Transcript Slide 1

Presentation prepared for
the Australian Centre for
Child Protection
University of South Australia
March 17, 2011
Judith Carta, Ph.D.
Juniper Gardens Children’s Project
University of Kansas
Australia and the US have much in common
and a wealth of knowledge and wisdom to
share
It’s been a
topic of
recent
discussion
among our
heads of
state.
JGCP began in the mid-1960s when residents of NE Kansas City,
KS, a low-income community, joined with University of Kansas
Faculty to address concerns about child development.

The Children’s Campus of Kansas
City
 Multiple agencies worked
together on capital campaign
to build a center of evidencebased practice
 Model Infant-Toddler and
Preschool Classrooms
 One-stop shopping for services
for families
 Evaluation and referral to
other family services
 Focus on translation of
research to practice
+
Today’s Focus
Some of the things
we’ve learned about
the effects of poverty
on children and how to
PREVENT adverse
outcomes.
Example of common risks for children in poverty
 More likely to live in a single-parent family
 Family experiences food insecurity
 Exposed to more environmental risks, toxins
 In homes with parental substance abuse, maternal
depression, lower levels of parent education
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In low quality child care
Substandard housing
Unsafe neighborhoods
Parents much less likely to be employed
Less access to quality health care
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Model of Caregiving Risks within Home Environments
Affected by Substance Abuse
Conditions for Poor Children Are Less Supportive
Substance
Abuse History
Phy sical
Abuse History
Family experiences food insecurity
Inconsistent
Caregiv ing
Exposed to more environmental risks, toxins
Env ironmental
Arrangements
Stres s
Lack of E m ploym ent
In homes with parental substance abuse, maternal
depression, lower levels of parent education
U nav ailable
C aregiv er
M ultiple F os ter
Plac em ents
More likely to live in a single-parent family
A busive Interaction s
 In low quality child care
 Substandard housing
 Unsafe neighborhoods
 Parents much less likely to be employed
D epres s ion
C ultural Bias
Violent
Neighborhood
Pov erty
Lim ited S ocial F unctioning
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Single
Parenthood
Dif f iculty
Understanding Child
Limited Knowledge of
Child Dev elopment
Limited
Education
Inadequate
Nutrition
Inaccessible
Health Care
Ecological-Transactional Model of11
Caregiving Risks
Caregiv ing Risks
Caregiv er
Characteristics
Sociodemographic
Risks
Consequences for Children in Poverty Are Really Different
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Born at lower birth weight
Less successful in school1
More likely to show behavior problems
(disobedience, impulsiveness) and, when older,
commit crimes1
Higher risk of becoming a teen parent2
Experience more accidents and injuries2
Be poor as an adult2
Obesity2
Chronic health problems (asthma, anemia)2
Receive lower quality child care2
_____________
1Duncan,
Zio-Guest, & Kalil (2010) 2Moore et al. (2009).
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Nationally-representative sample of approximately 11,000
children born in 2001
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Data collected at 9 months, 24 months, 48 months, and in
Kindergarten
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Current analyses focus on 9 and 24 months
• Analyses of the 9-month sample were limited to children aged 8-11
months (N = 7,400)
• Analyses of the 24-month sample were limited to children aged 22-25
months (N = 7,200)
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Fig. 3. Risk factors influence developmental trajectories related to school
readiness and the gap grows over time
Environmental Risks
(poor nutrition, toxins)
Ready to learn
Caregiver Characteristics
Risks (e.g. depression)
Caregiving Risks
(e.g., ignoring)
Normative
developmental trajectory
related to school
readiness:
--Social-Emotional,
Physical, Cognitive,
Language Skills
Evidence-Based Interventions in
Language, Literacy, Social
Competence
High Quality Child Care
Talking and Reading
to Child
Responsive
Parenting
Birth
Late Infancy
6 mo
12 mo
Early Infancy
18 mo
Late Toddler
24 mo
Early Toddler
3 yrs
Late Preschool
5 yrs Age
Early Preschool
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In our study of the effects of prenatal drug exposure, preschool
children prenatally exposed to drugs and alcohol WHO HAD
GREATER NUMBERS OF RISKS had Developmental Quotients that
were further from the norm of 100.
Why is it that we see this
multiplier effect of risk?
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 From Lisbeth Schorr:
–An example of how the presence
of risk factors and absence of
protective factors can influence
a child’s outcomes over time
– From Within Our Reach: Breaking the Cycle of Disadvantage
22
Model of Caregiving Risks within Home Environments
Affected by Substance Abuse
Conditions for Poor Children Are Less Supportive
Substance
Abuse History
Phy sical
Abuse History
Family experiences food insecurity
Inconsistent
Caregiv ing
Exposed to more environmental risks, toxins
Env ironmental
Arrangements
Stres s
Lack of E m ploym ent
In homes with parental substance abuse, maternal
depression, lower levels of parent education
U nav ailable
C aregiv er
M ultiple F os ter
Plac em ents
More likely to live in a single-parent family
A busive Interaction s
 In low quality child care
 Substandard housing
 Unsafe neighborhoods
 Parents much less likely to be employed
D epres s ion
C ultural Bias
Violent
Neighborhood
Pov erty
Lim ited S ocial F unctioning




Single
Parenthood
Dif f iculty
Understanding Child
Limited Knowledge of
Child Dev elopment
Limited
Education
Inadequate
Nutrition
Inaccessible
Health Care
Ecological-Transactional Model of23
Caregiving Risks
Caregiv ing Risks
Caregiv er
Characteristics
Sociodemographic
Risks
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Consistent
Warm
Nurturing
Stable
Predictable
Contingent
Enhancing Parent-Child
Interaction is Critical
But where do you begin?
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Immaturity and
inexperience
Low educational
attainment
Depression or other
mental health problems
Family violence
Substance abuse
Economic stress
Illness
In a Context of Multiple Risks
• Where Risks Affect Parenting,
• Parenting Affects Child Behaviors
and
• Child Behaviors Affect Outcomes,
Where do you begin to
intervene?
The Prevention Riddle
•What’s the best way to
cut through the onion?
Model of Caregiving Risks within Home Environments
Affected by Substance Abuse
Conditions for Poor Children Are Less Supportive
Substance
Abuse History
Phy sical
Abuse History
Family experiences food insecurity
Inconsistent
Caregiv ing
Exposed to more environmental risks, toxins
Env ironmental
Arrangements
Stres s
Lack of E m ploym ent
In homes with parental substance abuse, maternal
depression, lower levels of parent education
U nav ailable
C aregiv er
M ultiple F os ter
Plac em ents
More likely to live in a single-parent family
A busive Interaction s
 In low quality child care
 Substandard housing
 Unsafe neighborhoods
 Parents much less likely to be employed
D epres s ion
C ultural Bias
Violent
Neighborhood
Pov erty
Lim ited S ocial F unctioning




Single
Parenthood
Dif f iculty
Understanding Child
Limited Knowledge of
Child Dev elopment
Limited
Education
Inadequate
Nutrition
Inaccessible
Health Care
Ecological-Transactional Model of31
Caregiving Risks
Caregiv ing Risks
Caregiv er
Characteristics
Sociodemographic
Risks
Do you begin with the outer layers
and work inward…(distal risks)?
Or address the center first (parent and
child behaviors)?
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Parents who are dealing with survival and
safety will have difficulty responding to
parent training.
Programs must be able to respond to
families’ needs in a comprehensive,
intensive and flexible way.
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Relying simply on
enhancing family support
will probably not improve
child outcomes.
Children can’t wait for
distal risks to be
ameliorated.
Programs that focus on
enhancing specific
parent-child interactions
have greatest impact on
child outcomes.
Shonkoff & Phillips, From Neurons to Networks, 2000
How Intervention Programs Can Alter the
Developmental Trajectories of Infants and
Toddlers in Low-Income Families:
The Example of Early Head Start
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Early Head Start Is an Intensive and
Comprehensive
Two-Generation Program
Self-Sufficiency and
Healthy Families
Parenting
Child Development
Impacts on Parenting and Home Environment, by
Child’s Age
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Positive parenting, stimulation of learning and
language, positive home environment
 Enhanced at all 3 ages
 Negative parenting
 Reduction in spanking of 2- and 3-year-olds
 Mothers less detached when children were 2 and 3
 Improved parent mental health all 3 ages
 Less parenting distress, conflict at age 2
 Reduced maternal depression when kids were age 5
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Parental self-sufficiency
 Increased school and training when children were 2 and 3
 No impacts on income
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Impacts on Children’s Development, by Age
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Social-emotional development
 Reduced aggression at 2, 3, and 5
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Positive approaches to learning
 Enhanced at ages 3 and 5
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Cognitive and “academic” skills
 Positive at ages 2 and 3
 No impacts at age 5
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Language development
 Vocabulary, English speakers at 2 and 3
 Vocabulary, Spanish speakers at age 5
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Some positive health effects at each age
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EHS Impacts by Risk Levels
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No impacts for families in highest risk group when
children were 2 and 3 years old
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Effects more likely among moderate-risk families
when children were 2 and 3 years old.
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Possible reasons for lower impacts for
higher risk families
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In general, higher risk families received less
intervention
 More likely to drop out before their children reached
age 3
 More likely to miss home visiting appointments
 Less likely to be fully engaged and involved during
home visits
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Keep families engaged in a
parenting intervention
 Keep them from dropping
out
 Give parents ideas on how
to use the parenting
intervention throughout
their daily activities
 Strengthen relationship with
home visiting/parenting
coach
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Improve our ability to keep families
from dropping out of the intervention.
Keep families more actively engaged
in the intervention.
Help families learn to apply parenting
skills throughout their daily activities
with high fidelity, thus increasing the
“dosage” of the intervention.
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Randomized clinical trial testing the
effectiveness of Cell Phone Enhanced
Parenting
3 groups:
 Planned Activities Training (PAT) (like PPP)
 Cell Phone Enhanced Planned Activities
Training (CPAT)
 Wait-List Control Group
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A research-based intervention that teaches
parents to plan and structure activities to
prevent challenging child behaviors.
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Family coaches deliver training in homes in 5-7
sessions.
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Coaches teach parents positive interaction
skills and help parents teach child
expectations, routines, simple rules.
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Parents learn to engage the child in planning
and preparing in advance for daily routines
and play.
Parents in CPAT group:
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Given a cell phone and an allotment of
minutes provided by AT&T
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Receive twice daily text messages and
weekly phone calls from their coach
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CPAT mothers can use the phone to call/
text their coach and can also use it for
other reasons but cannot go over their
allotted minutes.
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A text message question is sent daily asking about
use of one aspect of PAT, their interactions with
their child, or their child’s behavior
 “On a scale of 1-10 (10 is best), how did a
mealtime go today?”
 “Did you have fun with your child today?”
 “What is one cute thing your child did today?”
 “How did you catch your child being good
today?”
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Messages designed so responses can be brief
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One text message each day to
remind parent to use a specific PAT
strategy.
Cell phones are used to confirm
home visits.
Text give parents up-to-date
information about free fun
community activities.
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Family Coaches send text messages
and receive parents’ responses in
different ways
 On the Family Coaches’ project cell
phone
 Using Notepager Pro software – can be
scheduled in advance and sent to a
group
 Using an email program
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Options save time and allow family
coach to schedule messages in
advance
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Reduced attrition and improved
engagement of high-risk families may
be worth cost of cell phones/minutes.
Cell phones increase ability to stay
connected with highly mobile families.
Being able to stay in touch throughout
the week can help us to strengthen
relationships with hard-to-reach
families.
1. High quality comprehensive support
services based on evidence-based
practice.
2. Focus on providing parents with
skills they need for supporting their
children’s development.
3. Intensity that matches what families
actually need.
4. Coordination and collaboration
among agencies that provide these
needed services to families.
[email protected]
Treatment:
Few
Provide intensive interventions for a few
children and families.
Early Intervention:
Some
Intervene early for some children and
families.
Universal Prevention:
All
Focus on evidence-based instruction and
supportive learning environment
Adapted from Osher, Dwyer, Jackson (2004)
Recommended practices for improving social-emotional
learning (Meta-analysis of 57 programs by Durlack, in press)
• Sequenced: Does the program apply a planned set of
activities to develop skills sequentially in a step-by-step
fashion?
• Active: Does the program use active forms of learning such
as role-plays and behavioral rehearsal with feedback?
• Focused: Does the program devote sufficient time
exclusively to developing social and emotional skills?
• Explicit: Does the program target specifi c social and
emotional skills?
Durlack, Journal of Community Psychology, in press)