Based on the Fun FRIENDS Program ROAD TO RESILIENCE Based on the Fun FRIENDS Program Dr. Imogen Hall Kimberly Court, M.S.W., RSW November 22, 2016

What We Know (Costello, Angold, Keeler, 1999) In Ontario alone, about one out of five 4-16 year-olds suffer from some type of psychiatric disorder Anxiety disorders are the most common at any one time affecting 6% of children Serious emotional disturbance can develop before the age of 6 Interferes with crucial emotional, cognitive, and physical development, presaging a lifetime of problems in schools and at home Must intervene before the onset of disorders by teaching children social and emotional skills to increase their competence and well- being   (Costello, Angold, Keeler, 1999) (Children’s Mental Health Ontario, 2013)

What We Know Cont’d Clinically relevant interventions, such as Fun Friends, are required to increase positive outcomes for children at risk by creating a “resilient mind-set” “Resilient mind-set” - based on the perception that all children experience pressure in our fast-paced, stress-filled environments Even children who are not faced with significant adversity or trauma are likely to experience the pressures around them (Goldstein and Brooks, 2005)

Rationale for Group Based Service More families able to access services Shorter wait times for service Time limited service Good use of scarce resources

What is Fun FRIENDS? Evidence based Created by Dr. Paula Barrett Positive program for preschool children focusing on increasing social-emotional competence and wellness Family based approach actively involving children and their parents in the intervention process Children and parents are taught developmentally sensitive cognitive behavioural techniques to cope with and manage worry and conquer challenges and adversity

Importance of Parental Engagement in Treatment Parental beliefs impact their desire to seek help, engage and continue in treatment, and outcomes Need to shift parental beliefs about their child’s problem, their perceptions, and their feelings about their ability to handle such problems (E. Morrissey-Kane, R.J. Prinz 1999)

The Research: Parental Engagement in Treatment S.L. Mendlowitz et. al (1999) noted that while cognitive behavioural group interventions reduced symptoms of anxiety concurrent parental involvement enhanced the effect of coping strategies. They also found families involved in concurrent intervention used more coping strategies post-treatment compared to child only or parent S. Spence et. al (2000) showed significantly greater reductions in children’s social and general anxiety during intervention 12 month-follow-up - these children had retained their improvement with a trend toward superior results when parents were involved in treatment.

When Is the Best Time to Intervene? Research suggests the preschool years are essential for building social-emotional skills Children who are socially and emotionally well adjusted : do better in school have increased confidence have good relationships take on and persist at challenging tasks and communicate well (National Research Council and Institute of Medicine, 2000)

Objectives   Assist in learning practical, useful strategies for coping with stress, worry, fear and sadness  Help children become more resilient when facing challenging or stressful situations   Help children learn important emotional regulation and social skills that will help them excel during their school years/life  Enhance caregiver awareness of anxiety/worry and its implications for children  Increase caregivers’ skill level to support their children’s coping by enhancing parental emotional competence and understanding Decrease anxiety scores Decrease behavioural inhibition  Identify caregiver and child strengths  Increase social and emotional competence for children 

Measures – Preschool Anxiety Scale (PAS) (Spence, Rapee, McDonald, & Ingram, 2001) Measures parent-report of child anxiety PAS is a downward extension of the Spence Children’s Anxiety Scale (SCAS; Spence, 1977) SCAS identifies six subtypes of anxiety (Panic disorder, separation anxiety, and fear of physical injury, social phobia, OCD, and Generalized Anxiety Disorder) as well as a total score SCAS - used in research on the FRIENDS program and significant decreases in anxiety were observed following the administration of the program. All pre-post comparisons were significant to at least the p = .01 level   (Stopa, Barrett, and Golingi, 2010)

Measures – Preschool Anxiety Scale (PAS) (Spence, Rapee, McDonald, & Ingram, 2001) PAS generates scores for (keeping with DSM-IV subtypes of anxiety disorders) Generalized anxiety Social anxiety OCD Physical injury fears Separation anxiety Total anxiety score PAS was developed for use with children 2.5 to 6.5 years of age PAS is available free for use   (Stopa, Barrett, and Golingi, 2010)

Measures - Strengths and Difficulties Questionnaire (SDQ)(Goodman 1997) Previous research on the Fun FRIENDS program (Stopa, et al., 2010) included a measure of “psychological adjustment” for children ages 3 to 16, the Strengths and Difficulties Questionnaire SDQ measures five sub-scales: emotional symptoms conduct problems hyperactivity/inattention peer relationship problems pro-social behavior Stopa et. al’s research (2010)- identified statistically significant change (pre-post) on three of the sub-scales: emotional symptoms, conduct problems, and peer relationship problems SDQ is available free for use

Measures – Road to Resilience Skills Survey Measures caregivers’ perceptions of their ability to help their child and themselves across multiple domains: Feeling identification Problem solving Socializing Relaxing Changing thinking patterns Domains matched the target areas of the group objectives PAS, SDQ and Road to Resilience Skills Survey - administered as pre- and post- test measures to allow for the evaluation of change/effectiveness

Pre/Post Measures PAS SDQ Caregiver Skills Survey All administered as pre- and post-test measures and allow for the evaluation of change/effectiveness

Measures – Satisfaction Survey Administered at the end of the program Evaluate parents’ perceptions of the program (e.g., effectiveness in terms of the group goals, benefits, strengths of the program, and areas in need of change)

Participants 55 began the groups, 51 completed 11 group 1 (11 completed) 13 group 2 (11 completed) 11 group 3 (10 completed) 12 group 4 (11 completed) 8 group 5 (8 completed)

Participants Average age at first session = 5 years, 1 month Range: 3 years, 11 months to 5 years, 11 months 49 of 51 parents completed pre- and post- data

Preschool Anxiety Scale (PAS) Pre-Post Data Analysis   Group Pre Post t df Generalized Anxiety 8.77 (4.73) 6.83 (4.30) 3.48** 47 Social Anxiety 9.00 (5.51) 7.40 (5.23) 2.46* 46 Obsessive Compulsive Disorder 4.58 (3.29) 3.35 (2.75) 2.17* Physical Injury Fears 7.98 (4.58) 6.65 (4.71) 2.31** Separation Anxiety 6.69 (4.41) 5.81 (4.37) 1.89 Total 37.10 (16.82) 29.96 (16.57) 3.95** Note. * = p < .05, ** = p < .01. Standard Deviations appear in parentheses below

Strengths and Difficulties Pre-Post Data Analysis   Group Pre Post t df Overall Stress 17.92 (5.24) 15.21 (6.92) 3.46*** 47 Emotional Distress 4.60 (2.25) 3.15 (2.42) 5.22*** Behavioral Problems 3.46 (2.28) 3.13 (1.95) 1.18 Hyperactivity and Attention Problems 6.25 (2.57) 5.81 (3.07) 1.58 Social Problems 3.60 (2.09) (2.32) 1.90 Kind and Helpful Behaviour 7.19 (2.08) 6.98 (2.36) .74 Note. * = p < .05, ** = p < .01, *** = p < .001. Standard Deviations appear in parentheses below

Strengths and Difficulties Pre-Post Data Analysis Cont’d   Group Pre Post t df Impact on Life 3.40 (1.88) 1.58 (1.84) 5.87*** 44 Any Diagnosis 2.40 (.75) 1.82 (.86) 4.95*** Emotional Diagnosis 1.91 (.85) 1.29 (.63) 5.59*** Behaviour Diagnosis 1.69 1.60 (.81) 1.07 Hyperactivity/ Concentration Diagnosis 1.53 (.50) 1.38 (.49) 2.46* Note. * = p < .05, *** = p < .001. Standard Deviations appear in parentheses below

Road to Resilience Skills Survey Pre-Post Data Analysis Group Pre Post   Group Pre Post t df Child Feelings 3.81 (.99) 4.30 (.72) -3.36** 46 Problem Solving 3.79 (.95) 4.09 (.75) -1.92 Socialization 3.28 (1.12) 3.91 (.90) -4.16*** Relaxation 3.35 4.00 (.76) -4.79*** 45 Thinking 3.23 (1.07) (.81) -4.66*** Note. ** = p < .01, *** = p < .001. Standard Deviations appear in parentheses below Problem solving was a trend (p = .061)

Road to Resilience Skills Survey Pre-Post Data Analysis   Group Pre Post t df Parent Feelings 3.98 (1.03) 4.53 (.69) -3.90*** 46 Problem Solving 4.21 (.78) 4.38 (.71) -1.59 Socialization 4.04 (.93) (.74) -2.49* Relaxation 3.57 (1.12) 4.11 (.87) -3.58*** Thinking 3.70 (1.02) 4.15 -3.39*** Note. * = p < .05, *** = p < .001. Standard Deviations appear in parentheses below

Conclusions After 5 groups, Road to Resilience has shown a number of benefits Generalized anxiety, social anxiety, OCD traits, and fears of physical injury are reduced Trend for improvements in separation anxiety Kids are less stressed and have less emotional distress Trend for fewer social problems Children are less at risk for MH diagnoses, in particular emotional or hyperactivity/concentration disorders, and the child’s presenting problems have less impact on the family’s functioning

Conclusions By the end of the group, parents perceive themselves as significantly better able to help their children identify feelings, socialize, relax, and change their thinking patterns Trend for feeling better able to help child problem solve By the end of the group, parents perceive themselves as significantly better able to help themselves identify feelings, socialize, relax, and change their own thinking patterns