an ecological approach to family intervention in early childhood: embedding services in wic thomas...
TRANSCRIPT
![Page 1: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/1.jpg)
An Ecological Approach to Family Intervention in Early
Childhood:Embedding Services in WIC
Thomas J. DishionUniversity of Oregon
&Child and Family Center
Presented at:Intervening Early Conference, Sept 18-19, 2007
![Page 2: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/2.jpg)
Acknowledgments
Thanks to:
NIDA Support
Research Colleagues
Daniel ShawMelvin Wilson
Frances Gardner
Early Steps Project Staff
Early Steps Families
![Page 3: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/3.jpg)
Challenges in Providing Child and Family Mental Health Services to the
Poor.
1-Many services are paid by personal insurance and cover only DSM disorders.
2-State funded services are often poorly supported, ineffective, not research based, and in some cases possibly iatrogenic.
3-Solution: Embed affordable and effective interventions in agencies that have wide access and repeated exposure to children and families (Hoagwood & Koretz, 1996)
![Page 4: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/4.jpg)
Three Goals of this Talk.
1-Provide an overview of the ecological approach to family intervention and treatment (ecoFIT).
2-Review findings from a pilot study applying the ecoFIT to high risk young families participating in WIC services.
3 - Review initial findings from a multi site outcome study applying the ecoFIT to high risk young families participating in WIC services.
![Page 5: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/5.jpg)
What is an ecological
approach to child and family therapy?
![Page 6: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/6.jpg)
EntrainedBiosocialResponse
Patterns Relationship Dynamics
Child Adjustment
Relationship Dynamics
Behavior Settings
Teachers
Parents
PeersSpouses
Siblings
Schools Home
Neighborhood
The Ecology of Self Regulation
![Page 7: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/7.jpg)
Six Features of An Ecological Approach to Child and Family Interventions (Eco
FIT)(From Dishion & Stormshak, 2006)
is based on an empirically based model of child and adolescent problem behavior;
is family-centered, addressing adult leadership and support in the change process;
is assessment driven, with decisions regarding intervention needs following careful assessments;
targets social interactions with parents and peers to make long lasting change;
addresses client motivation to change as a core component;
utilizes a health maintenance model delivered in service settings that involve children and families;
An ecologial approach….
![Page 8: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/8.jpg)
Parent-Child Relationship
Parent Guided Socialization
Peer Network Coalitions
Early MiddleChildhood Childhood Adolescence
A Developmental Model for the Influence of Family and Peers on Child Adjustment
(from Dishion & Patterson, 2006)
![Page 9: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/9.jpg)
Four nonspecific factors which undermine intervention effectiveness
(from Dishion & Stormshak, in press):
Potentially
Harmful—
Beneficial
+
Unsupervised
Peer Groups
Peer Contagion
Child Self Regulation
Adult Involvement
Positive Relationships
Behavior ManagementSkills
A Broad Overview of Intervention Outcome Literature(Dishion & Stormshak, 2007)
![Page 10: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/10.jpg)
Figure 1.4
Early ChildhoodOppositional
Problems
Middle ChildhoodAntisocialBehavior
AdolescentDelinquency
AdolescentSubstance Use
EffectiveParenting Interventions
Reduce. . .
Research on the Effectiveness Interventions that Target Parenting
![Page 11: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/11.jpg)
ES Training, March 2004
Process ofChange
Pre-contemplation
Co
ntem
platio
n
Prepara
tion
Action
Mai
nte
nan
ce
![Page 12: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/12.jpg)
Interventions that Address Motivation to Change
![Page 13: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/13.jpg)
An Overview of the ecoFIT Strategy (Dishion & Stormshak, 2007)
![Page 14: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/14.jpg)
ORI, May 2002
Service Systems Affecting Mental Healthof Children and Adolescents
DevelopmentalStage
EarlyChildhood
Childhood
EarlyAdolescence
Adolescence
Public SchoolSetting
CommunityPrograms:Treatment andRehabilitation
WIC, Preschools
![Page 15: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/15.jpg)
Early Steps Pilot Project Research Design (N=120)
W.I.C. Services
Screening
Assessment
Random Assignment
FCU Control
![Page 16: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/16.jpg)
Three Year Effects on Parent Report Problem Behavior in Early Childhood.
(Shaw, Dishion, Supplee & Gardner 2006)
1
2
3
4
Age 2 Age 3 Age 4
TreatmentControl
Effect size at age 4 = .45 sd
![Page 17: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/17.jpg)
Three Year Effects on Observations of Parent Monitoring in Early Childhood
(Shaw, Dishion et al, 2006)
1
1.5
2
2.5
Age 2 Age 3 Age 4
TreatmentControl
Effect size at age 4 = .48 sd
![Page 18: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/18.jpg)
Early Steps Multi-site Research Design (N=731: Eugene, Pittsburgh & Charlottesville)
W.I.C. Services
Screening
Assessment
Random Assignment
FCU Control
![Page 19: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/19.jpg)
Design of the Early Steps Multi Site Project (Dishion, Gardner, Shaw & Wilson)
•Study Sample: 731 WIC Families with Toddlers
•Design: Longitudinal follow-up age 2 to 5
•Retention: 89% from ages 2 to 3
•Ethnicity: 50.1% European American (n=366) 27.9% African American (n=204) 13.4% Hispanic/Latino (n=98)
8.6% Other (n=63)
•Gender: 50.5% Male (n=369) 49.5% Female (n=362)
![Page 20: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/20.jpg)
Primary Caregiver ratings on ProblemBehavior (Dishion, Shaw et al, under review)
18
17
16
15
14
13
12
11Age 2 Age 4: Age 2 Age 4
18
17
16
15
14
13
12
11
I = Intervention
C = Control
Inte
nsi
ty T
sc
ore
s
I
I
C
C
I IC
C
High Risk Typically Developing
Intervention Effect (.16)
![Page 21: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/21.jpg)
Intervention Outcomes on Direct Observations of Parent Positive Reinforcement
![Page 22: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/22.jpg)
Changes in Observed Parenting Mediates Reductions in Children’s Problem Behavior.
ObservedParentPBS
Age 2
ObservedParentPBS
Age 3
Int PBSlope
PB
.88*
-11*
Age 2 Ey. Age 3 Ey. Age 4 Ey.
(from Dishion, Shaw, Connell et al, under review)
ProactiveRatings
Parent Invol.Ratings
ObservedPos. Rein
ObservedInt. Eng.
ProactiveRatings
Parent Invol.Ratings
ObservedPos. Rein
ObservedInt. Eng.
![Page 23: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/23.jpg)
Concluding Comments. 1 Embedding family interventions within agencies
such as WIC is feasible and cost effective (average # hours=3 for toddlers);
2 The families that are the most at risk are the most likely to engage in the FCU (single parents, teen mothers, low education, low income)
3 Although effect sizes are small, they are enduring overtime
4 Future work on the ecoFIT model will focus on improving engagement in skill-building interventions that focus on parents ‘positive behavior support’.
![Page 24: An Ecological Approach to Family Intervention in Early Childhood: Embedding Services in WIC Thomas J. Dishion University of Oregon & Child and Family Center](https://reader035.vdocument.in/reader035/viewer/2022081519/56649f585503460f94c7d967/html5/thumbnails/24.jpg)
For more information:
[email protected]://cfc.uoregon.edu
Also See: Dishion, T. & Stormshak, E. (2007). Intervening in Children’s Lives: An Ecological, Family-centered Approach. APA: Washington DC