Are the kids alright? Importance of Early YearsAll Wales Mental Health Promotion Network

Flying Start – engaging with and influencing parents and their early years children

Wed 25th January 2012

Sam CarsonSenior Educational Psychologist

Encouragements

Discouragements

“Early differences in experience” Hart & Risley ( 1995 )

500K

Phrases addressed to the child by36 months

Professional Working class Welfare

35 million

Words Addressed to child by36 months

Professional Working class Welfare

1

2

Traumatic Life Events

Poor quality relationships

Chaotic parenting/ no boundaries

Violent parenting/Rigid boundaries

Anxiety / anger / grief / mistrust /

loss of confidence / broken continuity

Insecure attachments / high levels of

criticism / neglect

Uncertain sense of self / poor socialisation / poor concentration

Fear / abuse / anger / resentment

Risk aversion / low self esteem /

vulnerable

Social isolation / preoccupation / powerlessness /

aggression

Poor self-control / seek thrills /

Underachievement /acting out / provocative

/ no autonomy

Emotional,Behavioural&SocialDifficulties

Mental health problems

Youth criminality

RISK FACTORS FOR CHILDREN

Cardiff Flying StartEnhanced Health VisitingPart time Childcare for 2 year oldsLanguage & Play sessionsParenting:- 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 factorsc) 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 upChild 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 / affectionChild biting; scramming; swearing; rude; screamingDoes 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 worseChild appears sad; withdrawn; passiveChild hurting others in temper; often angry / destructive / defiantChild not settling to play activities

5 Parents are stuck / “giving up”. Parents in conflict over parenting Expressing dislike of / blaming the childFamily issues / personal problems having knock-on effect on home lifeParents need strategies or programmes to help them to take new approaches “on board” – motivate to changeChild 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 VisitWhat can Parents Plus offer?What other services are involved?What is the current situation at home / at school ?Identifying baseline measuresWhat are appropriate targets? [ PoI]When can we visit?

First sessionsPlaying with the childFinding what works for us with the child & modelling for the parentGetting to know the family situationData collectionBuilding rapport and a working relationship with the parent/s

Concluding sessionsChecking that the intervention is on targetPreparing to leave Identifying other appropriate services or community provisionQuestionnaireReport ( with Compliments Slip )

Intervention Process

Middle sessionsEngaging the parent / drawing them in to playIdentifying behavioural problems and suitable targetsClarifying wanted & unwanted behavioursGetting details e.g. observation in school; sleep diary A-B-C records; assessment toolsFamily relationships & contextual issuesEmpathising and counselling skillsClarifying barriers to changeCarrying out specific strategies with the child and familyHelping the parent/s to see what it could be like

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 InterviewingWilliam R Miller and Stephen Rollnick

Encouraging discrepancy

CHANGE

MikeHelen

Jane 8 yrsTom 2½ yrs

David

Structural-Strategic Family Systems

DemocraticNurturing – (often mother)

AssertiveFirm – (often father)

CHAOTICToo soft

HARSHToo strict

No routinesLack of stabilityChild feels insecureChild used decidingChild in control

Child has to work it all out for himself.

SmackingShoutingThreats“No” - all the timeRigid rules

Child does things out of

fear

Child can be a child andknow what pleases their parents

PARENTING STYLES

Behaviour : What is “Normal?"

Mother's Description of their Children at ages 2, 3 and 4

BEHAVIOUR

Age 2 Age 3 Age 4 % % %

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

50 26 37 70 46 56 52 52 56 75 14 7 82 49 26 72 75 92 54 47 42 44 51 64 68 52 46 95 92 85 94 48 42 83 65 85 83 72 70

100 48 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 problemAttention-seeking ( what does the child “get out” of

it? ) Fuss; adrenaline; excitement; provoking reactions; does not get attention/interaction other than by demanding

ANTECEDENTS CONSEQUENCES

BACKGROUND

Triggers

Regular patterns

Reactions

Risk & resilience factors

Parenting PositivelyCognitive-behavioural approach

C. Webster-Stratton – The Incredible Years

Lee Canter –Assertive Discipline

Applied Behavioural Analysis

WHERE ARE YOU PUTTING YOUR EFFORTS AND ATTENTION?

“Well behaved”

PlayingEngaged inWatchingJoining inSharing ChattingTurn takingLaughingCuddling

“Naughty”

HittingScreamingWhingingBreakingBitingKickingArguingProvokingDemanding

Parental Questionnaire responses at conclusion of interventions

Over 75% of responses indicated that theParents 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

30%

56%

70%

63%

41%

Significant perceived change =>2

PERCEIVED SIGNIFICANT CHANGES FOLLOWING INTERVENTIONS

100%

50%

BETTER HAPPIER IMPROVED PLAY RELATIONSHIPS BEHAVIOUR

Parent’s views [ Scale 1 – 5 ]

HLO’s views [ Scale 1 – 5 ]

41%

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.

Before intervention

Up to 4 years after interventionThe 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!”