Webcast Training
September 29, 2005
Presented by
California Institute for Mental Health

 Defining evidence-based practices
 Early childhood social-emotional development
 Early childhood specific practices
 Disorders in early childhood (DC:0-3)
Early Childhood Evidence Based Practices 2

 Established sleeping and eating patterns
 Demonstrates arousal and focused attention
 Sustained attention, concentration and persistence
 Inhibition of outburst to developmentally appropriate expectations
 Expression of autonomy in a socially acceptable manner
Early Childhood Evidence Based Practices 3

 Enduring and supportive relationship with primary caregivers
 Initiates play, discovery & learning
 Persists when discouraged or distracted
 Recovers from disruption, transition or disappointment
 Emotional responses match social-cultural context
Early Childhood Evidence Based Practices 4

 Physically healthy
 Temperamentally easy
 Developmentally competent
 Caregivers have social support and strong parenting skills
 Caregivers provide emotional support, guidance and loving supervision
 Safe, stable and calm home/community environment
Early Childhood Evidence Based Practices 5

 Child is not “emotionally” available
 Inborn capacity to initiate and respond to relationships, sustain attention, inhibit outbursts, and so forth
 Parent is not “emotionally” available
 Learned capacity to read and respond to infant/toddler’s cues, parenting model, and life circumstances
Early Childhood Evidence Based Practices 6

 Problematic behaviors are intensive, extensive, or pervasive; and/or
 Primary caregivers are overwhelmed
Early Childhood Evidence Based Practices 7

 Neurobehavioral functioning is compromised including sensory threshold, intensity of reaction, and self-regulation
 Low birth weight
 Development delays
 Physical disabilities
 Inadequate nutrition
 Drug or lead poisoning
 Maltreatment
 Exposure to violence
Early Childhood Evidence Based Practices 8

 Care-giving is compromised by inadequate parenting models, lack of social support, health/mental health or substance use disorders, or interpersonal/external stress
 Mental illness
 Substance abuse
 Limited parenting skills
 Teen parenthood
 Limited social support
 Poverty
 Domestic violence
Early Childhood Evidence Based Practices 9

Social, Economic, and Interpersonal
Factors
Early Childhood
Neurobiological
Factors
Limited Caregiver Emotional
Availability
Limited Child Emotional
Availability
Neurobiological
Factors
Evidence Based Practices 10

 “…the integration of the best research evidence with clinical expertise and patient values”
 Based on the definition used in “Crossing the
Quality Chasm: A New Health System for the
21st Century” (2001), by the Institute of
Medicine
Early Childhood Evidence Based Practices 11

 Effective --achieves outcomes, controlled research (random assignment), with independent replication in usual care settings.
 Efficacious --achieves outcomes, controlled research (random assignment), independent replication in controlled settings .
 Not effective --significant evidence of a null, negative, or harmful effect.
 Promising --some positive research evidence, quasi-experimental, of success and/or expert consensus.
 Emerging practice --recognizable as a distinct practice with “face” validity or common sense test
.
Early Childhood Evidence Based Practices 12

 Higher levels mean more confidence that if implemented in your community (with high model adherence) similar good outcomes will be achieved
 Consider lower levels of science when there is no alternative at a higher level, or interested in a practice-to-science initiative
Early Childhood Evidence Based Practices 13

 Play therapy (therapist--child)
 Behavioral skills (practitioner--child)
 Parent training (practitioner--parent)
 Dyadic interaction (guided parent--child)
 Teacher trained ( teacher--child )
 Childcare consultation (practitioner--teacher)
 Home visitation (practitioner--parent--child)
 Wraparound (interagency child and family team)
Early Childhood Evidence Based Practices 14

 Effective
 Children 2-12
 Decreases child behavior problems
 Increases parenting competencies
 Decreases maternal stress
 Strengthens parent-teacher and parent-caregiver relationships
 Carolyn Webster-Stratton, University of Washington
 www.incredibleyears.org
Early Childhood Evidence Based Practices 15

 Facilitated group intervention, practitioners with diverse educational backgrounds
 Three sets of comprehensive developmentally based curriculums for parents, teachers and children to promote emotional and social competence
 Basic parenting (early and school age)
 Advanced parenting
 Supporting your child’s education
 Child social skills
 Classroom based
 Teacher training
 Weekly groups (12-14 sessions), 2 hours in length
 Uses work books, and video-vignettes to illustrate skills
Early Childhood Evidence Based Practices 16

 Effective
 Children 0-16
 Improves parenting skills
 Decrease in parental stress and depression
 Improves coping skills
 Decrease in child behavior problems
 Improves partner support
 Improves parent anger management skills
 Decreases social isolation
 Matt Sanders, University of Queensland
 www1.triplep.net
Early Childhood Evidence Based Practices 17

 Practitioners with diverse educational backgrounds
 Parenting program
 Titrated levels of intervention
 Detailed support material for parents
 Five levels of intervention from primary prevention to treatment
 Universal Triple P (primary prevention)
 Selected Triple P
 Primary Care Triple P
 Standard Triple P (individual or group)
 Enhanced Triple P
Early Childhood Evidence Based Practices 18

 Effective
 Children ages 2-8 years
 Parent-child guided intervention
 Decrease child behavior problems
 Increases parenting competencies
 Sheila Eyberg and colleagues, University of Florida
 www.pcit.org
 http://www.ucdmc.ucdavis.edu/caare/mental/pcit_traince nter.html
Early Childhood Evidence Based Practices 19

 Therapists
 Clinic with twoway mirror, and “bug in the ear” technology
 Individual sessions (about 12)
 Home models being developed
 Parent-child guided intervention
 Relationship
 Discipline
Early Childhood Evidence Based Practices 20

 Effective
 Low-income, high risk first time parents
(pregnancy-age 2)
 Intensive home visitation to promote health and welfare of parents and children
 Improved pregnancy outcomes
 Improved child health and well being
 Increases economic self-sufficiency
 David Olds and his colleagues, University of
Colorado
 www.nursefamilypartnership.org
Early Childhood Evidence Based Practices 21

 Registered nurse
 Intensive home visitation
 Mother’s personal health
 Quality of care
 Life course outcomes
 Visitations begin no later than 28 weeks of gestation until age 2
 Visits involve mother’s support system
Early Childhood Evidence Based Practices 22

 Promising--efficacious
 Preschool age foster children
 Increases foster parent competencies
 Strong support for foster parents
 Decrease in child behavior problems
 Develops age appropriate child competencies
 Improves parenting competencies
 Decreases parental stress and depression
 Increase in social support
 Promotes reunification
 Phil Fisher and colleagues from Oregon Social
Learning Center
 Pfisher@oslc.org
Early Childhood Evidence Based Practices 23

 Interdisciplinary team
 Intensive foster parent training
 Foster parent support groups
 Daily support calls
 24 support to foster parent and biological family
 Child focused therapy
 Behavioral specialist for child in preschool, childcare or home settings
 Parent training
Early Childhood Evidence Based Practices 24

 Provisional system
 Multiaxial
 Axis I: Primary classification
 Axis II: Relationship classification
 Axis III: Physical, neurological, developmental or mental health disorders
 Axis IV: Psychosocial stress
 Axis V: Functional emotional developmental level
 Designed to supplement
 Problems not addressed
 Earlier manifestations
Early Childhood Evidence Based Practices 25

 Traumatic stress
 Disorders of affect
 Adjustment disorder
 Regulatory disorders
 Sleeping behavior disorder
 Eating behavior disorder
 Disorders of relating and communicating
Early Childhood Evidence Based Practices 26

 Existence of a traumatic event
 Re-experiencing of the traumatic event
 Numbing of responsiveness in a child or interference with developmental momentum
 Symptoms of increased arousal
 Fears or aggression
Early Childhood Evidence Based Practices 27

 General feature of the child’s functioning
 No severe developmental delays or significant constitutional variations
 Not specific to only a single relationship or context
Early Childhood Evidence Based Practices 28

 Anxiety
 Prolonged bereavement/grief reaction
 Depression
 Mixed disorder of emotional expressiveness
 Gender identity disorder
 Reactive attachment deprivation/maltreatment disorder
Early Childhood Evidence Based Practices 29

 Mild, transient situational disturbances
 Not explained by other conditions
 Onset tied to a clear event or change
 Lasting days, up to 4 months
Early Childhood Evidence Based Practices 30

 Sensory, sensory-motor, or processing difficulty and one or more behavioral symptoms
 Hypersensitive
 Fearful and cautious
 Negative and defiant
 Under-reactive
 Withdrawn and difficult to engage
 Self-absorbed
 Motorically disorganized, impulsive
Early Childhood Evidence Based Practices 31

 Sleep disturbance is the only presenting problem for a child <3 years
 Initiating or maintaining or excessive sleep
 Not attributable to affect or relationship disturbances, trauma or adjustment problems
Early Childhood Evidence Based Practices 32

 Difficulties in establishing regular feeding patterns with adequate food intake; does not regulate eating in accordance with physiologic feelings of hunger
 Not attributable to sensory reactivity or processing or motor difficulties
 Not explained by relationships, trauma, or adjustments
Early Childhood Evidence Based Practices 33

 Significant impairment in, but not complete lack of, the ability to engage in an emotional and social relationship with a primary caregiver
 Significant impairment in forming, maintaining and developing communication
 Significant dysfunction in auditory processing
 Significant dysfunction in the processing of other sensations
Early Childhood Evidence Based Practices 34

 Traumatic stress disorder considered first
 Regulatory disorders if clear constitutionally or maturational-based sensory, motor, processing difficulty
 Adjustment disorder considered if mild and of relatively short duration
 Disorders of affect considered when there is no constitutionally or maturational-based difficulty or trauma/stress, and the difficulty is not mild or of short duration
Early Childhood Evidence Based Practices 35

 Multisystem developmental disorder and reactive attachment, deprivation/maltreatment take precedence over all other categories
 Relationship disorders considered when difficulty occurs only in relationship to a particular person
36 Early Childhood Evidence Based Practices

 Overinvolved
 Underinvolved
 Anxious/Tense
 Angry/Hostile
 Mixed
 Abusive
Early Childhood Evidence Based Practices 37

 Mutual attention
 Mutual engagement
 Interactive intentionality and reciprocity
 Representational/affective communication
 Representational elaboration
 Representational differentiation I & II
Early Childhood Evidence Based Practices 38