Are the kids alright? Importance of Early Years All Wales Mental Health Promotion Network Flying...
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Transcript of Are the kids alright? Importance of Early Years All Wales Mental Health Promotion Network Flying...
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
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