1. Helen Henningham School of Psychology

2. Why is early childhood important?  Brain development most rapid and vulnerable from conception to 5 years.  Experiences in early childhood can have lasting effects on children’s ability to learn and their behaviour.  Interventions are more cost-effective than at other ages.  Without quality early childhood care children arrive at formal schooling with deficits in cognitive and social skills. This detrimentally affects their school progress.

3. Millions of children < 5y not fulfilling their potential in development (WHO, 2006; UNICEF 2006) Stunted Poverty Disadvantaged < -2z scores < $1/day (Poor &/or stunted) HAZ 156m 126m 219m (39% of children <5y) Stunted + Poverty not stunted

4. 1.Deficit in grades attained (Brazil) 2. Deficit in learning per grade (Phillipines, Jamaica) 3. Estimate total deficit (1+2) 20 % loss of yearly adult income Loss of yearly adult income

5. Conclusion Loss of children’s potential is an enormous problem affecting >200million It has economic and social costs both to individual and nations

6. Interventions for the Home

7. Importance of stimulation Unstimulating environments and lack of quality parent-child interaction are major risk factors for poor development

8. Stimulation: Weekly 1hr home visits by community health aides. Play session with mother and child. Focus on: Enhancing maternal- child interactions Language Praise Showing mother how to promote development through play

10. In Jamaica, we have shown benefits of psychosocial intervention to children’s development as well as mothers’ child rearing knowledge and practices

11. Children enrolled at age 9-24 months received 2 years of intervention Followed up at age 22 years

12. Benefits of Stimulation at age 22y: IQ Benefits of Stimulation at age 22y: IQ p=0.003 p=0.004 p=0.02

13. Benefits of Stimulation at age 22y: Education p=.004 p=.014 p=.005 Reading Maths General Knowledge

14. Benefits of Stimulation at age 22y: Psychological Functioning p=.03 p=.05

15. Benefits of Stimulation at age 22y: Reduced violent behaviour p=.04p=.06

16. Interventions for the Clinic

17. Parenting DVDs Developed 9 modules (3 minutes each) 1. Love 2. Comfort 3. Talk to baby 4. Bath time 5. Toys 6. Praise 7. Books 8. Drawing 9. Puzzles

18. Health Centre Intervention 3 modules were shown at each Child Health clinic when the subjects: 3 months 6 months 9 months 12 months 18 months

19. Group discussion & demonstration with mothers 1. Discuss the video with caregivers − What did they see on the video − What can they do with their baby − Practice − Praise caregivers and label what they are doing 2. Song or Game 3. Homemade toy − How to make it − How to use it

20. During Nurse Consulation Nurse asks mother what she saw on the video and what she thinks she could try Gives mother a message card and reads it through with her Encourage mother to try these behaviours at home If the mother has not yet seen the video encourage her to watch it

21. Supplements to DVD – Message cards, Books and Puzzles

22. Interventions for the School

23. Children with social, emotional and behavioural problems School entry Primary school Poor relationships with teachersPoor relationships with teachers Peer rejectionPeer rejection Poor parent- teacher relationshipsPoor parent- teacher relationships Low participation in the classroomLow participation in the classroom Continuing behavior problemsContinuing behavior problems Low level of bonding to schoolLow level of bonding to school Associate with deviant peersAssociate with deviant peers Low academic achievementLow academic achievement

24. Primary school Adolescence Adulthood Aggressive & disruptive behaviour Juvenile delinquency Truant / dropout from school Substance abuse Depression & suicide ideation Crime and violence Antisocial personality disorder Low educational and economic attainment

25. Content 1.How to create an emotionally supportive classroom environment  Praise, incentives, play, following child’s interests 2.How to be proactive to prevent problems  Classroom rules and routines, keeping children engaged, ‘with-it-ness’ 3.Dealing with child misbehaviours  Ignore, redirect, consequences 4.Teaching social skills to children  Sharing, asking, waiting, trading

26. Process  Video vignettes of Jamaican classrooms  Group discussion  Role plays  Practical activities  Small group work  Classroom assignments  In-class support: modelling, coaching & praising

27. Build on Teachers’ Previous Knowledge  Brainstorm at the beginning of each new topic:  Advantages, disadvantages, barriers  What are the advantages of attention, encouragement and praise:  To children  To teacher-parent relationships  To teacher-child relationships  What are the barriers to praising children:  In general  For the more difficult children

28. Small Group Activities  Activities given to small groups:  e.g. Scenarios involving child misbehaviour and group must decide what strategies they would use  Groups role play their solutions for the whole group  Detailed feedback on strategies used by the group:  What was good  Why was it good  Whole group brainstorms other strategies that may be used

29.  Classroom Rules:  Quiet hand up  Walking feet  Inside voice  Eyes on teacher  Friendship Skills:  Sharing  Waiting  Asking  Taking turns Teaching Skills to Children

30.  Explicitly teach children examples and non-examples of the skill  Have a visual aid  Let children role play the skill  Practice the skill in different contexts during the day  Promote children’s use of the skill – e.g. praise children who are using the skill throughout the regular school day How to Teach a Skill

31. In-Class Consultations  Boost teacher confidence and motivate them to use the strategies consistently  Help teachers to problem-solve  Help tailor strategies to fit the classrooms  Promote continued use of strategies over time

32. Classroom Assignments  Practice a specific skill taught in workshop  E.g. Labelled praise, ignore minor misbehaviour  Record on prepared sheet  What child was doing  What teacher said / did  Observe and record the effect on child/ren  What child did or said  How child was feeling

33. Results: benefits to children

34. Observations Teacher Report Parent Report Change in conduct problems in intervened and control classrooms Intervened Control p<0.01 p<0.05

35. Change in friendship skills in intervened and control classrooms Parent Report Observations Teacher Report Intervened Control p<0.001 p<0.05

36. Results: benefits to teachers

37. Teacher Positives Teacher Negatives Change in observations of teachers’ classroom behaviours in intervened and control classrooms Intervened Control p<0.001 p < 0.001; Values are median frequency / 90 minutes of observation

38. Change in observed teacher interactions to high risk children in intervened and control classrooms Teacher Positives Teacher Negatives Intervened Control p<0.001 p < 0.001; Values are median frequency / hour of observation

39. Percentage of teachers using physical punishment through observation % ns

40. New Initiatives Developing and evaluating an integrated intervention to promote child development from conception to age 5 to be embedded in existing government services in rural Colombia (with University de los Andes, Bogota & Institute of Fiscal Studies, London) Developing and evaluating a combined intervention of CBT for depression and early stimulation for depressed mothers and their infants in rural Bangladesh (with the International Centre for the Diarrhoeal Disease Research, Bangladesh)

41. New Initiatives in Jamaica Simplify and scale-up teacher training intervention for Jamaican preschool teachers Pilot a consultative model of teacher training with Jamaican primary school teachers Develop training materials and package the Jamaican home-visiting early stimulation curriculum for global dissemination on-line

42. Thank you for your attention Diolch yn Fawr Iawn