The E-SEE trial v1
Research type
Research Study
Full title
Enhancing Social-Emotional Health and Wellbeing in the Early Years: A Community-based Randomised Controlled Trial (and Economic) Evaluation of the Incredible Years Infant and Toddler (0-2) Parenting Programmes
IRAS ID
173946
Contact name
Tracey Bywater
Contact email
Duration of Study in the UK
3 years, 11 months, 29 days
Research summary
Research Summary
Behavioural and mental disorders have become a public health crisis. There is a strong link between parent and child wellbeing. Incredible Years (IY) group-based parent programmes aim to promote social and emotional wellbeing in children aged 0 to 12 years. Robust evidence for IY (3 + years) demonstrates increased child social and emotional wellbeing, fewer behavioural difficulties and, importantly, a positive impact on parent wellbeing – a major risk factor for healthy child development; but few programmes and little evidence exist for the 0 to 2 year age range.
We aim to investigate whether the IY-Infant and IY-Toddler (0 to 2 years) programmes are effective and cost-effective in enhancing child social and emotional wellbeing at 20 months of age compared to services as usual (SAU).
The intervention will be delivered in community settings across four local authorities (LAs). Parents of children aged 0 to 2 months at baseline will be recruited according to level of need as assessed by completion of a mental health questionnaire.
We plan an 18-month internal pilot randomised controlled trial (RCT) leading to a definitive 30-month RCT. Participants will be randomly allocated to IY or SAU according to level of need based on primary carer depression scores and gender of child and primary carer. Intervention parents will receive an IY-I book (universal level) followed by an IY-I programme (8 to 10 weeks; 2 hours/ week) and/or IY-T (12 weeks; 2 hours/ week) dependent on level of need at data collection points 2 and 3. Control parents will receive services as usual. IY-I and IY-T will not be SAU in participating LAs.
Primary outcomes, including child social and emotional wellbeing and primary parent depression levels, will be assessed at the final 18-month follow-up when the child is 20 months old.
Summary of Results
Behavioural & mental health disorders have become a public health crisis. There is a strong causal link between parent & child wellbeing. We identified a parent programme to support young children, called Incredible Years®. We first conducted a large randomised pilot study involving two research sites, over 200 families, and parent advisory committees, which informed the design and implementation of this trial. We mostly wanted to see if Incredible Years®, which has versions for parents of babies, and for parents of toddlers could improve young children’s wellbeing, but we were also interested in family wellbeing and health, parent competence, use of community, or health, services, parent-child relationships. Robust evidence for Incredible Years® (3+ years) demonstrates increased child social & emotional wellbeing, fewer behavioural difficulties, & importantly, a positive impact on parent wellbeing - a major risk factor for healthy child development. However, few programmes, & little evidence, exists for the 0-2 year age range.
Two newly developed Incredible Years® programmes for parents of 0-2 year-olds, Incredible Years® Infant and Toddler programmes, have not been rigorously evaluated. We aimed to deliver Incredible Years® as a proportionate universal intervention based on assessment of risk/need and answer the following research question:
Are the Incredible Years® Infant and Toddler programmes, when delivered in a dose proportionate to need, & when compared to services as usual, effective & cost-effective in enhancing child social & emotional wellbeing at 20 months of age?
From the 341 participants, 285 and 56 were randomised to E-SEE model and control respectively. We also had an additional 68 co-parents in the study at the start (reducing to 47 at the end) who completed questionnaires, and some attended Incredible Years® groups. Not all parents who were eligible and offered the group programmes accepted, or turned up for it – 101 families were offered the Incredible Years® Infant programme, but only 51 attended. 101 families were also eligible and offered the Toddler programme, but only 21 attended.
We found that E-SEE Steps did not impact on child wellbeing when comparing scores on the Ages and Stages Questionnaire, Social Emotional (ASQ:SE-2) to those who did not receive E-SEE Steps, i.e. there was no difference. This may have been influenced by the low take-up of the Incredible Years® group programmes, and we can also not be sure if parents read the Incredible Years® Baby book. In addition, no other measures showed a difference between those who received and didn’t receive E-SEE Steps, e.g. parent-child relationship, parent competence. However, E-SEE Steps was found to be on the border of being financially worthwhile, mostly because there were very small gains for parent mental health for those allocated to E-SEE Steps. E-SEE Steps was found to cost £621 per family more than usual services, but this cost would reduce with future delivery as staff training costs would not need to be included in the future now that staff have been trained to deliver.
REC name
Wales REC 5
REC reference
15/WA/0178
Date of REC Opinion
22 May 2015
REC opinion
Favourable Opinion