
• For each individual, calculates whether change on a given measures over time is greater than could be expected by chance alone
• We have categorised each participant as showing reliable change on at least 1 measure (Y/N)
• Comparisons by condition expressed as OR
* Jacobson & Truax (1991) Journal of Consulting & Clinical Psychology
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Study Participants
2228 parent/child dyads
Infant = 1002 Toddler = 1226
Randomisation was successful
There was selective attrition – families with higher risk were more likely to be lost at post and follow-up
Final sample for analysis:
* Varies due to tapes excluded as ‘not able to be coded’
Infant (n) Toddler (n)
Self-report (CATI) 750 – 800 940 – 1010
Observations (videotaped)* 90 – 100 120 – 130
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Overall pattern:
• smalltalk plus was better than (or the same as) smalktalk
• smalltalk was better than (or the same as) standard
For simplicity, we present:
• smalltalk plus vs. standard comparisons
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Infant Platform – self report data
smalltalk plus vs. standard
pre to post
N=798
pre to follow-up
N=757
ES p ES p
Parenting warmth 0.11 0.223 0.01 0.862
Parenting irritability -0.03 0.703 0.13 0.075
Parent verbal responsivity 0.18 0.012 0.08 0.285
Home activities 0.20 0.005 0.00 0.971
Literacy environment 0.19 0.007 0.03 0.671
OR (CI) p OR (CI) p
High household confusion0.80
(0.43, 1.48)0.478
1.09
(0.56, 2.12)0.807
Reliable change (1 or more
areas)
1.77
(1.26, 2.48)0.001
1.14
(0.83, 1.58)0.419
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Infant Platform – observational data
smalltalk plus vs. standard
pre to post
N=100
pre to follow-up
N=88
ES p ES p
Acceptance & warmth -0.05 0.856 0.20 0.379
Descriptive language 0.63 0.014 0.16 0.635
Follow child’s lead 0.56 0.022 0.25 0.482
Maintains child’s interest 0.03 0.907 0.32 0.362
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Toddler Platform – self report datasmalltalk plus vs. standard
pre to post
N=1014
pre to follow-up
N=940
ES p ES p
Parenting warmth -0.04 0.679 0.05 0.532
Parenting irritability -0.10 0.080 -0.09 0.145
Parent verbal responsivity 0.08 0.233 0.04 0.630
Home activities 0.16 0.011 0.11 0.152
Literacy environment -0.05 0.444 0.05 0.379
OR (CI) p OR (CI) p
High household confusion1.04
(0.68, 1.60)0.858
1.38 (0.88, 2.18) 0.163
Reliable change (1 or more
areas)
1.26 (0.80, 1.98)
0.3231.94
(1.36, 2.78) 0.000
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Toddler Platform – observational data
smalltalk plus vs. standard
pre to post
N=119
pre to follow-up
N=129
ES p ES p
Acceptance & warmth 0.20 0.298 0.19 0.291
Descriptive language 0.77 0.000 0.46 0.038
Follow child’s lead 0.18 0.440 0.35 0.071
Maintains child’s interest 0.52 0.029 0.55 0.008
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Summary of findings:
Infant platform
• Early improvements in parent reported and observed behaviours
• Differences not sustained to follow up
Toddler platform
• Fewer early improvements parent reported and observed behaviours
• Differences were sustained and strengthened to follow up
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Conclusions
1. Coproduction is the ‘way to go’
• High level of ‘buy in’ from families , practitioners & services
• Referral, reach & attendance/ retention indicate high acceptability/relevance for families
• Good fit to existing service model and staff training
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Conclusions
2. It is possible to change parent behaviour to improve the quality of the home learning environment through a relatively light touch intervention
• although more intensive intervention is required for the most vulnerable families
Recommendation: Use data to inform effective ‘triage’ processes to ensure that the families who receive this limited resource are the ones who need it most
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Conclusions
3. It is possible to embed rigorous and complex research design into real world service delivery
• Engage services as meaningful research partners.
• Provide intensive support around research design, study implementation & data collection
Services and practitioners took on ‘ownership’ of the study.
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What next?
Impact on long term child outcomes
• Awarded research grant funding to assess child outcomes at school entry
PRC is supporting the transition to full implementation
• State government have secured ongoing funding for smalltalk
Aims are to achieve
• evidence-informed scale-up – match services to community profiles
• make smalltalk supported playgroups more broadly available
• effectively triage the additional home coaching component to the families who would benefit the most
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