We are the Association for Child and Adolescent Mental Health, or ACAMH for short, and this is ACAMH Learn. So, hello, my name is Ariadna Albajara, and I'm a postdoctoral research associate at the Department of Psychiatry at the University of Cambridge. Today, I'm going to talk to you about the incredible years teacher classroom management programme, a prevention programme designed to strengthen teacher classroom management strategies. In this presentation, I will focus on its key principles, specific strategies, and relevant research conducted on the topic. So I would like to start by explaining why mental health prevention is important. So according to recent data from 2023, in England, about 1 in 5 children and young people, aged 8 to 25 years old, had a probable mental health disorder. This data was published by NHS England. So here, in light grey, you can see the rates for both girls and boys combined, in dark grey, the rates for girls and young women, and in blue, the rates for boys and young men. Overall, we can see that these numbers are quite alarming. In fact, as you can see in this slide, these numbers have been increasing since 2017 and remain stable in 2022 and 2023. Prevention is also necessary because nearly half of all individuals experience their first mental health disorder before the age of 18. And you can see here, data from the 2021 study by Solmi shows that the peak onset age is 14 and 1/2 years old, meaning that this is the age at which the highest number of new cases of mental disorders are reported. And you can also see here the peak onset age for specific disorders, including the neurodevelopmental disorders and anxiety disorders, which peak at 5 and 1/2 years old, and later, obsessive compulsive and eating disorders. Prevention is also important because of the consequences of poor mental health in childhood. In fact, poor mental health in childhood and adolescence often persist into adulthood and is associated with negative long-term outcomes, including educational, occupational, financial, and social difficulties. So effective prevention focuses on reducing risk factors and strengthening protective factors. Early intervention is necessary because treatment interventions, offered during adolescence, show limited effects, as some dysfunctional behaviours are already established, and secondary risk factors are present. So this brings me to the Incredible Years programmes. The Incredible Years programmes are a series of interlocking programmes, meaning they complement each other, designed for parents, teachers and children. They address multiple risk factors, across home and school, with the goal of reducing risk factors and strengthening protective factors to prevent dysfunctional developmental trajectories. The programmes were developed by Dr. Carolyn Webster-Stratton and were first published in 1984 in the United States. The main goals of these programmes are, one, to prevent and treat behavioural difficulties in young children, and two, to promote their social and emotional competence, as well as academic readiness. The short-term goals of the Incredible Years programmes include strengthening parent-teacher child relationships, reducing hard discipline, and improving homeschool communication. They also provide support for parents and teachers to reduce stress, while promoting children's social skills, emotional regulation, problem solving, and school readiness, and additionally, they aim to prevent and address early social and emotional difficulties. So there are three types of programmes-- programmes for parents, child training programmes, and programmes for teachers. As you can see in this image, in fact, there are several different programmes for children, parents, and teachers. So this is the logic model of the Incredible Years programmes, representing the theory of how the intervention produces its outcomes. First, you can see here, the three programme components-- the programmes for children, for parents, and for teachers. So as I mentioned before, the main goals are to decrease risk factors and increase protective factors. The short-term outcomes of the programme are presented next, including increased school readiness, emotional regulation, and social competence, and improved parenting, teaching, and relationships between children, parents, and teachers. And finally, the long term outcomes include reduced school dropout, increased academic achievement, and reduced conduct disorder and substance use. So parenting programmes were developed first, and studies have shown a positive effect of this training. However, changes at home may not always translate into improvements at school. It is also important to note that schools represent an ideal setting for intervention, as they increase accessibility and allow for reaching a larger number of children. So, since most children attend school and typically spend a significant portion of their time there, working in schools is essentially a population-based approach. In this talk, I will focus on teacher programmes, and particularly, the teacher classroom management programme. So the content of the teacher programmes is designed to reduce school factors and increase school protective factors. School risk factors include poor classroom management skills and classroom aggression, and school protective factors include proactive teaching strategies, positive teacher-parent relationships, and children's emotional regulation. The specific goals of the teacher programmes are to strengthen teacher classroom management skills, use academic persistence, social and emotional coaching, and build positive teacher-student relationships. It also aims to improve discipline strategies, foster collaboration with parents, teach key social and emotional skills, and reduce classroom aggression. So, as I mentioned before, there are different types of interventions for teachers, adapted to specific age groups or the presence of neurodevelopmental conditions. The teacher classroom management training focuses on children aged 3 to 8 years old and is primarily designed for teachers, but also teacher aides, school psychologists, and school counsellors. The Incredible beginnings training focuses on children, aged 1 to 5 years old and is directed at daycare and preschool teachers. And here, in orange, you can see the helping preschool children with autism training, which focuses on children, aged 3 to five years old on the autism spectrum and is directed at teachers and parents of preschool children on the autism spectrum. For the rest of the presentation, I'm going to focus on the first programme, the teacher classroom management training. So first, why is classroom behaviour management important? Disruptive classroom behaviour is common and is often associated with mental health disorders in childhood, such as ADHD and conduct disorder. It has never negative consequences for disruptive child, the other children in the classroom, but also for teachers. The problem is that teachers don't always feel confident in managing classroom behaviour. In this context, governmental institutions, like the Department for Education or the OECD are increasingly recognising the need for classroom management training. So the Incredible Years Teacher Classroom Management Programme aims to strengthen teachers classroom management strategies and promote school readiness and prosocial behaviour. The programme consists of six full day workshops, spread out over six months, with sessions held monthly to allow teachers to practise the strategies learned between sessions. The pyramid here illustrates the content of the programme. So basically, the base of the pyramid represents the fundamental behaviours and activities that should be widely used to support skill development. It emphasises building strong relationships with students and parents, using proactive strategies, and applying academic, social and emotional coaching, as you will see in the first workshops that I'm going to present now. The model assumes that positive relationships must come before discipline, and that reinforcing positive behaviours should be far more frequent than addressing negative ones. Only with this solid foundation will the strategies higher up on the pyramid be effective. So now I'm going to describe in more detail the content of each workshop. The first workshop focuses on two key areas-- building positive relationships with students and being a proactive teacher. So let's start with building positive relationships. A strong teacher student relationship is essential, especially for students who struggle. This involves showing trust in them, fostering their sense of responsibility, and giving them choices when possible. It is also important to challenge negative labels, maintain positive communication with parents, and create a supportive classroom environment, where students feel valued and included. So some specific strategies for building positive relationships with students include getting to know their hobbies and interests, spending time playing with them, acknowledging their birthdays in some way, and sending texts to parents or call them to tell them about something their child has done well at school. The second part of the workshop focuses on preventing behaviour problems by being a proactive teacher. This involves establishing clear rules, maintaining a structured schedule, and setting up an optimal classroom environment to support positive behaviour. So the idea behind this is that structured environments make problematic behaviours less likely to occur. So for instance, having the schedule and the classroom rules visibly displayed in the classroom are some of the specific strategies proposed. Preparing students for transitions, giving clear instructions, and using helpful reminders can also be helpful, and also engaging students through verbal and nonverbal cues, providing positive attention and monitoring, and offering choices when possible. So finally, reinforcing school rules at home, through parent communication, ensures consistency between behavioural expectations. So in this slide, you can see examples of ineffective and effective commands. And ineffective command will be something vague like stop running or let's don't do that anymore. Effective commands are clear, specific, and positive, giving one direction at a time with the action verb at the beginning of the sentence. For example, instead of saying, stop running, a more effective command would be walk in the hall. So the second workshop focuses on teacher attention, praise, encouragement, and coaching to foster positive behaviour in the classroom. This session helps teachers use praise and encouragement effectively to reinforce desired behaviours. Praise can be directed at the whole group, individual students, and even self praise to help children build confidence. The workshop also introduces coaching, which involves using descriptive comments to highlight specific learning skills. Essentially, the teacher narrates what the student is doing or feeling, helping them become more aware of their actions, their thoughts and emotions. So there are different types of coaching-- academic, persistent, social, and emotional. And you can see examples of each in this table here. So academic coaching can help children expand their vocabulary. For example, instead of asking too many questions, like what colour is the car, what is this object, while playing, which can feel like a test rather than a play activity, teachers use descriptive comments, such as you have the red car and the yellow truck. This makes learning more engaging and less intimidating. Persistent coaching encourages students to keep trying, even when tasks are difficult. And social coaching helps children develop their social and friendship skills. And finally, emotional coaching helps children develop their emotional literacy. Teachers labour students emotions when they see them, helping children associate feeling words with their emotional states. So workshop three explores how incentives can be an effective tool for motivating students and encouraging positive behaviour, especially for students struggling with social, behavioural, or academic challenges. It covers how to set up individual and group incentive programmes, ensuring they are varied, meaningful, and promote internal motivations. Strategies include using unexpected rewards, complement chart, and involving parents to reinforce positive behaviours. So on this slide, you can see an example of a behaviour plan, which helps students replace negative behaviours with positive alternatives, along with specific strategies tailored to each child. So next, workshop 4, focuses on managing disruptive behaviours through ignoring and redirecting. Teachers learn when and how to ignore minor misbehaviors to avoid reinforcing them. Students are also taught to ignore their peers when they are misbehaving, but dangerous or abusive behaviour should not be ignored. So distracted or off task students should be redirected rather than ignored. Teachers can use verbal cues, like simply mentioning the child's name, and non-verbal cues, like making eye contact to re-engage students, and reminding are warnings help guide behaviour before escalation, and staying calm is key for effective classroom management. So next, workshop 5 focuses on following through with consequences to manage inappropriate behaviour effectively. Teachers learn how to use timeout properly. So timeout is a form of ignoring, where students are temporarily removed from sources of positive reinforcement, like teacher and peer attention. It serves as a nonviolent response to conflict, stops the attention the misbehaviour is getting, and provides a cooling off period for both students and teachers. So this workshop also covers strategies for handling common misbehaviors, like impulsivity and noncompliance, and the application of structured approaches, like a colour coded system. So teachers also learn how to use logical consequences. As shown in the speech bubble here, they represent a negative outcome that results from the child's behaviour because the teacher set it up that way. So these warnings provide the child with a choice to change the negative behaviour and a warning about the consequences if he or she does not. So finally, teachers learn how to use the anger thermometer, which is a visual tool to help students recognise and manage their emotions. A countdown thermometer can also be placed in the timeout area. So this will help students develop self-control and monitor their emotions during moments of distress. So workshop 6, which is the last workshop, focuses on helping students develop emotional regulation, social skills, and problem solving abilities. Students learn to ask for what they want appropriately, communicate effectively, and solve problems. So a key aspect is emotional literacy and promoting positive self-talk to help shift negative thinking patterns. So the speech bubbles here show an example of this, turning self-criticism into a more positive and growth-oriented mindset. And teachers also learn to adapt coaching to students developmental levels. And parents play a role in reinforcing also these skills at home. So in the next section, I am going to talk about the research conducted on the effectiveness, implementation, and sustainability of the Incredible Years Teacher Classroom Management Training. So what does research say on its effectiveness? So previous studies, for instance, this meta-analysis from Korest and Carlson from 2022 and this systematic review for from Nye collaborators from 2019 have shown positive effects of the programme on teachers classroom management strategies and pupil mental health. One particular study that was conducted in the UK is the STAR trial, which was led by Professor Tamasin Ford. The goal of the trial was to explore the effect of the TCM training on teachers behaviour management strategies and subsequent pupils mental health. So the trial included 80 UK primary schools across Devon, Plymouth, and Torbay. So 40 teachers receive the training, and 40 other teachers continued teaching as usual. And the finding showed a small improvement in mental health for pupils with trained teachers. But programme effectiveness alone does not ensure its successful implementation and sustainability. So the STARS team explored teachers views on the implementation and impact of the TCM programme, using a qualitative design as well. Teachers who had attended the TCM training participated in focus groups and interviews, two months after the end of the training. So they identified barriers for the implementation of the programme, related to the school context and also training gaps. They also reported a positive impact of the course on pupils, teacher-parent relationships and on themselves. So the problem is that initial programme outcomes do not necessarily continue in later phases. So this is why we decided to carry out a study on the sustainability of the programme. So what is sustainability? There are multiple definitions of sustainability, but sustainability can be described as the continued use of a programme after the end of external support, for example, from the research team. And the programme continues to produce benefits, even if it has been adapted to the broader ecological context to the school. The issue is that previous studies have shown low levels of sustainability, of evidence-based intervention in schools. And contextual factors seem to play an important role in intervention sustainability. So the aim of our study was to explore teachers views on the sustainability of the TCM approach, using a qualitative approach. We wanted to know if teachers were still using TCM strategies, one year after the end of the training, and if benefits were still maintained. But also, what were the factors influencing sustainability and whether the TCM approach was used across the school. Participants in this study were 25 teachers from the STARS trial who had attended the TCM training. So focus group and semi-structured interviews were used to capture teachers views and experiences, and these were conducted, one year after the end of the training. So the transcripts of audio recordings were then entered into NVivo, which is a computer software for qualitative data analysis, and the framework method, which is characterised by the creation of a matrix summarising data, was used. So regarding the results, so our analysis generated a series of themes. Here, they are presented in the boxes and subthemes, that I'm going to describe. So one year after the end of the training, teachers reported that they were still using TCM strategies, and that the TCM approach was embedded into routine practise, which is one of the key constructs of sustainability. So here, for example, we have a quote from a teacher illustrating this, saying that he or she was using the strategy subconsciously, and that strategies had become part of her or his everyday practise. So teachers were not using all the strategies, but the ones that they perceive to be more effective, easier to implement, the ones that children like the most and the ones that work better with children with special educational or behavioural needs. So at the two-month follow up, teachers reported a positive impact of the programme in children, parents, and themselves, one year after the training, which means that the benefits of the programme were maintained, which is a fundamental aspect of sustainability, and means that the positive impact was maintained in a new cohort of children and parents. However, the experiences with children, with special educational or behavioural needs were mixed, so some teachers felt that the strategies did not work with some children with extreme behaviour, and that they would need additional training or support. So since the end of the training, teachers have changed schools or cohorts, and they said that they had adapted their use of the TCM approach to their new cohorts of children, who are younger or older, more disruptive or less disruptive. And teachers also talked about changes that had happened at their schools, that had made more difficult for them to use the TCM strategies. For example, changes in behaviour policy or the introduction of a more demanding curriculum. So since the end of the training, teachers had shared the strategies with other teachers at their schools, but their responses were mixed. So some showed interest and adopted the strategies in the class, or teachers were even asked to write the school behaviour policy and others showed resistance. And for example, some teachers who passed the strategies to the new teacher, said that the new teacher had not used the strategies, and the disruptive behaviours had reappeared. And responses from teaching assistants were also mixed. And this is very important because teacher assistants play a very important role in classroom behaviour management, and it is important to keep consistency within the classroom to avoid unsettling children. So finally, teachers said that they supported refresher sessions to help them revisit the strategies. And teachers also thought that the course would be useful for other teachers in general, and also for school staff, including teaching assistant at their schools. So they supported a whole school training to promote a consistent approach to behaviour management across the school and within the classroom, and increase staff buying. So in conclusion, teachers were still using TCM strategies, one year after the end of the training and still perceived the TCM approach as beneficial. Changes at the school level related to the introduction of incompatible behaviour management strategies by senior leader, and competing academic demands were identified as barriers for sustainability. A whole school training would increase consistency across the school and increase staff buy in, according to teachers. And so further longitudinal studies, exploring sustainability of the different components of the programme are needed to improve this programme. So I would like to thank all the people involved in this study, and I hope you enjoyed this presentation and learn more about the Incredible Years Teacher Classroom Management training. Thank you very much.