1. Evidence-Based Parenting Programs supported by Children’s Administration in Region 2 North July 28, 2011 Michael Tyers, MA and; Jennifer Paddock, MA,MAC Region 2 North, Children’s Administration (425) 339- 1830

2. What constitutes an Evidence- Based Program?  In Washington State we follow the California Evidence-Based Clearinghouse for Child Welfare (CEBC) CEBC rating scale is to evaluate each practice based on the:  Best research evidence  Best clinical experience  Consistency with patient (family/client) values.

3. Programs covered in this presentation:  NCAST Assessments  Promoting First Relationships  Project SafeCare  Incredible Years  Triple P- Positive Parenting Program  Homebuilders-Intensive Family Preservation Services  Wrap-Around High-Fidelity  Parent Child Interaction Training (PCIT)  Functional Family Therapy

4. Nursing Child Assessment Satellite Training (NCAST) The most widely used scales for measuring parent-child interaction today, birth to age 3. Valid and reliable measure for assessing parent-child interaction Describes observable behavior brought to the interaction by caregiver and child Easily identifies strengths as well as areas needing improvement

5. PCI Subscales  Assesses Child and Parent in the 1. Feeding Element for up to age 1 2. Teaching Element for up to 3 years of age  Four subscales describe the parent's responsibilities to the interaction.  Two subscales describe the child's responsibilities.

6. Parent Subscales  Sensitivity to Cues  Response to Distress  Social-Emotional Growth Fostering  Cognitive Growth Fostering Child Subscales  Clarity of Cues  Responsiveness to Caregiver

7. Typical cases referred for NCAST  To evaluate the adequacy of the caregiver-child interaction, of the caregiver style, ability or the environment  Failure to thrive?  Determine the need for an intervention plan for the caregiver-child pair  Drug positive baby at birth  Assess responsivity between caregiver and child

8. Promoting First Relationships (PFR)  Promoting First Relationships is a prevention program dedicated to promoting children's social- emotional development through responsive, nurturing caregiver- child relationships.  Appropriate for ages birth to 3.

9. Features of the PFR training program include:  Videotaping caregiver-child interactions to provide insight into real-life situations.  Giving positive feedback that builds caregivers' competence with and commitment to their children.  Focusing on the deeper emotional needs underlying children's challenging behaviors.

10. What happens during the 10 sessions?  Caregivers learn about 10 basic social and emotional needs infants/toddlers have.  Caregivers learn behaviors that help create healthy attachments  Staying connected with infants and toddlers during difficult times is also discussed  Where challenging behaviors come from in infants and toddlers  How to reach out and get support  Building reflective capacity through video taping parent-child interactions

11. Project SafeCare  Project SafeCare is a parent-training curriculum for parents who are at-risk or have been reported for child maltreatment.  The program is appropriate for children birth to 5.  Through SafeCare, trained professionals work with at-risk families in their home environments to improve parents’ skills in several domains.

12. The Project SafeCare Modules 1. Parent-child or parent-infant interaction 2. Child Health 3. Home Safety and cleanliness 4. Problem Solving worksheet

13. Common Elements of each PSC module:  Describe desired target behaviors  Explain the rationale or reason for each behavior  Model each behavior (demonstrate desired behavior)  Ask parent to practice behavior  Provide positive feedback (point out positive aspects of performance)  Provide constructive feedback (point out aspects of performance needing improvement)  Review parent's performance, have them practice areas that need improvement, and set goals for the week.

14. Incredible Years  Appropriate for ages birth – seven  Families have a need to learn appropriate parenting skills & discipline or improve bonding Short Term Objectives  To prevent and reduce aggression and behavior problems in young children.  To promote social, emotional and academic competence in young children. Long Term Objectives  To prevent delinquency, substance abuse and violence in adolescence.

15. The BASIC IY program  Incredible Years Basic Preschool Program  18 group sessions (for high risk populations)  Increase developmentally appropriate & nurturing parenting practices  Persistence, academic, social and emotional coaching & child directed play  Praising and Motivating Children

16. The BASIC IY program continued…  Predictable routines & schedules  Using non-punitive and more consistent discipline approaches for misbehavior  Learning how to help children self-regulate, use appropriate social skills, problem solve & develop imaginary play  Promoting parent-teacher collaboration

17. Incredible Years Parenting Program Group Methods & Process  Developmentally based  Culturally sensitive  Emphasizes the therapeutic relationship: “collaborative process”  Coping (vs. Mastery model)  Video modeling/DVDs  Role play practice & rehearsal  Home assignments  Group support  Sensitive to socioeconomic barriers

18. Research tells us:  Parent training remains the single most effective strategy for preventing behavior problems and promoting social and emotional competence in young children!

19. Triple P- Positive Parenting Program  Appropriate for birth to 12.  The program is based on self-regulation.  The goals are for children to develop emotional self-regulation and for parents to become resourceful, independent problem-solvers.  As families determine their own particular goals, the program is tailored to suit their aspirations.  Practitioners consult and guide through active skills training.  Parents decide what they wish to take on.

20. Triple P levels for Child Welfare involved Families.  Standard Triple P  This 10-session program incorporates sessions on causes of children’s behavior problems, strategies for encouraging children’s development and strategies for managing misbehavior.  Skills training includes:  modeling  rehearsal  self-evaluation  homework tasks  Home or clinic practice sessions are also conducted in which parents self-select goals to practice.  They are then are observed interacting with their child and implementing parenting skills, and subsequently encouraged to self- evaluate their progress toward meeting their goals.

21. Homebuilders-Intensive Family Preservation Services  Appropriate for birth to 18  One of the oldest and best documented programs in the U.S.  Intensive in-home crisis intervention, counseling and life skills education.

22. Homebuilders Elements  One or more children is in imminent danger of being placed out of home or is returning home from placement.  Client seen within 24 hours of referral  Treatment is in home and therapists are responsive 24/7.  Targeted 4 week concentrated service.  Therapist are flexible and carry only 2-3 cases at a time.  Service is in-home and averages 40-50 hours of direct service.

23. Homebuilders continued…  Therapist has flexibility to address crisis in variety of ways: 1. Food, clothing, gas 2. Shelter 3. Transportation 4. Parent skill training 5. Counseling (Financial, Anger, Development, Communication etc.)

24. Parent Child Interaction Training (PCIT)  PCIT is appropriate for ages 2-7.  PCIT is a parent training program that:  helps parents improve parenting skills  helps establish a warm and responsive relationship with their child  helps to decrease child behavior problems

25. PCIT continued:  The service includes:  20 weeks of individualized, one-hour parent-child sessions  Trained therapists coach the parents: use of a one way mirror in which therapist uses a microphone device from another room in clinic completed in family’s home  Child management techniques include: praising appropriate behavior ignore undesirable behavior give clear age-appropriate instructions appropriate discipline methods

26. High Fidelity Wraparound Program  Currently a Promising Practice moving towards becoming Evidence-Based.  Appropriate for ages 3 to 17.  Provides a community-based team that focuses on the “voice and choice” of the family.

27. Wraparound Program continued…  Family focused approach that assesses family and individual strengths, natural supports and cultural importance's.

28. Wraparound Principles  Family and Youth Voice  Unconditional/Persistent  Strength Based  Culturally/Linguistically Competent  Community Based  Individualized  Natural Supports  Collaboration  Team based  Outcome based

29. Phases of Wraparound Program 1. Phase One; Engagement and Team Preparation 2. Initial Plan Development 3. Plan Implementation 4. Transition Services and support are offered through multiple community agencies

30. Functional Family Therapy (FFT)  Appropriate for ages 11-18.  FFT is a family therapy that is provided usually in a family home.  FFT focuses reducing conflict in the family, improving communication, increasing use of age appropriate parenting skills, and improving parent supervision of children.  The program lasts an average of 4 months.  The entire family participates in FFT.

31. FFT Service Steps  Step 1- Case Processing Gather client information, establish appointment times with the family  Step 2- Engagement and Motivation Initial face to face meeting, increase family’s interest and motivation for change Conduct assessments  Step 3- Behavioral Change, Generalization and Closure Individualized change plans that reduce risks and increase protective factors, relapse plan developed and family/community connections established to sustain treatment gains.

32. Evidence-Based Parenting Programs supported by Children’s Administration in WA State Thank you for attending