Abstract
We evaluated the effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management (TCM) programme as a universal intervention, given schools' important influence on child mental health. A two-arm, pragmatic, parallel group, superiority, cluster randomised controlled trial recruited three cohorts of schools (clusters) between 2012 and 2014, randomising them to TCM (intervention) or Teaching As Usual (TAU-control). TCM was delivered to teachers in six whole-day sessions, spread over 6 months. Schools and teachers were not masked to allocation. The primary outcome was teacher-reported Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score. Random effects linear regression and marginal logistic regression models using Generalised Estimating Equations were used to analyse the outcomes. ISRCTN84130388. Eighty schools (2075 children) were enrolled; 40 (1037 children) to TCM and 40 (1038 children) to TAU. Outcome data were collected at 9, 18, and 30-months for 96, 89, and 85% of children, respectively. The intervention reduced the SDQ-Total Difficulties score at 9 months (mean (s.d.):5.5 (5.4) in TCM v. 6.2 (6.2) in TAU; adjusted mean difference = -1.0; 95% CI-1.9 to -0.1; p = 0.03) but this did not persist at 18 or 30 months. Cost-effectiveness analysis suggested that TCM may be cost-effective compared with TAU at 30-months, but this result was associated with uncertainty so no firm conclusions can be drawn. A priori subgroup analyses suggested TCM is more effective for children with poor mental health. TCM provided a small, short-term improvement to children's mental health particularly for children who are already struggling.
Highlights
Poor childhood mental health is common, persistent, and associated with many adverse outcomes (Costello and Maughan, 2015; Ford et al, 2017)
The study design and procedures are presented in full in the published trial protocol (Ford et al, 2012) which was approved by the Trial Steering Committee (TSC) and Data Monitoring Committee (DMC)
We recruited a total of 80 schools; 40 were allocated to each arm across all three cohorts (10 and 5 schools in the Teacher Classroom Management (TCM) and teaching as usual (TAU) arms, respectively, for Cohort 1; 15 and 15 for Cohort 2; and 15 and 20 for Cohort 3)
Summary
Poor childhood mental health is common, persistent, and associated with many adverse outcomes (Costello and Maughan, 2015; Ford et al, 2017). As three quarters of adults with poor mental health first experience difficulties in childhood (Kim-Cohen et al, 2003), and parents and children are more likely to first contact teachers and specialist education professionals about mental health concerns than their GP (generalised practitioner), paediatricians or specialist child and adolescent mental health services (Ford et al, 2007), there is a growing policy focus on children’s mental health and the role of schools in particular (Department of Health and Department of Education, 2017). The intervention reduced the SDQ-Total Difficulties score at 9 months (mean (S.D.):5.5 (5.4) in TCM v. Cost-effectiveness analysis suggested that TCM may be cost-effective compared with TAU at 30-months, but this result was associated with uncertainty so no firm conclusions can be drawn. A priori subgroup analyses suggested TCM is more effective for children with poor mental health. TCM provided a small, short-term improvement to children’s mental health for children who are already struggling
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