1

Catherine Ayoub, EdD.

Associate Professor, Harvard Medical

School

Brazleton Touchpoints Center

National Center on Parent, Family &

Community

Mechanisms of Early Head

Start Programming on

Parent & Family

Characteristics, Parent-

Child Interaction, & Child

Outcomes

Plan for today

•A Framework for family policy & practice

•EHS research findings & implications for policy & practice

Early Head Start & Head Start in 2012

• Two generational programming as a mandate

•Emphasis on child outcomes & school readiness

•Increased rigor for review & re-competition

•Increased interest in evidence-based practice

•Emphasis family engagement to advance family outcomes that contribute to child outcomes

4/9/2012 Framework Session w. Notes 4 Systemic Integrated Comprehensive

Begin with the end in mind…

Desired Child Outcomes:

1. Children ready for school

1. Children sustain development and

learning gains through third grade

5

CHILD OUTCOMES

1. Family Well-Being

2. Parent-Child Relationships

3. Families as Lifelong Educators

4. Families as Learners

5. Family Engagement in Transitions

6. Family Connections with Community

7. Families as Advocates and Leaders

6

FAMILY OUTCOMES Family Engagement

Outcomes

Developmental Pathways to Integrated Social Skills: The Roles of Parenting and Early

Intervention in Raising Healthy Children

7

Ayoub, C., Vallotton, C., & Mastergeorge, A. (2011)., Child

Development, 82:2, pp. 583–600

Early Head Start Influences on Language & Self-Regulation in the

Context of Family Risks, Stress, & Positive Parenting

Child

Self-Regulation

Skills

Child

Language

Skills

Sensitivity,

Cognitive Stimulation

Family Demographic Risks:

Poverty, Low Education, Single

Parenthood, Unemployment,

Teen Parenting

Parents’

General Stress

Parenting-

Related Stress

Gender

E

EHS

Program

Language

Self-Regulation

Child Outcomes

•EHS protects parenting, child

language, & self-regulatory

development from the effects of

demographic risks & parenting

stress

•EHS bolsters development in

language & self-regulation.

Early Head Start

•Family risks

•Parenting-related stresses

• Parent–child interaction in the context of:

•Cognitive stimulation & teaching

•Sensitivity

Family Well Being

Parents as Lifelong Educators

Positive Parent Child Relationships

Highlights of the EHS Research: Impact Study

• 3,001 families

• Random assignment of families to either program or control group

• Collecting child and family outcome data when children are 14, 24, and 36 months of age

– Video taped observations

– Child & adult assessments

• Services data at 6, 15, and 26 months after enrollment & at exit

Early Head Start Research Sites

Brattleboro,

VT

New

York,

NY

Pittsburgh,

PA

Sumter, SC

Jackson,

MI

Russellville,

AR

Kansas City,

MO

Marshalltown,

IA

Kansas

City, KS

Logan,

UTDenver, CO

(2 programs)

Kent, WA

Sunnyside,

WA

Alexandria,

VA

Venice,

CA

McKenzie,

TN

Highlights of the Early Head Start Research & Evaluation Design

• 17 research sites from first two waves (1995 and 1996)

• Diverse programs: geographic regions, urban/rural, program approaches, populations served

• Resemble all Wave I and II Early Head Start programs and the families enrolled

• Programs located in diverse communities

Early Head Start Influences Study: Measures

• Five demographic risks:

*Teen parenting (TEEN MOM)

*Temporary Aid to Needy Families (TANF)

*Mother with no high school diploma

Unemployment

Single parent Family Well Being

Early Head Start Influences Study: Measures

Parenting Stress Index (Abidin, 1995): Short form 2 scales

Of 4 new sub-scales (Whiteside-Mansell, 2007) we used 2: general stress, parenting-related stress

Family Well Being

Early Head Start Influences Study: Measures

Parent-Child Interaction:

•Video taped observation of mothers & children - 10-min, semi-structured interaction, three bag task

•Ratings ranged from 1 (very low) to 7 (very high) based on both the quantity and quality of observed behaviors

Early Head Start Influences Study: Measures

Parent-Child Interaction (3 bag task):

Cognitive stimulation (STIMULATION) or effortful teaching appropriate to the child’s developmental level, such as providing explanations, offering activities with toys, and asking questions Sensitivity to children’s cues (SENSITIVITY), including accurately observing and responding to children’s needs, moods, interests, and abilities .

Positive Parent Child

Relationships

Parents as Lifelong

Educators

Early Head Start Influences Study: Measures

MacArthur Communicative Development Inventory (CDI - Fenson et al., 1994).

•Collected at 24 months (VOCABULARY)

•normed for child age

• ranges from 0 to 100 Child Outcomes

Early Head Start Influences Study: Measures

Self-regulation (REGULATE) (Bayley Behavior Rating Scale (BBRS).

• a seven-item subscale

•5-point scale - better self-regulatory skills = higher scores. Ratings averaged into a single score between 1 (poor regulation) &

5 (good regulation). Child Outcomes

Early Head Start Influences Study : Measures

Child Age

Child Gender

Site & model type

EHS or control

Analytic Framework

• Two different contexts, two separate groups

– Control

– EHS

• Developmental mechanisms

– Test a series of mediations in separate groups

• Effect of EHS context

– Examine differences in the direct impacts and mediations in control and EHS contexts

Analytic strategy

– multi-level nested models (SAS PROC MIXED)(Singer, 1998; Singer & Willett, 2003)

– test a series of mediation relationships determine whether mediator affects outcome in the presence of predictor; effect of predictor is diminished when mediator is in the model

– First, use overall model fit as indicated by significant reduction in the negative two log likelihood (-2LL) statistic. Second, confirm the effects of the EHS program by fitting the equivalent models using the entire combined sample

Summary of Findings for Child Outcomes

• Early Head Start protects children :

– Families with demographic risks from reduced cognitive stimulation/intentional teaching (cg = .77 SD vs. EHS = .27 SD)

– Families with risks of poverty (rate of change) & teen parent (level) from reduced vocabulary.

– Families with cumulative risks (3) from reduced self regulation (effects of cumulative risk = half of that for control group

– Mothers with parenting stress from reduced self regulation

– Parental insensitivity from reduced vocabulary

Summary of Findings for Child Outcomes

• EHS bolsters child development:

– Better self regulation even in face of variation in

language development – most difference at 24 months

– Better language development in the face of:

• Poverty (TANF) – vocabulary rate of change

• Teen parent - vocabulary level at 24 months

• Vocabulary growth in girls (.19 SD = control; .32 SD greater in EHS when compared to boys).

Summary of Findings across Developmental Domains

Early Head Start affects relationships between developmental domains

– EHS supports self regulation in light of low language skills

– EHS effects self regulation even in the face of variation in language

Early Head Start & Parenting: Demographic Risks & Parenting Stress

• Effects of general adult stresses on child development are largely entwined with families’ demographic risks & are not easily impacted by Early Head Start

• Without Early Head Start intervention, higher general & parenting-related stresses reduce children’s language & self-regulation skills

• EHS participation plays a role in ameliorating the effects of parenting stress

• EHS promotes positive parent-child interaction despite of risks & stresses

Effects of risks (teen parenting, low maternal education, & poverty) & Early Head Start on the development of children’s self-regulation, & effects of the Early Head Start intervention on self-regulation for girls & boys, accounting

for average differences in language skills for each group of children

3.2

3.4

3.6

3.8

4

4.2

4.4

12 24 36

No Risks

3 Risks

Panel A:

EHS Intervention

Children

Self

-Reg

ula

tio

n S

core

3.2

3.4

3.6

3.8

4

4.2

4.4

12 24 36

No Risks

3 Risks

Panel B:

Control Group Children

Child Age in Months

Parent-Child Interaction: Sensitivity & Cognitive Stimulation/Teaching

EHS parents interact with their children in ways that better stimulate their cognitive development

If parents interact insensitively with their children, this insensitivity does not hurt EHS children’s vocabulary as much as it does other children.

Effects of demographic risks and parental sensitivity on the vocabulary skills of children at 24 months old for children who were assigned to the EHS

intervention and those in the control group

CD

I V

oca

bu

lary

Sco

re

at 2

4 M

on

ths

30

40

50

60

70

No Risks 3 Risks

EHS

Control

30

40

50

60

70

Average

Sensitivity

Very Low

Sensitivity

EHS

Control

Panel A. Effect of demographic risks on child language for EHS & control group children.

Panel B. Effect of parental insensitivity on child language for EHS & control group children.

Effects of children’s vocabulary score at 24 months on the development of self-regulation for boys and girls controlling the effects of parent sensitivity and

cognitive stimulation during parent-child interaction.

3.2

3.4

3.6

3.8

4

4.2

4.4

12 24 36

3.2

3.4

3.6

3.8

4

4.2

4.4

12 24 36

Good Vocabulary

Average Vocabulary

Poor Vocabulary

Panel A. GIRLS

Child Age in Months

Self

-Re

gula

tio

n S

core

Panel B.

BOYS

Summary of the direct, partially mediated, and fully mediated relationships for the control and EHS

groups

i. 0.08303***

( 0.08303***)

ii. 0.01621~

(0.04380*)

-2.24**

(-1.44~)

-2.96***

(-1.99**)

i. 2.68**

ii. 3.43***

-0.02993*

(-0.00820)

-0.03148*

(-0.02120)

a. 0.05777*

b. 0.01620**

c.-0.00065**

i. -0.0599*

ii.-0.1478~

i. -0.0542*

ii.-0.1358~

i. -0.6294***

ii.-0.8854**

–1.6361*** – 0.5860~

4.2595**

a. 0.17360***

b. 0.00466~

Family Demographic Risks:

A. Teen Parenting, B. Low Education, C. Poverty

General

Stress

Child Language Skills

at 24 months

Parent Interaction Characteristics:

i. Sensitivity,

ii. Cognitive Stimulation

Parenting- Related

Stress

Child is

Female

Child Self-Regulation Development

from 14 to 36 months:

a. intercept, b. linear change, c. quadratic change

Family Demographic Risks:

A. Teen Parenting, B. Low Education, C. Poverty

General

Stress

Parent Interaction Characteristics:

i. Sensitivity,

ii. Cognitive Stimulation

Child is

Female

Child Language Skills

at 24 months

Child Self-Regulation Development

from 14 to 36 months:

a. intercept, b. linear change, c. quadratic change

Parenting- Related

Stress

Control Group: EHS Group:

i. -0.0582*

ii.-0.1069

i. -0.6872***

ii.-0.3689

–1.4511* –0.4005

i. -0.0598*

ii.-0.0871

-2.33***

(-2.39**)

-2.30***

(-2.31**) i. 0.07

ii. 3.94***

7.4266***

a. 0.10380*

b. 0.00639*

-0.03100*

(-0.02642~)

-0.01643

(-0.00470)

a. 0.01888

b. 0.01630**

c.-0.00057**

i. 0.09041***

( 0.07453***)

ii. 0.01446

( 0.07015***)

Figure 4 Key: Direct Effect

Partially Mediated

Fully Mediated Relationship for Control but not EHS

4/9/2012 Framework Session w. Notes 32

Risks

General Stress

Adversity Parenting

Stress

Sensitivity

Cognitive

Stimulation/

Teaching

Language

Self-Regulation

Research to Policy & Practice

•Demographic risks matter – intervene with any one

•General stress is not impacted by EHS – add special programs

•Parenting stress is impacted by EHS – keep engaging parents in parenting activities

•Parent-child interaction is an important mediator for child outcomes – increase focus on parent engagement in learning

•Developmental domains are not independent – consider learning activities that cross domains

Family Connections: A model of system-wide preventive mental health consultation

• Child assessment & intervention – developmental assessment, pair play therapy & social skill/conflict resolution

• Classroom assessment & consultation • Classroom interventions plus – Social skill groups , Tell Me a Story,

& pair play therapy

• Staff climate & team building activities - Staff support groups, activity groups, regular planning & review

• Parent Engagement – informal limited to ongoing support groups & referrals

• System-wide training series on preventive mental health,

perspective taking, & self care

Tell Me a Story Project

• A curriculum that uses books & related literacy-based activities to promote social emotional themes and support healthy discussion of difficult topics

• A training series & book guides designed to promote adult/child interactions, increase emotional expressiveness, & staff outreach to families around managing emotions & difficult topics for teachers and parents

• When My Mom Is Sad: a picture book explaining parental depression to young children

4/9/2012 Framework Session w. Notes 36

Family

Connections

MHC

4/9/2012 Framework Session w. Notes 38

“The test of our progress is not

whether we add more to the

abundance of those who

have much; it is whether

we provide enough for those

who have too little.”

Franklin Delano Roosevelt (1937)

39

40

Contact us at:

Thank you.

Contact at:

Catherine.Ayoub@childrens.harvard.edu

NCPFCE@childrens.harvard.edu

Or

855-208-0909

(Toll Free) for NCPFCE

ncpfce@childrens.harvard.edu

www.childrenshospital.org/familyconnections

Effects of each predictor on

each outcome for families in

the control and intervention groups of the National Early

Head Start study

Predictor Outcome Effect for Control Effect for EHS

Demographic Risks General Stress -1.6361*** -1.4511*

Demographic Risks Parenting Stress -0.5860~ -0.4005

Demographic Risks Sensitivity -0.6294*** -0.6872***

Demographic Risks Stimulation -0.8854** -0.3689

Demographic Risks Level of Self-Regulation -0.2018** -0.0938

TANF Change in Self-Regulation (Linear) -0.2150~ -0.0136

TANF Change in Self-Regulation (Quadratic) 0.0011* 0.0007

General Stress Sensitivity -0.0542* -0.0598*

General Stress Stimulation -0.1358~ -0.0871

General Stress Vocabulary

(mediated by interaction)

-2.9600***

(-1.9900**)

-2.3000***

(-2.3100**)

General Stress Level of Self-Regulation

(mediated by vocabulary)

-0.0299*

(-0.0082)

-0.0310*

(-0.0264~)

Parenting Stress Sensitivity -0.0599* -0.0582*

Parenting Stress Stimulation -0.1478~ -0.1069

Parenting Stress Vocabulary

(mediated by interaction)

-2.2400**

(-1.4400~)

-2.3300***

(-2.3900**)

Parenting Stress Level of Self-Regulation

(mediated by vocabulary)

-0.0315*

(-0.0212)

0.0164

(0.0047)

Sensitivity Vocabulary 2.6800** 0.0700

Sensitivity Level of Self-Regulation

(mediated by vocabulary)

0.0830***

(0.0830***)

0.0904***

(0.0745***)

Stimulation Vocabulary 3.4300*** 3.9400***

Stimulation Level of Self-Regulation

(mediated by vocabulary)

0.0162~

(0.0438*)

0.0145

(0.0702***)

Vocabulary Level of Self-Regulation 0.0578* 0.0189

Vocabulary Change in Self Regulation (Linear) 0.0162** 0.0163**

Vocabulary Change in Self-Regulation (Quadratic) -0.0007** -0.0006**

Gender Vocabulary 4.2595** 7.4266***

Gender Level of Self-Regulation 0.1736*** 0.1038*

Gender Change in Self-Regulation (Linear) 0.0047~ 0.0064*

~ p < .10, * p < .05, ** p < .01, *** p < .001