Transcript Document

Are the kids alright? Importance of Early Years
All Wales Mental Health Promotion Network
Flying Start – engaging with and influencing parents and
their early years children
Wed 25th January 2012
Sam Carson
Senior Educational Psychologist
“Early differences in experience”
Hart & Risley ( 1995 )
Encouragements
500K
Discouragements
2
Phrases
addressed to
the child by
36 months
Professional
Working class
Welfare
Working class
Welfare
35 million
1
Words
Addressed
to child by
36 months
Professional
RISK FACTORS FOR CHILDREN
Traumatic Life
Events
Poor quality
relationships
Chaotic parenting/
no boundaries
Violent parenting/
Rigid boundaries
Anxiety / anger /
grief / mistrust /
loss of confidence /
broken continuity
Social isolation /
preoccupation /
powerlessness /
aggression
Insecure attachments /
high levels of criticism
/ neglect
Risk aversion /
low self esteem /
vulnerable
Uncertain sense of self /
poor socialisation /
poor concentration
Fear / abuse / anger /
resentment
Poor self-control /
seek thrills /
Underachievement /
acting out / provocative
/ no autonomy
Mental health
problems
Emotional,
Behavioural
&
Social
Difficulties
Youth
criminality
Cardiff Flying Start
Enhanced Health Visiting
Part time Childcare for 2 year olds
Language & Play sessions
Parenting:- Parent Nurturing Programme
- Parents Plus
Parents Plus is a psychology service for pre-school
children with behavioural difficulties and their
families within Flying Start areas in Cardiff.
The psychologist makes a detailed assessment of
the child’s progress and their family context.
EY Home Liaison Officers carry out a structured and
time-limited intervention towards objectives that
have been agreed with the parents. These are in
keeping with a Parenting Positively approach.
Accessing Parents Plus
Families are eligible to use the services if they meet the following criteria: The parents of the child wish to use the service
 The child is under 4 years of age at the point of referral
 Parents Plus is inclusive – we welcome involvement with all children
and families.
Early intervention contributes to:a) Prevention of difficulties arising / becoming entrenched
b) Building resilience & reducing risk factors
c) Early identification and assessment of a child’s needs & referral to the
appropriate existing service
Parents Plus will be available if it is considered
to add value to existing services.
APPROPRIATE REFERRAL PATHWAY – criteria
Referrer’s assessment
1
Fairly typical / normal problems e.g. temper tantrums; dummy; crying; bedtimes
2
Parents asking for advice on behaviour.
Parents “out-of-step” in their management.
Child uncooperative; not sharing; winding others up
Child has short concentration; play skills not well established
3
Parents would benefit from fresh ideas.
Getting stuck in negative interactions.
Child seen as problem. Risk of breakdown in bonding / affection
Child biting; scramming; swearing; rude; screaming
Does not play purposefully; attention-seeking
4
Parents need clear ideas and alternatives to current approach. New routines needed.
Un-resolving difficulties in spite of earlier support / advice
Escalating problems in managing the child; things are getting worse
Child appears sad; withdrawn; passive
Child hurting others in temper; often angry / destructive / defiant
Child not settling to play activities
5
Parents are stuck / “giving up”. Parents in conflict over parenting
Expressing dislike of / blaming the child
Family issues / personal problems having knock-on effect on home life
Parents need strategies or programmes to help them to take new approaches “on board”
– motivate to change
Child is becoming out-of-control of the parent(s)
Child in control at home; they’re ”Boss”
Outrageous / risky behaviours – seeking out others to hit; vomiting; smearing; provoking;
6
Significant worries about levels of parenting / relationships / behaviour / well being
Initial Assessment Visit
What can Parents Plus offer?
What other services are involved?
What is the current situation at home / at school ?
Identifying baseline measures
What are appropriate targets? [ PoI]
When can we visit?
Intervention Process
First sessions
Playing with the child
Finding what works for us with the child & modelling for the parent
Getting to know the family situation
Data collection
Building rapport and a working relationship with the parent/s
Middle sessions
Engaging the parent / drawing them in to play
Identifying behavioural problems and suitable targets
Clarifying wanted & unwanted behaviours
Getting details e.g. observation in school; sleep diary
A-B-C records; assessment tools
Family relationships & contextual issues
Empathising and counselling skills
Clarifying barriers to change
Carrying out specific strategies with the child and family
Helping the parent/s to see what it could be like
Concluding sessions
Checking that the intervention is on target
Preparing to leave
Identifying other appropriate services or community provision
Questionnaire
Report ( with Compliments Slip )
Parents Plus -
Psychological basis
•Normative play development
•Motivational Interviewing
•Human Givens & Needs
•Ecological theory & Attachment Theory
•Risks & Resiliences - social learning theory
•Structural Family Systems
•Parenting Styles
•Parenting Positively: cognitive-behavioural approach
•Collaborative supervision & reflective practice
•Record-keeping & Evaluation
Motivational Interviewing
William R Miller and Stephen Rollnick
CHANGE
Encouraging
discrepancy
Structural-Strategic
Family Systems
David
Helen
Tom 2½ yrs
Mike
Jane 8 yrs
PARENTING STYLES
Child can be a child and
know what pleases their parents
CHAOTIC
Democratic
Assertive
HARSH
Too soft
Nurturing – (often mother)
Firm – (often father)
Too strict
No routines
Lack of stability
Child feels insecure
Child used deciding
Child in control
Child has to
work it all out
for himself.
Smacking
Shouting
Threats
“No” - all the time
Rigid rules
Child does
things out of
fear
Behaviour : What is “Normal?"
Mother's Description of their Children at ages 2, 3 and 4
BEHAVIOUR
Eats too little
Resists going to bed
Wakes during the night
Wets self during day
Wets at night
Fights or quarrels
Jealous
Hurts younger sibling
Hits others or takes things
Stubborn
Constantly seeks attention
Whinges and nags
Temper tantrums
Active, hardly ever still
Age 2
%
50
70
52
75
82
72
54
44
68
95
94
83
83
100
Age 3
%
26
46
52
14
49
75
47
51
52
92
48
65
72
48
Age 4
%
37
56
56
7
26
92
42
64
46
85
42
85
70
40
WHAT ARE THE IMPLICATIONS
OF DIFFERENT UNDERSTANDINGS
OF A CHILD’S INAPPROPRIATE BEHAVIOUR?
 This is what they are like ( attribution )
Naughty; bad; do it on purpose; blamed for being like this;
 There is something wrong with them – ( labelling )
Conduct Disordered; Attention Deficit Hyperactivity
Disorder
 Patterns of interactions established ( parent - child )
Stuck in a negative approach; only noticing misbehaviour;
same thing happens over-and-over; escalating problem
 Attention-seeking ( what does the child “get out” of it? )
Fuss; adrenaline; excitement; provoking reactions;
does not get attention/interaction other than by demanding
Parenting Positively
Cognitive-behavioural approach
Regular patterns
ANTECEDENTS
Triggers
C. Webster-Stratton – The Incredible Years
Lee Canter –Assertive Discipline
Applied Behavioural Analysis
BACKGROUND
Risk & resilience factors
CONSEQUENCES
Reactions
WHERE ARE YOU PUTTING YOUR
EFFORTS AND ATTENTION?
“Well behaved”
Playing
Engaged in
Watching
Joining in
Sharing
Chatting
Turn taking
Laughing
Cuddling
“Naughty”
Hitting
Screaming
Whinging
Breaking
Biting
Kicking
Arguing
Provoking
Demanding
Parental Questionnaire responses
at conclusion of interventions
Over 75% of responses indicated that the
Parents Plus intervention has:
 Helped the parent(s) to take more control of
their child’s behaviour
 Helped the parent(s) to understand their
child better
 Helped the child(ren)to respond better to
their parent’s management
PERCEIVED SIGNIFICANT CHANGES
FOLLOWING INTERVENTIONS
100%
70%
63%
56%
50%
30%
BETTER
PLAY
41%
HAPPIER
RELATIONSHIPS
41%
Significant perceived
change =>2
IMPROVED
BEHAVIOUR
Parent’s views [ Scale 1 – 5 ]
HLO’s views
[ Scale 1 – 5 ]
Before intervention
 All parents indicated they were having
serious difficulties managing their child’s
behaviour before the intervention.
 All of the mothers admitted to feeling in a low
state before the intervention
 They said that their child’s behaviour made
them angry, stressed and/or down
 Several mothers said they were suffering
from depression; and two felt they had no
bond with their child.
Up to 4 years after intervention
 The most significant changes occurred when the
parents (a) engaged in the intervention process
(b) acquired new skills & strategies
(c) gained an understanding of how they
can affect their child’s behaviour and their
emotional well-being
 Many of the parents were able to describe in detail
several of the behaviour techniques that they had
acquired and are still using, four years on.
 For a couple of parents, they felt that we did not
change their child’s behaviour
Parents said they were pleased to get ideas
for playing with & bringing on their child;
with positive behaviour management; &
with improving their family interactions &
relationships
“Absolutely fantastic! As
soon as you can manage
the behaviour, you can
do the bonding!”