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Watch, Wait and Wonder, The Hincks-Dellcrest Centre and University of Toronto, (Muir, Lojkasek & Cohen)
Watch, Wait and Wonder (WWW) is a child-led psychotherapeutic approach, which uses the child/infant’s activity in free play to enhance maternal sensitivity and responsiveness to her infant. The goal is to facilitate mothers and infants in developing secure attachment relationships by teaching mothers to be sensitive to their infant’s cues. Parents are encouraged to gain an understanding of their own emotional response to their child. Therapists work directly with the mother-infant relationship to support the fragile connection that characterizes the relationships of mothers and infants who need help in this area. This programme is designed to reset the protective system of the mother/child relationship when it has gone awry.
Results from a evaluation study (Cohen, Muir, Lojkaseki, Muir, Parker, Barwick & Brown (2000) indicate that over a 5 month period those mothers and infants receiving WWW showed a greater shift toward more organized, secure attachment relationship and a greater improvement in cognitive development and emotion regulation than a control group of infants and mothers. Mothers in the WWW group reported a larger increase in parenting satisfaction and a decrease in depression compared to the control mothers.
This programme is based on premise that mother’s can be successfully taught to attend to their infants cues and to respond in a sensitive, responsive manner. The programme emphasizes the mother “watching” the infant and letting the infant lead.
Circle of Security, University of Virginia (Marvin, Cooper, Kent, Hoffman & Powel, 2002)
The Circle of Security, an international intervention program, is a 20 week, group-based, parent education and psychotherapy intervention designed to shift patterns of attachment care-giving interactions in high-risk caregiver-child dyads to a more appropriate developmental pathway. The program has been developed based on attachment theory, current research on early relationships and objects relation theory. Using videotapes of their interactions with their children caregivers are encouraged to increase their sensitivity and responsiveness to their child’s cues and signals, increase their ability to reflect on their own and their child’s behaviour, thoughts and feelings regarding their attachment care-giving interactions and to reflect on their own histories that affect their current care-giving patterns.
An evaluation of 75 mothers and their infants who completed the program suggests that a significant shift occurred from disordered to ordered child attachment patterns (from 55% to 20%), an increase (from 32% to 40%) in the number of children classified as Secure, and a decrease in the number of caregivers classified as Disordered (from 60% to 15%). Training for this program has recently been made available in Canada. The Calgary Family Services Training Institute sponsored a 3-day training workshop in May 2008.
The Connect Parent Group (Moretti, M, Holland, R., Moore, K. and McKay, S. 2004, Simon Fraser University and The Maples Adolescent Treatment Centre, Burnaby, BC).
The Connect Parent Group program is an attachment-based parenting program for the parents of severely conduct disordered adolescents. It is a structured, brief program (10 weeks) for parents/caregivers based on attachment principles & directed at
reducing aggression and violence, and promoting healthy relationships. This brief psycho-educational program focuses on promoting enhanced parental-reflective capacity, attunement, and empathy.
Each session begins with the presentation of an attachment principle that helps parents understand attachment issues underlying challenging interactions with their adolescent. Parents learn, for example, that conflict is part of attachment and is particularly acute during times of transition in the relationship, such as the transition through adolescence. Parents also learn to ‘step back’ in emotionally charged situations, recognize and modulate their own feelings, and consider the possible meanings behind their adolescent’s behaviour. Helping parents be (and feel) more competent in these areas helps them ‘reframe’ their adolescent’s behaviours and needs allowing them to keep their emotions in check when dealing with difficult situations, while clearly setting limits and expectations but in a way that maintains the relationship.
Preliminary findings (Moretti, Holland, Morre and McKay, 2004) based on parent reports of child behaviour as assessed by the Child Behavior Checklist (CBCL) showed a significant reductions in adolescents externalizing behaviours and total behaviour problems as well as high parental acceptance of the intervention. The majority of parents rated the educational focus on attachment in the group as helpful (46%) or very helpful (38%). Parents also rated the group as helpful (50%) or very helpful (38%) in enhancing their understanding of their child, and helpful (33%) or very helpful (46%) in enhancing their understanding of themselves as parents.
Because of the many positive outcomes associated with a secure attachment the implications of programmes such as those described above is clear. Prevention and intervention programmes designed to promote a secure parent-infant attachment relationship or improve the parent-child attachment relationship later on in development can improve the developmental outcomes of children and youth who are at risk for poor developmental outcomes and prevent later problem behaviour and psychopathology. Despite the strong theoretical and empirical evidence of the importance of secure attachment relationships to the promotion of resilience capacity, to date, these types of programmes are not commonly made available across Canada to those families in need.
The Nurse Family Partnership Program (Olds, 1998, 2002, Pediatrics, Psychiatry & Preventative Medicine, University of Colorado) This program represents the most successful example of an evidence-based home visiting program, the goal of which is to strengthen family capacity. This is achieved by hiring trained nurses who visit young low-income, single, adolescents pregnant for the first time. These women are visited in their homes 9 times during their pregnancy and 23 times during their child’s first 2 years of life. These visits focus on three areas: 1. improving the young women’s prenatal health and pregnancy outcomes, 2. improving the quality of childcare provided to the infants once they are born in order to promote better child health and development and 3. improving the women’s personal development in such areas as educational achievement, career development, and future family planning.These three programmes all focus on the development of effective parenting skills as a means to facilitate resilience capacity in groups of high-risk children. Although these programmes differ substantially in the age group targeted (infants versus school entry), the population targeted and the strategies they utilize, all three are focused on the development of the parent’s ability to provide consistent, predictable care giving. In general, this type of focus is a more common approach among intervention programmes for high-risk groups.
Early research has indicated that compared to high-risk women who had not received visits, program participants had 79% fewer verified reports of child abuse or neglect, spent less time on public assistance, had 44% fewer maternal alcohol and drug abuse problems, and had 69% fewer arrests. A 15-year follow-up of these women’s children showed that, compared to the children of high-risk women who had not received visits, there were 60% fewer instances of running away, 56% fewer arrests, and 56% fewer days of alcohol consumption (Olds, Henderson, Cole, et al., 1998). Subsequent research (Olds, 2000) has indicated reduced low birth weight, reduction in preterm delivery, reduction in emergency room visits and child abuse. By age 4 reduced punishment used by mothers, increased mother employment, delay of second child by more than 12 months, and higher child IQ scores. By age 15 years they found decreased likelihood of child alcohol and drugs, fewer arrests, fewer convictions, reduction in sexual partners, and improvement in families’ financial sustainability. Research also indicates that the use of nurses compared to paraprofessionals is critical to programme success. A 2005 evaluation of the programme found that the rate of infant mortality among mothers is less than half the rate among other first-time mothers in spite of the fact that mothers in the nurse-home visiting programme were younger, poorer and more likely to be unmarried.
This program was initially implemented in Elmira, New York, and replicated in Memphis, Tennessee, and Denver, Colorado. It is presently operating in 20 states across the United States, addressing the needs of 20,000 families with plans by 2010 to be in 38 states. The costs of the program are recovered by the first child’s fourth birthday (Karoly et al., 1998). In 1998 it was estimated that over time the Elmira programme would save as much as $4 in government spending for every $1 in programme costs. In 2008 the City of Hamilton Health Services in partnership with the Offord Centre for Child Studies at McMaster University implemented the Nurse Family Partnership programme in Canada.
SAFEChildren- Schools and Families Educating Children (Tolan, Gorman-Smith & Henry, Families and Communities Research Group, Institute for Juvenile
Research, Department of Psychiatry, the University of Illinois at Chicago, established 1997)
Schools and Families Educating Children (SAFEChildren) is a family-based preventive intervention programme for children who live in inner city neighborhoods and are entering first grade. The goal of the program is to help families gain or increase parenting and family management skills that would facilitate successful child academic and social adjustment and, therefore, to promote social and academic competence and to lower risk for later antisocial behavior. In addition, the intervention concentrates on promoting initial academic success.
This intervention is based on a developmental–ecological perspective regarding risk and prevention efforts that views normal developmental transitions as a time when intervention may be particularly useful. This approach emphasizes the interdependence among multiple risk factors in explaining the development of antisocial behavior. There is also the recognition that the necessity and salience of a given risk factor can vary as a function of the social ecology in which the child develops.
SAFEChildren combines two components: multiple family groups and individual reading tutoring. The multiple family groups component consists of weekly multiple family group meetings and addresses parenting, family relations, and parents’ involvement and investment in their children’s schooling. The intervention consists of 20 weekly sessions and deals with the family’s role in their child’s schooling and with helping the family focus on their identity and responsibility to each other, the relation of home to school and the structure needed in the home to help children succeed in school as well as family relations.
The one-on-one reading tutoring program is based on teaching the basic skills of reading. The purpose of this component is to increase children’s opportunities to apply reading skills; to reinforce the skills, values, and beliefs taught as part of the family-based intervention; and to use this opportunity to address ethnic identity. Trained tutors spend a portion of each session reading with the child.
The SAFEChildren program was evaluated by taking 424 families residing in inner city neighborhoods whose children were entering first grade in one of seven schools and, after baseline assessments were made, randomly assigning the families to the intervention group or the control group. Data was obtained from parents and children at four points including a 6-month follow-up. Individual interviews were conducted with the primary and secondary caregivers and the target child over the course of the study. The study targeted four major effects for the intervention: a) child’s school functioning b) child’s behavior c) child’s social competence (BASC), and d) parenting and family relationships.
The results indicate that 6 months after the intervention the program had produced an overall effect of increased academic performance and better parental involvement in school. Intervention families remained engaged in school and their children progressed academically at a rate comparable with the national rate. The program also produced additional benefits for parental monitoring, child problem behaviors, and children’s social competence. Among families with less adequate parenting skills and family relationship quality there was a decrease over time in aggression. In addition, SAFEChildren showed an improvement in concentration relative to those who did not receive the intervention. Among children with the highest levels of problem behaviors at pretest SAFEChildren participants showed a decrease in aggression, while those who did not receive the intervention had a slight increase in aggression. This programme has been listed on the National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Caring Dads: Helping Fathers Value their Children (Crooks, Francis, Kelly and Scott. 2004, University of Western Ontario, London, ON) The Caring Dads programme is one of the first group intervention programmes designed specifically for men who have maltreated their children and /or exposed them to domestic violence. This 15-week group intervention aims to increase men's awareness of the impact of coercive, shaming and under-involved behaviour on children, enhance fathers' motivation to change, reduce attitudes and perceptions that support maltreatment of children, and improve father-child relationships. It was also designed to reduce men's involvement in child-focused marital conflict and increase fathers’ cooperation and problem solving around childcare issues. The programme is organized around four goals: engaging men; building positive parenting; recognizing and countering abuse; and rebuilding trust with children. The strategies used to achieve these goals include a range of approaches, such as motivational interviewing, psycho education, cognitive-behavioral techniques, confrontation, and shame work.
This programme is still in its infancy. Two pilot projects were conducted in London, ON in 2002. The results of these pilot studies (Scott, Kelly, Crooks and Francis, n.d.) suggest some promise of the Caring Dads program as a whole. In a qualitative report, fathers reported being satisfied with the program and as having gained a valuable perspective on their style of parenting. Moreover, men reported that they were continuing to make changes in the way they dealt with their children even after treatment. The biggest challenge was dropout of participants before the end of the programme. This is not surprising since this is a difficult group to work with.
Self-Regulation Focused Programmes
The Preventive Treatment Program (also known as the Montreal Longitudinal Study and the Montreal Prevention Experiment) (Tremblay, GRIP, Université de Montréal) This program was designed for disruptive kindergarten boys and their parents, with the goal of reducing short- and long-term antisocial behaviour. The focus is on providing parent management training to prevent antisocial behavioural problems and delinquent behaviour and child social skills training to foster abilities to interact in prosocial ways as well as self-control. Intensive support is provided to high-risk families with the goal of helping young children learn to regulate physical aggression. The program provides training for both parents and boys. The parent-training component is based on a model developed at the Oregon Social Learning Center (Patterson, 1974). Parents received an average of 17 sessions (some received as many as 42) that concentrated on monitoring their children’s behaviour, giving positive reinforcement for prosocial behaviour, using punishment effectively, and managing family crises. Caseworkers helped parents generalize what they learned through home visits, and teachers were encouraged to cooperate with the intervention. The school-based component emphasized promoting social competence and emotional regulation by stressing problem-solving skills, life skills, conflict resolution, and self-control.
Results of evaluations of this programme (Tremblay et al. 1992, 1995) have demonstrated both short- and long-term gains for youth. After 2 years the boys were less physically aggressive at school, were more age appropriate in regular classrooms, showed less serious school adjustment problems and demonstrated fewer delinquent behaviors. At age 12, 3 years after the intervention, treated boys were less likely to report the following offenses: trespassing, taking objects worth less than $10, taking objects worth more than $10, and stealing bicycles. They were rated by teachers as fighting less often, were more well-adjusted, displayed less serious difficulties in school, and fewer were held back or placed in special education classes. At age 15, those receiving the intervention were less likely to report gang involvement, having been drunk or taken drugs in the past 12 months, having committed delinquent acts (stealing, vandalism, drug use), and having friends arrested by the police.
Based on these findings this programme is listed on the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention – Public Health Agency of Canada (http://cbpp-pcpe.phac-aspc.gc.ca/intervention/243/view-eng.html) and the National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration) (http://mentalhealth.samhsa.gov/publications/allpubs/SVP-0054/appendix.asp)
Tools of the Mind (Bodrova & Leong, 1993, 1996, 2001, Metropolitan State College of Denver) The Tools of the Mind (TOM) curriculum is a Vygotskian-based early childhood education curriculum (preschool through 2nd grade) that provides teachers with a series of tools and strategies to support the development of early literacy, self-regulation, and foundational cognitive skills (Bodrova and Leong, 2001). The curriculum has two main goals that are viewed as inseparable: (1) the development of underlying cognitive skills such as self-regulation (of behavior, emotions and cognition), deliberate memory and focused attention; and, (2) the development of specific academic skills such as symbolic thought, literacy, and an understanding of mathematics (Leong & Hensen, 2003).
Tools of the Mind is a research-based early childhood program that builds strong foundations for school success in preschool and kindergarten children by promoting intentional and self-regulated learning. Teachers systematically scaffold children's moving along the continuum of self-regulation from being regulated by others to engaging in "shared" regulation to eventually becoming "masters of their own behavior." Children gain control of their social, emotional, and cognitive behaviors by learning how to use a variety of "mental tools." Teaching of early literacy and mathematics emphasizes building underlying cognitive competencies such as reflective thinking and metacognition. Children practice self-regulated learning throughout the day by engaging in a variety of specifically designed developmentally appropriate self-regulation activities.
Teaching self-regulation means revamping the classroom and how activities are implemented. The Tools of the Mind programme focuses on eliminating preschool classroom activities that promote unregulated behavior such as waiting in line with nothing to do, wandering around the classroom during center time, being unclear about what to do during an activity and not being able to get help. It requires teachers to create a consistent classroom where teacher expectations are clear and enforced fairly. It means having activities where children have the responsibility for deciding and following through with this responsibility. Research shows that this approach of embedding self-regulation in all classroom activities works better than teaching self-regulation as a separate stand alone activity.
Diamond, Barnett, Thomas, & Munroe, (2007) have shown that children who attended Tools classrooms have higher rates of self-regulation than closely matched pairs and that the level of self-regulation correlated with child achievement in literacy and mathematics. In a double-randomized design study of preschool children (Barnett et al. 2006) Tools was compared to a control group using a high-quality ECE program with no emphasis on self-regulation. Children in Tools were found to have higher rates of self-regulation and teachers trained in Tools scored higher in classroom management measures, used classroom time more productively, and had a higher rate of appropriate and cognitively challenging interactions. At-risk 5-year-old children in Tools showed markedly better executive function performance compared with closely matched peers.
Currently the Tools of the Mind program is being implemented in Colorado, Massachusetts, New Jersey, New Mexico, and Oregon. Adele Diamond of the University of British Columbia has been conducting research on the effectiveness of this programme. Most current interventions addressing executive functions target the consequences of poor self-control rather than seeking prevention at an early age, as the Tools programme does. Diamond et al.( 2007) believes that "Early intervention (heading off problems before they develop) costs far less and achieves far better results than trying to correct problems once they have developed".
The Reaching In Reaching Reaching Out Programme (RIRO) (Sponsored by the Child and Family Partnership, a group of four organizations committed to promoting resilience in children and families. They include the YMCA of Greater Toronto , the Child Development Institute, George Brown College, and the University of Guelph) is Canada's only evidence-based program for teaching resiliency thinking and coping skills to young children to foster self-efficacy and mastery motivation.
Founded as a pilot project in 2002, RIRO is a resilience and strengths-based approach designed to reach young children from birth to seven years by laying a strong foundation of thinking and coping skills that support resilience in the adults who care for and work with them. RIRO teaches "3Rs of Resilience"– skills to help Relax, Reflect and Respond effectively to life's challenges. The resiliency skills help adults and children develop several critical abilities associated with resilience: being in charge of our emotions, controlling our impulses, analyzing the cause of problems, empathizing with others, believing in our competence, maintaining realistic optimism and reaching out to others and opportunities.
Consisting of 12 hours of content in two parts, Part 1 helps adults build a foundation of critical resiliency abilities they can model with children and families. Specifically, they learn to: identify and strengthen critical abilities associated with resilience, use strategies to stay calm and focused in stressful times, identify how their thoughts can affect their ability to cope with stress and challenges, challenge thinking habits that hinder resilience, generate alternative ways to handle conflict, problems and stress.
In Part 2 of the program, participants learn to apply the skills with children. They learn to: model the skills and foster resilience in the children around them, use their own resiliency skills to increase their understanding of children's behaviour, incorporate resiliency skills into their work setting by using child-friendly approaches such as children's literature, puppets, and play-based activities.
An evaluation of 27 ECE trained teachers and 225 preschool children reported that sixty-five percent of teachers reported changes in children’s impulse control and 61% in emotional regulation that they believed was related to the teachers’ resiliency training. “Calming/ focusing” activities, which impacted on resilience through emotional regulation, were viewed as the top resiliency skill area for preschool children to learn. For kindergarten children, teachers rated learning to “put things into perspective” as the most important new skill after “calming/focusing” skills were in place.
RIRO has trained more than 3,000 professionals and paraprofessionals, benefiting an estimated 30,000 children in Canada. More than 150 training professionals and educators across Canada have already completed RIRO's 5-day trainer "intensive."
Future training plans include development of a resiliency skills training program for parents so children are exposed to the skills at home. RIRO's unique delivery model is very cost effective. By engaging established networks of professionals who work with children, RIRO-trained professionals can transfer resiliency skills to children for less than $7.00 per child.
Since 2000, there have been nine independent evaluations of the effectiveness of Roots of Empathy, as well as two reviews of the program as a whole. Results have shown that compared to comparison groups, Roots of Empathy children demonstrated: increased social and emotional knowledge, decreased aggression, increased prosocial behaviour, increased perceptions of the classroom as a caring environment and increased understanding of infants and parenting. In 2001, the Government of Manitoba commissioned a three-year follow-up study of Roots of Empathy, measuring prosocial behaviour, physical aggression, and indirect aggression. Results showed a significant improvement in all three behaviours immediately after the program, with improvements in behaviours maintained three years later. Curriculum Services Canada has reviewed and recommended the Roots of Empathy curriculum "as a valid program for use with students in Kindergarten to grade 8 to promote understanding of human development, diversity, and the uniqueness of individuals."
The Incredible Years (Webster-Stratton Programme)Conclusions
The Incredible Years Parent, Teacher, and Child Training Series is a set of curricula designed to promote social competence and prevent, reduce, and treat aggression and related conduct problems in babies, toddlers, young children, and school-aged children. This programme consists of parent training, teacher training, and child training programs guided by developmental theory concerning the role of multiple interacting risk and protective factors (child, family, and school) in the development of conduct problems. The Incredible Years parent training intervention is a series of programs focused on strengthening parenting competencies (monitoring, positive discipline, confidence) and fostering parents' involvement in children's school experiences in order to promote children's academic, social and emotional competencies and reduce conduct problems. The Parents & Babies program focuses on helping parents learn to observe and read their babies' cues and learning ways to provide nurturing and responsive care including physical, tactile, and visual stimulation as well as verbal communication. The Incredible Years Parents and Toddlers Program supports parents and focuses on strengthening positive and nurturing parenting skills. At ages 3-6 the program focuses on strengthening parenting skills and consists of components that build upon one another. At ages 6-12 the programme focuses on the importance of promoting positive behaviors, interpersonal issues such as building social skills, and effective praise.
Webster-Stratton & Reid (2008) report that extensive research evaluating the Incredible Years Parenting Programs in numerous randomized control group trials indicates that the program is an effective treatment approach for reducing early onset-conduct disorder and producing significant changes in parents' behavior and reductions in children’s levels of aggression.
Despite the success of this programme Carolyn Webster-Stratton warns that there are key elements that need to be put in place to enable programmes of this type to succeed in their impact. Particularly, she notes the critical role that a consistent agency supervisor plays in providing support and approval, the need for the active participation of both the case worker and parent, the need for attendance incentives such as food, childcare, and transportation to ensure that the neediest and most challenged families are motivated to continue their participation, and the need for staff stability and adaptability of timetables and scheduling. Finally she noted that parents expressed a strong desire for a high degree of parental involvement in selecting appropriate behavioural goals for themselves rather than being dictated to.
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