Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

The following article was not written by myself.  It is excellent and I have included a part of it here; however to read the entire article you will need to click on the link at the end.

"The reproduction of this document is encouraged. Permission to copy is not required.


Th is publication was produced by the Technical Assistance Center on Social Emotional Intervention for Young

Children funded by the Offi ce of Special Education Programs, U. S. Department of Education (H326B070002).

Th e views expressed in this document do not necessarily represent the positions or policies of the Department of

Education. No offi cial endorsement by the U.S. Department of Education of any product, commodity, service or

enterprise mentioned in this publication is intended or should be inferred.

Suggested Citation:

Powell, D. and Dunlap, G. (2010). Family-Focused Interventions for Promoting Social-Emotional Development in

Infants and Toddlers with or at Risk for Disabilities. Roadmap to Eff ective Intervention Practices #5. Tampa, Florida:

University of South Florida, Technical Assistance Center on Social Emotional Intervention for Young Children.

http://www.challengingbehavior.org/

Roadmap to Effective Intervention Practices


Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities

Diane Powell and Glen Dunlap, September 2010

INTRODUCTION

This document is one in a series of syntheses intended to provide summaries of existing evidence related to assessment and intervention for social-emotional challenges of young children and for promoting the social-emotional competence of all young children. The purpose of the syntheses is to offer consumers (professionals, other practitioners, administrators, families, etc.) practical information in a useful, concise format and to provide references to more complete descriptions of validated assessment and intervention practices. The syntheses are produced and disseminated by the OSEP Technical Assistance

Center on Social-Emotional Interventions (TACSEI).

This synthesis considers family-focused services and practices

for promoting social-emotional development of children served in Part C. Its specific focus is on interventions that influence parenting practices for infants and toddlers with or at risk for disabilities.

The general effectiveness of early intervention services in promoting the well-being and development of children and their families has been well established through what Guralnick (1997) has termed “first-generation” research. This includes many strategies including procedures that seek to enhance child development through parent mediated interventions.
The field has now moved on to more specific “second-generation”


research questions: what works for which families and children, under what conditions? Answers to these questions can provide practitioners with specific guidance in the selection,

design and implementation of interventions and practices that produce optimal outcomes for infants and toddlers and their families. A substantial knowledge base exists regarding: 1) the role of positive interactional and parenting practices in shaping social emotional development of infants and toddlers, and 2) specific family-focused strategies and interventions that are effective in addressing social emotional competencies and challenging behavior in young children. The results of this research form the basis for this synthesis.

The development of behavioral/emotional self-regulation and the ability to establish secure attachments and positive relationships

with others during infancy and toddlerhood form the foundation for later social emotional competence and well-being (National Scientific Council on the Developing Child, 2004a). It is through interactions with others, and especially with primary caregivers, that these foundational capacities and competencies emerge. This is true for all children, both typically developing and those with or at risk of disabilities (National Scientific Council on the Developing Child, 2004b, 2008; National Research Council and Institute of Medicine, 2000). Many young children at risk for disabilities or with
identified disabilities develop social emotional competencies on an age-appropriate timeline. For others, deficits in physical, cognitive or communicative abilities may interfere with social emotional development, making early intervention to support effective caregiving practices even more critical.


The important role of family-mediated

strategies in early intervention

is well accepted as evidenced by the inclusion of parenting competencies in early intervention

theories of practice (Odom & Wolery, 2003), the recommended practices of the Division of Early Childhood of the Council for Exceptional Children (Trivette & Dunst, 2005) and in recommendations

for family outcomes in early intervenion (Bailey et al., 2006). In fact, some have argued that ensuring parent involvement and responsiveness is a necessary

component of early intervention without which child directed intervention services are unlikely to be effective (Mahoney, 2009).

The need for early intervention systems to develop the capacity to provide effective parenting interventions to families they serve has taken on heightened importance with the advent of the CAPTA and IDEA mandates for referral to Part C of children involved with the child welfare system. The developmental

and early intervention needs of infants and toddlers served by the child welfare system are well documented (Barth, et al., 2008; Rosenberg & Smith, 2008; Wiggins, Fenichel & Mann, 2007). It is estimated that these new mandates will result in large increases in referrals and enrollment of infants and toddlers with substantiated maltreatment in early intervention

systems (Derrington & Lippitt, 2008).

The teaching of nurturing, responsive interactions and effective parenting practices is central to many interventions that have demonstrated effectiveness in preventing and intervening with parents who are at-risk for child maltreatment (Baggett, Carta, et al., 2010; Chaffin & Friedrich, 2004; Geeraert, Van den Noortgate, Grietens & Onghena, 2004; Hammond, 2008). However, providing such interventions to families involved in child welfare presents new and complex challenges for early intervention systems. These challenges include engaging and serving families with severe and multiple risks; the voluntary

nature of early intervention services in contrast to the mandates and court orders that typically govern family involvement

with child welfare systems; continuity of programming for children who may experience frequent changes of placements

and caregivers; and coordinating with multiple service providers from different systems (Derrington & Lippitt, 2008; Dicker & Gordon, 2006; Rosenberg, Smith & Levinson, 2007; Stahmer, Thorp Sutton, Fox & Leslie, 2008).
While this synthesis does not focus specifically on interventions for maltreatment, it does note when an intervention has been evaluated with children experiencing trauma or maltreatment or with parents for whom child maltreatment is a concern.


PURPOSE, SCOPE AND ORGANIZATION OF THE SYNTHESIS

The purpose of this synthesis is to present summary information

on family-centered practices, and on interventions aimed at promoting positive parenting practices, teaching parenting skills, and influencing parent child interactions that have demonstrated associations with positive social emotional development

for children aged 0-3 years. The synthesis is intended to provide guidance to early intervention personnel, both those providing services to families and children within the Part C system and those working within other service frameworks.

The synthesis does not include interventions aimed primarily at communication and language outcomes for children unless the practices have also been demonstrated to enhance social emotional outcomes. It also does not include large scale, multi-component service delivery models such as Early Head Start, Healthy Families, SafeCare and Nurse-Family Partnership although it should be noted that there is a substantial literature

documenting the efficacy and effectiveness of such models in supporting multi-risk families (Chaffin & Friedrich, 2004; Geeraert et al., 2004; Love et al., 2005). Rather, the focus of this synthesis is on the parenting knowledge, skill sets and practices that have proven effectiveness and can serve as the content of parenting education delivered through these service models.

The synthesis first reviews the evidence for family-centered approaches and practices. Next it examines the literature concerning parent-child interactions and parenting behavior including knowledge gleaned from existing meta-analyses and reviews of the pertinent empirical literature. This includes both content (parenting/caregiving behaviors that impact infant/toddler social emotional outcomes) and methods (practices effective in supporting and changing caregiver behavior). This is followed by a consideration of some of the relevant intervention materials, packages, curricula and models for families of infants and toddlers that are available. Finally, factors to consider in selecting family-focused interventions are discussed.

REVIEW OF THE EVIDENCE

Family-Centered Approach and Practices

Family-centeredness refers to a philosophy of service delivery—an approach to the delivery of services based on values and beliefs regarding how professionals interact with and relate to the families they serve. While there are variations


in how family-centeredness is defined and characterized,

it typically includes: 1) treating families with dignity and respect; 2) practices that are individualized, flexible, and responsive to the expressed needs of families; 3) information sharing that enables families to make informed choices; 4) family choice regarding program practices and intervention options; 5) parent-professional collaboration and partnerships;

and 6) active involvement of family members in the mobilization of services and supports (Dempsey and Keen, 2008; Dunst, Trivette & Hamby, 2008). Similar conceptualizations

emphasizing the primary role of families and family strengths and assets-based practices can be found in DEC’s recommendations for family-based practices (Trivette & Dunst, 2005).

A family-centered approach has been well accepted in the field of early intervention from a philosophical and values-based perspective. Recent reviews and meta-analyses have provided documentation that when service delivery incorporates family-centered practices, outcomes for family and children are improved including parenting capabilities and positive child behavior and functioning (Dempsey & Keen, 2008; Dunst, Trivette and Hamby, 2006, 2007, 2008). Dunst, Trivette and Hamby (2006, 2007, 2008) classified family-centered practices as relational (clinical skills such as active listening, compassion, empathy, respect and beliefs regarding family member strengths and capabilities) or participatory (individualized,

flexible, responsive to family priorities, providing informed choices and family involvement in achieving goals and outcomes) and found in their meta-analyses that participatory

practices were most strongly linked with child outcomes including behavioral outcomes.

We now turn to a consideration of the role of parent responsiveness

and parenting behaviors in the social emotional development of infants and toddlers. Parents or other primary care providers are the key mediators of experience for infants and toddlers, and thus their influence is critical during this period of rapid development

of foundational skills and competencies."

To read or make a copy of the entire article, go to: http://www.challengingbehavior.org/do/resources/documents/roadmap_5.pdf

Autism: The right intervention for the right child

Fortunately we now know enough about Autism to know which children are most likely to benefit from intensive interventions and which types of interventions provide the most benefit for the child, considering: age of child, specific Autism Spectrum diagnosis, functioning level of the child, and willingness of the parent(s) to be active participants in treatment.

In many cases intervention can be provided for even less than $10,000.00 per year. Sometimes significantly less. If the right intervention is provided for three years to the child best suited to benefit from that intervention by a well qualified therapist properly implementing the intervention with active and continuing participation by the parent, government will literally save hundreds of thousands and in some cases even millions of dollars over the life of the child; plus it’s the right thing to do for the child and family. It’s the right thing to do fiscally, therapeutically, and humanely.
If it is the wrong intervention provided by poorly qualified interventionists without active parental(guardian) participation and without well written contextually mediated objectives, it is a disservice to the child, family, and taxpayer.
Depending on the type of intervention, the time spent by the parent can be either time set aside to specifically work on the intervention, a part of the parent and child’s typical routines, or a combination of both.
The right intervention for the right child, correctly implemented, will provide significant improvement in both functioning level and behavior.
More specific detailed information, references, and resources can be found at: http://www.bestoutcomes.blogspot.com/ and some additional linked websites.

Mental Health and Developmental Objectives Treatment Goals and Objectives PowerPoint

For those of you looking for a PowerPoint, I do have one; however, I would need to send it to you. If you wish to leave your name and e-mail address with the request in the comments section I can send you a power point; however, if you start at the beginning of the blog and work forward, that is, for the most part, the same information as is in the PowerPoint. You can bring it on line, start with the first posting and then just continue to click newer post. That will take you through the basics of the PowerPoint. Of course, additional explanation, examples, and activities, with the slides is always helpful.

Specific example of mental health or developmental disability goals and objectives

People often find this site by doing a search using the above words or something similar.

The best way to have a thorough understanding of this process is to start at the very earliest posting in this blog and move forward. The first set of postings review the basics of a training I have presented a number of times on how to write measurable behavioral objectives, goals, and plans. That is the best way to understand this very technical professional process, along with practice and ongoing feedback. You simply are not going to get what you want unless you know where you’re starting from (assessment and data) and have a very specific and clear plan (measurable behavioral objectives, goals, and plans) on how to get there.

With that said, I also realize that our world today often wants quick answers, and while sometimes the answers are simply not quick if you want the best outcomes, I’ll attempt to respond the best I am able.

While there are examples of poorly written objectives as well as well written objectives and a large example of great goals specific to young children with autism, it is impossibly to provide examples of goals and/or objectives for every situation and every child; however, it is possible to ask questions which will bring you to the right goals and objectives. If you want feedback, just write them in the comments without personally identifying information (you can make up a name) and I will respond.

Here are the questions:
What do you want the person to do? (in specific measurable terms)
How will the person know, or what cue will tell him or her it’s time to do what you want done?
How will you know it has been accomplished? (What are the specific criteria for success? {Never average over a long period of time})
That, with the name of the person will give you the basics of the objective.

The goal can be more broad and general and does not have to be quite as measurable.

For example:
Goal: John will come to school clean.
Objective: When John’s alarm rings in the morning at 6:30 A.M. , he will go directly to his drawer and pick out clean clothes, then go to the bathroom, take his shower, and put on deodorant, then the clean clothes he has chosen from his drawer. He will do this five days in a row for two consecutive weeks.

There are a number of assumptions in this goal and objective. John is obviously high functioning and has mastered the basic steps. If not, a more specific objective would have to be written for the steps. Sometimes we might include and reference a chart showing the steps for some functions such as taking a shower; however, this too would still imply that John has basically mastered the process.

The plan would detail others involved in the process to include arranging for clean clothing in the drawer and appropriate reinforcement.

This all starts though; from what you want John to do and then build from there. If you clearly know what you want the person to do. When the person will do it, to include what trigger or cue will tell the person it’s time to do…whatever it is you want the person to do. And if you have a clear and reasonable criteria for success, you have the basic information for your objective. The goal is simply the overarching, umbrella, behavior or skill you are looking for.

Any rote, prewritten, more generic objectives, are simply a terribly disservice to the child (or adult).