1. Evidence Based Practice Early Childhood Webcast Training September 29, 2005 Presented by California Institute for Mental Health

2. Early ChildhoodEvidence Based Practices2 Main Points Defining evidence-based practices Early childhood social-emotional development Early childhood specific practices Disorders in early childhood (DC:0-3)

3. Early ChildhoodEvidence Based Practices3 Typical Emotional Development 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

4. Early ChildhoodEvidence Based Practices4 Typical Emotional Development 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

5. Early ChildhoodEvidence Based Practices5 Factors that Promote Optimal Development 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

6. Early ChildhoodEvidence Based Practices6 Factors that Contribute to Emotional Disorders 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

7. Early ChildhoodEvidence Based Practices7 Signs of a Problem Problematic behaviors are intensive, extensive, or pervasive; and/or Primary caregivers are overwhelmed

8. Early ChildhoodEvidence Based Practices8 Child’s Emotional Availability 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

9. Early ChildhoodEvidence Based Practices9 Caregiver Emotional Availability 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

10. Early ChildhoodEvidence Based Practices10 Neurobiological Factors Limited Caregiver Emotional Availability Social, Economic, and Interpersonal Factors Neurobiological Factors Limited Child Emotional Availability

11. Early ChildhoodEvidence Based Practices11 Evidence-Based Practices “…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

12. Early ChildhoodEvidence Based Practices12 Levels of Science 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.

13. Early ChildhoodEvidence Based Practices13 Which Level of Science to Select 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

14. Early ChildhoodEvidence Based Practices14 Treatment Approaches 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)

15. Early ChildhoodEvidence Based Practices15 The Incredible Years 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

16. Early ChildhoodEvidence Based Practices16 Incredible Years 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

17. Early ChildhoodEvidence Based Practices17 Triple P Parenting 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

18. Early ChildhoodEvidence Based Practices18 Triple P Parenting 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

19. Early ChildhoodEvidence Based Practices19 Parent-Child Interaction Therapy 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 http://www.ucdmc.ucdavis.edu/caare/mental/pcit_traince nter.html

20. Early ChildhoodEvidence Based Practices20 Parent-Child Interaction Therapy Therapists Clinic with two-way mirror, and “bug in the ear” technology Individual sessions (about 12) Home models being developed Parent-child guided intervention  Relationship  Discipline

21. Early ChildhoodEvidence Based Practices21 Nurse Family Partnership 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

22. Early ChildhoodEvidence Based Practices22 Nurse Family Partnership 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

23. Early ChildhoodEvidence Based Practices23 Early Intervention Foster Care 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

24. Early ChildhoodEvidence Based Practices24 Early Intervention Foster Care 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

25. Early ChildhoodEvidence Based Practices25 Diagnostic Classification 0-3 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

26. Early ChildhoodEvidence Based Practices26 Primary Diagnoses Traumatic stress Disorders of affect Adjustment disorder Regulatory disorders Sleeping behavior disorder Eating behavior disorder Disorders of relating and communicating

27. Early ChildhoodEvidence Based Practices27 Traumatic Stress 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

28. Early ChildhoodEvidence Based Practices28 Disorders of Affect General feature of the child’s functioning No severe developmental delays or significant constitutional variations Not specific to only a single relationship or context

29. Early ChildhoodEvidence Based Practices29 Disorders of Affect Anxiety Prolonged bereavement/grief reaction Depression Mixed disorder of emotional expressiveness Gender identity disorder Reactive attachment deprivation/maltreatment disorder

30. Early ChildhoodEvidence Based Practices30 Adjustment Disorder Mild, transient situational disturbances Not explained by other conditions Onset tied to a clear event or change Lasting days, up to 4 months

31. Early ChildhoodEvidence Based Practices31 Regulatory Disorders 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

32. Early ChildhoodEvidence Based Practices32 Sleep Behavior Disorder 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

33. Early ChildhoodEvidence Based Practices33 Eating Behavior Disorder 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

34. Early ChildhoodEvidence Based Practices34 Disorders of Relating and Communicating (Multisystem Developmental Disorder) 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

35. Early ChildhoodEvidence Based Practices35 Differential Diagnosis 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

36. Early ChildhoodEvidence Based Practices36 Differential Diagnosis 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

37. Early ChildhoodEvidence Based Practices37 Relationship Disorders Overinvolved Underinvolved Anxious/Tense Angry/Hostile Mixed Abusive

38. Early ChildhoodEvidence Based Practices38 Functional Emotional Developmental Level Mutual attention Mutual engagement Interactive intentionality and reciprocity Representational/affective communication Representational elaboration Representational differentiation I & II