Beginning of The Incredible Years®

©The Incredible Years®
Inspire ~ Innovate ~ Impact
What can be more inspiring than Denmark?

38 Incredible Years!
The Innovation of the Incredible Years ® Programs:
Where have we been and where do we go from here?

What is innovation?
Innovation is:
• Not just about change
• Starts with a concept or new idea that leads to doing
something differently or better

Innovation can be messy & awesome
1929

Innovations involves improvements
1929 2010

My Story ~ Why did I bring about the innovation of a new intervention
designed to prevent and treat behavior problems in young children?
Carolyn strapped
into pram or on
clothes line.

Journey to Becoming the Incredible Years Developer
Did I have any idea I was developing a
programme that would be used world-wide?
Did I think I would become a researcher?

The How and Why of Innovation of Incredible Years?
Innovation of the Incredible Years is the result of
my personal experiences, a particular passion,
technological advances, research studies,
collective action, and ultimately a measure of
serendipity.
Journey to Becoming Incredible Years Developer

Parents’ Background

Father as Model for Innovation ~ O’Cedar
Sponge Mop

Personal Experiences ~ Darkroom Experiences with my
Father

Father as Model for Accepting Technology & Change

Passion for Photography

The Post Adolescent Years are Critical
To Adult Development
Graduated University
of Toronto with
Bachelor’s in Nursing,
1970

Early Experiences – Training Nurses in Africa (1970)

Early Experiences – Impact of a 2nd Model/Mentor

Early Experiences – Changing Family Behaviors

Early Experiences – Changing Child Behaviors

Early Experiences – Families Resisting Change

Early Experiences – Involving Local People
In Innovation

Understanding Culture & The Value of
Collaboration When Innovating

Early Experiences – Understanding Culture:
Cree & Ojibway Indians, Hudson Bay (1971)

Early Experiences – Understanding Culture:
Tlingkit & Haida Tribes, Alaska (1974-76)

Early Experiences – Volunteer Experience,
3rd Mentor (1977)
Dr. Kate Kogan,
Professor Emeritus

Early Experiences – Volunteer Experience &
First Publication
Existing Training Methods
(1976-78)
• Bug-in-the-ear method
• Video feedback
• One-on-one individualized
approach

Early Experiences – “bug in the ear” coaching
• Coaching via bug
while watching parent-child interactions through
a one-way mirror

First Questions – How do can you use video
technology in a more cost effective way?
New Ideas
• Video modeling. Will parents
learn from watching
standardized tapes?
• What is the value of group
learning vs. individualized
approach?

Early Experiences – Developing Content From
Existing Giants
Giants and their theories (1970s)
• Attachment Theory (Bowlby, Ainsworth)
• Social Learning Theory (Patterson)
• Child-Directed Play (Hanf)
• Cognitive, self-efficacy & modeling theory
(Bandura)
• Developmental theory (Piaget)
Albert Bandura
John Bowlby Jean Piaget
Patterson
Mary Ainsworth

Incredible Years Parenting Pyramid® Model (1980)

My Questions and Hypotheses –
Test, Learn, Refine, Improve
Phase One Intervention (1980-2000)
1. Who needs to be involved in intervention (parents,
children, or teachers)? How early to intervene?
What age children? Treatment vs. prevention?
2. How does the intervention work to change children’s
behaviors? What are the essential aspects of
program content?
3. What critical training methods are essential for
changing parent, teacher or child behavior? (video
vs group discussion,therapist training)

Questions and Hypotheses –
Test, Learn, Refine, Improve
Phase Two Dissemination (2000 to 2018)
1. What is necessary for effective program dissemination and training of others to
deliver the programs? (manuals, coaching, background of therapists, videos,
accreditation)
2. How to ensure ongoing evaluation, improvement and sustainability of programs?

Understanding Normal Development:
Trajectories of Aggressive Behavior
0
1
2
3
4
5
6
Age in Years
Frequency
Aggression
Little Aggression
Some Aggression
Modest Aggression
High Aggression
Reproduced with
permission from
Tremblay et al (2003)
1 3 10 15 20 30

The Earlier the Intervention the Better
• Early intervention has a greater chance of preventing later academic, social
& emotional problems because it prevents the cascading of cumulating risk
factors
• Treatment in adolescence is more difficult, lengthy and more costly

My Mission, Goals, & Passion 1980
• Strengthen parenting competencies
& nurturing with children
• Build family support networks
• Prevent and reduce aggression in
young children
• Strengthen children’s social and
emotional competence, problem
solving, and academic readiness

Hypotheses
Strengthening protective factors (positive parenting and family support and
children’s social competence and problem solving) and reducing risk factors
(neglect, abuse, isolation, and aggression) will prevent and reduce children’s
aggressive behaviors.
In the long term, this will result in reductions in children’s violence, drug abuse,
delinquency, child abuse, and neglect.

Understanding the Impact
Importance of Randomized Control Group Trials (RCTs)
Randomized Controlled Trials (RCTs) are the best
way of determining whether a program is working
– it enables you to compare the effectiveness of a
new intervention against what would happen if
you change nothing.

Asking Questions ~ Does video modeling work?
First randomized control group intervention study (RCT)
(JCCP 1980, 1981)
• 3-5 year olds
• Middle class families with borderline
problems
• RCT
• 4 topics – 4 sessions
Results:
• Significant increase in mother positive
affect & decrease in child non–acceptance
and dominance behaviors
• Decrease in child negative affect, behavior
problems & increase positive affect

Asking Questions ~ Does video modeling work?
2nd randomized control group intervention study (RCT)
(JCCP 1984)
• 35, clinic-referred parents of 3-8 year olds
• Low income families with diagnosed behavior
problems
• RCT video-based group vs one-on-one
personalized therapy vs Control
• 9 sessions
Results:
• No difference between 2 treatment groups
• Both improved parenting and reductions in
behavior problems compared to control
• 1-year later both treatment groups continued
improvement in child misbehaviors

IY Development – Who needs to be involved? Who should be targeted?
Where? Yesterday, Today, and Tomorrow
1980s Treatment for Parents with Diagnosed Children (Oppositional Defiant Disorder, ODD)
Parents of children with ODD (3-6 years)
1990s Treatment for Teachers and Children as well as Parents for Diagnosed Children (3-8
years)
Selective Prevention in Schools for Higher Risk Parents
• Children with ODD (added teacher & child group programs)
• High risk families (Head Start) (parent program)
• Head Start teachers (teacher program)
2000-2014 Parent & Teacher Partnerships (0-12 years)
Choosing Prevention and Treatment Programs According to Risk Factors
• High risk families (low income) (child and teacher programs as selected prevention &
parent for indicated prevention in schools)
• New populations – children with ADHD using combined child and parent program; younger
age groups (babies) & older children (8-12 years)
• Culturally diverse & child welfare populations & foster parents
Present &
Tomorrow
• Spectrum of services across age span according risk factors
• New programs developed for universal delivery (parents “attentive parenting” & teachers
“Incredible Beginnings” for children (1-5 years) * Well Baby Program (0-9 months)
• New Programs developed for Parents and Teachers Children on the Autism Spectrum

IY Development – What essential content and methods need to
be present? Length of time? Yesterday, today, and tomorrow.
1980s BASIC Parenting Content & Skills
• Nurturing parent-child relationships/attachment • Group-based methods
• Proactive, developmentally appropriate discipline • Self-administered methods
1990s BASIC Teacher Classroom Management Skills &
ADVANCE training for Parents and Teachers in Social and Emotional Competence
• Positive teacher-student and parent relationships
• Proactive behavior management strategies
• Teaching children emotional literacy, self-regulation, problem solving, anger management
and friendship skills
• ADVANCE skills for parents and teachers – anger & depression management, building
support networks, problem solving
2000-2014 Adapting/Tailoring Program Content & Dosage according to Risk Factors
• Choosing IY program adjuncts e.g., school readiness program, advance program, attentive
parenting program
• Minimum program dosage with flexible expansion
• Tailoring program protocols with fidelity e.g., prevention and treatment
Present &
Tomorrow
•New content as needed to meet needs of different populations; e.g., children on autism
spectrum; day care providers;
• Home-based individualized program delivery/web-based delivery

IY Building Blocks
Developing the Parent Foundation
1980/2008* 1985/2008* 1990/2008*2008/2017*
* Revisions

Recent IY Parent Program Innovations
2014 2012 20152004

Incredible Years Parents, Teachers & Children’s
Programs’ Objectives
Short Term Objectives
• To increase parent and teacher competence
and support families.
• To prevent and reduce externalyzing and
internalyzing problems in young children.
• To promote social, emotional and academic
competence in young children.
Long Term Objectives
• To prevent delinquency, school drop out
substance abuse and violence in adolescence.

Incredible Years®
Teachers Classroom Management Program

Three IY Teacher Program Innovations
For Promoting Children’s Social, Emotional & Academic Skills:
2015 20161995/2011

IY Dina Dinosaur Social and
Emotional Skills Child Programs

The Incredible Years® A System of Interventions

38 Years of Research Studies ~
Thanks to Parents and Teachers
for Making this Possible

38 Years Later…
Incredible Years ® (IY) Programs are Evidence-Based
• Over 38 years of research: starting with parent programs, then child programs,
and then teacher programs
• Parent programs: 9 RCT treatment trials & 4 RCT prevention trials by developer
and 14+ independent RCTs from 6+ countries (including England, Holland,
Norway, Portugal, Spain, Wales).
• Child programs: 3 RCT treatment trials & 2 prevention trials by developer and 3+
independent RCTS from 3 countries (including Norway, Wales, Spain, US)
• Teacher programs: 3 RCT trials by developer
and 7+ independent RCTs from 4 countries
(including Ireland, Norway, Portugal, US)

The Incredible Years® Development:
How does change happen? What training methods and processes are important to
assure change? Yesterday, Today, and Tomorrow
1980s Training Parents: Individual vs. Group Parent Training Format
• Study comparing one-on-one with parent and child vs. group video training
• Study comparing self-admin video learning vs. group discussion vs. group +video
• Study comparing self-admin video with and without therapist consultation
1990s Core Training Methods of all IY Parent, Teacher & Child Programs
• Video modeling & leader mediation of vignettes
• Experiential learning – group practices and assignments – active, participatory vs self-admin
• Principles learning – empowering – self-reflection
• Collaboration, goals setting & relationship building
2000-2010 Training IY Group Leaders/Therapists to Deliver/Promoting IY Program Fidelity
• Authorized group leader training by accredited mentors
• Group leader Accreditation/Certification
• Consultation, coaching and support from IY coaches, mentors and trainers post workshop
• Administrator support and monitoring of program fidelity and assessing outcomes
• Building a supportive infrastructure
• Culturally diverse & child welfare populations & foster parents
Present &
Tomorrow
• Developing a sustainable plan for on-going quality delivery
• On-going group leader learning, self-reflection and support
• Peer coaching to enhance fidelity
• International delivery and networking

Training Research Regarding the Implementation
of Evidence-Based Programs (EBPs)
Research on training others to deliver evidence-based programs
indicates:
• Traditional, brief, single shot didactic training workshops with
passive participation are ineffective in changing behavior
• Longer, quality, active training workshops lead to increased
therapist proficiency, treatment adherence and fidelity but may
not be sustained at follow-up

Training Research Regarding the Implementation
of Evidence-Based Programs (EBPs)

Improving IY Therapist Implementation Fidelity
Study Objective (2008–2013)
To study the effects of providing
therapist/group leader training, support and
coaching to ensure fidelity of delivery of
evidenced based practice (EBP),
specifically the Incredible Years (IY) parent
training program, in community mental
health agencies.

Study Conclusions
• Workshop condition led to reasonable levels of fidelity (most
therapists were MA level with > 6 years of experience)
• Data monitoring condition may have increased fidelity beyond what
would normally occur after basic training
• Enhanced coaching condition therapists rated significantly higher
skills on collaboration, knowledge level, use of vignettes, practical
considerations such as child care etc.
Webster-Stratton, C., J.M. Reid, and L. Marsenich, Improving Therapist
Fidelity During Implementation of Evidence-Based Practices: Incredible
Years Program. Psychiatric Services, 2014.

Coaching & Consultation is Needed to Assure
Fidelity of Program Delivery

On-going Coaching and Supervision is Essential
to Achieve Delivery Fidelity of EBPs
Research indicates that…
Combining ongoing coaching, video feedback, consultation
& organizational support to quality training workshops
improves adoption of innovation, retention of
therapist/group leader proficiency, intervention delivery
fidelity (Sholomskas, 2005; Webster-Stratton, 2012) and
leads to better outcomes.
Herschell,A. D., Kolko, D. J., Baumann, B.L., Davis, A. C. (2010) The role of therapist
training in the implementation of psychosocial treatments: A review and critique with
recommendations. Clinical Psychology Review, 30, 448-466.

Development of IY Quality Support Infrastructure
Group Leaders (accredited) • Lead Groups
• Engage in ongoing peer review
• Attend ongoing consultation post accreditation
IY Trainers (advanced professional training &
work closely with developer)
(Strong, long-term dedication to IY training)
• Provide training internationally
• Review videos for accreditation/certification
• Promote accreditation & dissemination principles
Mentors (must be accredited coach in designated
program)
Responsible for supporting agency or region; often
one segment of professional identity
• Train new group leaders in designated region or
agency
• Provide telephone consultation
• Review DVDs of group leaders for accreditation
• Provide face-to-face consultation workgroups
• Meet with other mentors on a regular basis
• Support peer coaches
Peer Coaches (must be accredited group leaders)
(leaders within local organization)
• Assist and observe new group leaders
• Provide supportive feedback to new group leaders and
review videos
• On going supervision and support of mentors

What we learned:
Incredible Years Program Adaptability
• Parent, teacher and child training is adaptable
• The historical development of IY embodies adaptation and tailoring
– this is embedded in collaborative process of delivery
• The model itself designed to include adaptation/tailoring to local
populations, participant goals & children’s development level

Non-Beneficial IY Adaptability Occurs
• Dramatic shortening of program (content missed or poorly
covered)
• Infrequent use of role play and behavioral practice during
sessions
• Insufficient use of video vignettes to trigger discussions
• Use of video vignettes as content to watch passively rather than
as prompts for collaborative discussion & self-reflection or
leaving them out
• Failure to incorporate planning hours into use of the program
• Failure to make cultural and family adaptations with fidelity
• Failure to lengthen number of sessions as needed for particular
group needs, background and nature of children’s problems

Beneficial IY Adaptations with Fidelity do occur…
• Language/cultural adaptations
• Home-based intervention delivery combined
with group approach for families involved with
child welfare
• Increasing number of sessions as needed for
some populations & translation needs
• On-going booster sessions and programs to
maintain and sustain effects for high risk
populations

Future Research – Improving Fidelity
Implementation
Present &
Tomorrow
Research Training Group Leaders/Therapists/Coaches and Mentors
• Linking group leader/therapist proficiency levels in adherence competence in
delivery of IY programs to better outcomes
• Evaluating the effects of IY trained coaches in promoting fidelity delivery as
shown by completing accreditation
• Evaluating the impact of organizational support to promote fidelity delivery
• Supporting Organizations to Deliver, Support and Monitor Evidence-based
Programs and promote therapist/group leader accreditation

Future Directions & Research for Incredible
Years
Future Research
• More research on new programs ~Incredible Baby program,
Attentive Parenting® , Incredible Beginnings & Autism
programs
• Additional populations researched (e.g., developmentally
delayed children, children on Autism Spectrum, child welfare
population)
• Effects of quality support/peer coaching for group leaders,
therapists, mentors & teachers
• Benefit of booster training for parents as children enter
different developmental phases
That IY could go…
• Ongoing parenting programs and support provided across the
developmental transitions for high risk families
• Working in developing countries
• Universal parent program delivery to ALL families for
prevention ~ immunize all parents

Impact: How are we doing training others?

• Australia
• Canada
• China
• Denmark
• Estonia
• Finland
• Holland
• Hong Kong
• Ireland Republic
• Japan
• New Zealand
• Norway
• Portugal
• Russia
• Slovenia
• Spain
• Sweden
• United Kingdom (Wales, Scotland, N Ireland)
• United States
Where Are IY Programs Being Delivered in the World ?
19+ Countries

• Head Start Centers, Sure Start
• Primary Grade Schools
• Mental Health Centers
• Community Health Centers
• Jails for Incarcerated Parents
(Scotland, Holland)
• Homeless Shelters
• Foster Parents (New York)
• Home Visits (Native Americans,
California)
• Businesses as Employee Benefit
(Goodwill)
• Doctor’s Offices
What Agencies or Organizations Deliver the IY Programs?

Group Leaders Trained by Country
Parent, Child & Teacher Programs (January 2018)
Australia 758 Canada
2433
Denmark 824 Estonia 94
Finland 480
Hong Kong 164
Ireland 1982
Netherlands 149
New Zealand
2405
Norway
2591
Portugal 432
Russia 89
Singapore 183
Slovenia 50
Spain 43
Sweden 523
United States
18615
England 19179
Northern
Ireland 1239
Scotland 1480
Wales 6088

Group Leaders Trained in
IY Parent Programs (January 2018)
Australia 758
Canada 1528 Denmark
632
Estonia
94
Finland
418
Hong Kong 164
Ireland
909
Netherlands
149New
Zealand
1513
Norway
1312
Portugal
402
Russia 89
Singapore 72
Sweden 512
United States
10967England 17445
Northern
Ireland 1035
Scotland 1188
Wales 4692

Group Leaders Trained in Parent Programs
(Denmark)
Babies 188
Basic 369
School Age
Supplement
75

IY Child Programs (January 2018)
Canada,
905
Denmark, 141
Finland, 39
Ireland, 833
New Zealand,
148
Norway, 796
Singapore, 97
United
States, 6555
England,
1533
Northern
Ireland, 137
Scotland, 292
Wales,
904

IY Teacher Classroom Management Program
(January 2018)
Denmark, 51 Finland, 38
Ireland, 240
New Zealand, 744
Norway, 483
Portugal, 30
United States,
1093
England, 201
Northern
Ireland, 67 Wales, 492

Group Leaders Trained in Child and Teacher
Programs (Denmark)
Classroom Dina 55
Small Group Dina
87
Teacher Classroom
Management 51

Certified Peer Coaches by Country
(January 2018)
Denmark
14
Finland 1
Ireland 6
Netherlands 2
New Zealand 53
Norway 12
Portugal 4
United States 7
England
11
Northern
Ireland 3
Scotland 1
Wales 2

Trainers/Mentors by Country
(January 2018)
Australia, 1 Canada, 2 (1
in-process)
Denmark, 6 (1
in-process)
Ireland, 3 (2
in-process)
Netherlands, 2
New Zealand, 8 (2
in-process)
Norway, 12 (2 in-
process)
Portugal, 4 (2
in-process)Russia, 1
USA, 18 (5 in-
process)
England, 13 (2 in-
process)
Northern Ireland, 2
(1 in-process)
Scotland, 2
Wales, 4

59
33
11 10
4 6
7
15
0
10
20
30
40
50
60
70
80
90
Accredited Parent
Group Leaders
Accredited Child
Group Leaders
Accredited
Teacher Group
Leaders
Accredited
ParentPeer
Coaches
Accredited Child
Peer Coaches
Mentors (*1 in-
process)
Baby
Toddler
Basic
Danish Accreditations by Program
(2018)

Summary
What brings about success in regard to innovation or
inspires change?
• Change is a verb – take an idea and
transform it into something real &
continue to refine it with further
research
• It is a long and difficult process, you
must be stubborn, persistent &
committed
• Change is messy and continues to
change

Summary
What brings about success in regard to innovation or
inspires change?
• Innovation makes use of
technological advances but is not
enough. Trusting, culturally sensitive
relationships are essential
• Innovation requires collaboration,
teamwork, research, support… and
collective action
• Innovation requires commitment to
quality program delivery
Maori IY mentor

Change and Innovation Needs Collaboration, Collective
Action, & Commitment– IY Mentors & Trainers (2017)

Thankyou Denmark Team
for your commitment to supporting
families and teachers
Please stand up if you are a manager.
Please stand up if you have been trained in
parent program, child program, teacher
program.
Please stay standing if you are accredited
leader.
Please stay standing if you are an accredited
coach.
Please stay standing if you are a mentor.

Mentors and Peer Coaches

Line Moller
Parent Programme
Ole Falkesgard
Parent Programme
Astrid Honore
Parent Programme
Lene Straarup
Parent Programme
Ditte-Maria
Baby Programme
Barbara Palmer
Parent and Baby
Programmes
Anton Rasmussen
Ikast-Brande
Helle Hartung
Center for ADHD

Conclusion
Research paints a picture of both hope and
warning. It tells us that young children are
resilient; emotional and social behavior
problems may be transitory given nurturing
parents, health care professionals and teachers
who work together. But it also warns about the
risks if we don’t provide the environmental
supports for higher risk young children.

Early Intervention: Utilizing Innovation to Build
Society’s Bank Account for the Future

Beginning of The Incredible Years®

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