Early intervention: parental involvement,child agency and participation in creative play

Early intervention activities for very young disabled children are frequently linked to developmental targets and goals. A key challenge for parents and practitioners involved in early intervention programmes is to encourage their child to play and develop creatively through enjoyable, everyday childhood experiences. This paper reports on a small-scale ethnographic study involving two young children identified with Down syndrome participating in early intervention programmes and whether and how their creative process was supported through their play and activities with parents and professionals. The ‘in-the-picture’ method used within this ethnographic study was developed from a listening to children paradigm. This article provides examples of the ways in which early intervention that recognises child agency can support children’s play and self-directing ‘little c’ of creativity.     

Typology for parents of abused children

This paper reports an effort to classify the parents of abused children with some existing and some new empirically/clinically consistent typologies, which are derived from the parents' psychopathological personality profiles. Such a classification scheme is informative and helpful for both treatment planning and permanency planning for abusive parents and abused children, whether or not the children have been separated from their parents. Several previously reported typologies for abusive parents are reviewed and then elaborated in light of the additional data and insights gained from an ongoing study of 50 abusive parents who were separated from their children due to severe child abuse. Such typological analyses based upon principal personality characteristics and dynamics promise to help in formulating both secondary and even primary child abuse prevention procedures and programs. The parent typologies which represent the more favorable prognoses, as determined by their therapist's estimate of their response to ongoing treatment, are those classified as rigid-compulsive, or experiencing identity/role crisis, or displaced abuse/violence. Parents whose child abusive behavior is a function of extremely maladaptive resolutions of major life issues fall into the hostile-aggressive, passive-dependent, and severe mental illness typologies, where the prognoses are considerably more guarded. The relatively high incidence of hostile-aggressive fathers coupled with passive-dependent mothers as abusive parents to children in a residential program for severely abused children also helps explain some of the children's psychopathology.     

Service needs of adolescent parents in child welfare: Is an evidence-based,structured, in-home behavioral parent training protocol effective?

SafeCare is an evidence-based behavioral parent training intervention that has been successfully implemented in multiple state child welfare systems. A statewide implementation in Oklahoma established the effectiveness of SafeCare with a diverse group of parents, which included adolescent parents under 21 years of age, a particularly at-risk group. The current study examined whether SafeCare is also effective for this subsample of 294 adolescent parents with regard to child welfare recidivism, depression and child abuse potential, and attainment of service goals. Post-treatment adolescent parent ratings of program engagement and satisfaction were also examined. Among the subsample of adolescent parents, the SafeCare intervention did not result in significantly improved outcomes in terms of preventing recidivism or reduction in risk factors associated with child abuse and neglect as compared to child welfare services as usual. Further, no significant differences in program engagement and satisfaction between SafeCare and services as usual were detected. These findings shed light on the potential differences in program effectiveness between adolescent and adult parents, and the need for future research to rigorously evaluate the effectiveness of behavioral parenting programs with adolescent parents.     

Treatment of parents who abuse their children: A literature review and implications for professionals

This article contains a review of the current treatment approaches to child abuse in terms of the following models: psychopathological, sociological, social-situational, family systems and social learning. The psychopathological model of child abuse emphasizes direct services. The services provided may consist of individual, group and lay treatment, volunteer companions, and self-help groups. The sociological model's approach to intervention emphasizes the need for wide-ranging changes in social values and structures. The socio-situational model's approach to treatment is based upon the assumption that the cause of child abuse lies not in the individual, but in the social situation, which may, in turn, be maintaining abusive patterns of behavior. The family systems approach to treatment resembles that of the socio-situational model in that it too emphasizes changing the family's pattern of interaction and behaviors. Finally, the social learning approach to treatment involves the identification of behavioral goals, specific techniques for achieving these goals, and the use of social reinforcers to facilitate this process. Data indicate that parents who abuse their children face multiple social and psychological difficulties. It has been suggested that the reason why treatment programs have not prodoced significant results in treating parents who abuse their children is that they focus on only one of the factors that operate to produce child abuse, i.e., lack of child management skills, marital dissatisfaction, or vocation or interpersonal skills dissatisfaction. It is logical that a treatment approach to abuse must view the problem as multi-determined and services should be structured in such a manner. Thus, the comprehensive treatment program should consist of the following; (1) Child Management Program; (2) Marital Enrichment Program; (3) Vocational Skills Enrichment Program; (4) Interpersonal Skills Enrichment Program. Programs to accomplish the acquisition of requisite skills in each of the four areas of emphasis are chosen from the technology of applied behavioral analysis. Each of the four program components is reviewed along with the rationale for a comprehensive program delivered through a behavioral group work approach. The article concludes with a discussion of the implementation and evaluation of the program.     

Parental experience of child protection intervention: a qualitative study

OBJECTIVE: To explore the ways in which parents experience and negotiate child protection intervention. METHOD: A qualitative grounded theory approach was used. In-depth qualitative interviews explored the experiences of 18 parents who had received child protection services. Grounded theory methods were used to build a model representing the ways these parents perceived and reacted to intervention. RESULTS: The ways parents perceive workers using power was shown to be the primary influence shaping parents' views of intervention and their reactions to it. Two perceptions of power emerged: parents perceived power being used over them as a form of control or power with them as a form of support. Three ways of responding to intervention emerged: parents fought workers by openly opposing them, "played the game" by feigning co-operation, or worked with them in collaborative relationships. Parents experiencing power being used over them tended to fight or play the game while parents experiencing power being used with them tended to work with intervention. No evidence was found linking case type (non-voluntary or voluntary cases) to whether parents perceived power being used by workers over them or with them. CONCLUSIONS: Findings highlight the importance of practitioners and policy makers being aware of the impact power has on worker-parent interaction. Doubts are raised about the viability of policies separating policing and helping in child protection through differential response systems.     

Characteristics of abusive parents: A look at self-esteem

Low self-esteem has often been cited in the child abuse literature as a characteristic of abusive parents. However, most of these references have been based on individual case studies and practitioner reports rather than explicitly designed inquiries that attempt to control bias associated with clinical observations. Data for this study were derived from a broader exploratory research project conducted within the states of Arkansas, Louisiana, and Texas. As part of the project, a total of 111 abusive parents were administered the Tennessee Self Concept Scale (TSCS). The TSCS score profiles for this group are examined along with a discussion of the implications of the findings for intervention services. The profiles permit a comparison between abusive parents' self-concepts, a group of normal self-concepts, and a group drawn from a mental hospital population. The departure of the abusive parents' self-concepts from the normal group and the apparent greater similarity to self-concepts of mental patients suggest a lengthier and more involved treatment than may have been formerly thought.     

School-based intervention for the modification of excessive absenteeism

Three procedures to modify excessive absenteeism were implemented by an elementary school principal and assessed with an across-subjects multiple baseline design. In one condition, the principal praised the child in the classroom for attending school. In a second and third condition, parents were contacted by telephone and either praised for their child's attendance or given disapproval for absences and prompts for future attendance. Results indicated that classroom intervention with the child produced a transitory increase in attendance. However, intervention with parents, both approval for attendance and disapproval for absences, produced sustained increases in attendance and parent-initiated contacts with the school. The data suggest that intervention with parents of elementary school children is more effective and efficient than direct intervention with the child in the modification of excessive school absences. School-based intervention strategies for early reduction of absenteeism may be important in the prevention of chronic truancy and of the necessity for extensive remediation.     

Web-based parenting skills to reduce behavior problems following abusive head trauma: A pilot study

Pediatric abusive head trauma causes significant cognitive and behavioral morbidity, yet very few post-acute interventions exist to facilitate long-term recovery. To meet the needs of this vulnerable population, we piloted a web-based intervention with live coaching designed to improve positive parenting and child behavior. The efficacy of this parenting skills intervention was compared with access to Internet resources on brain injury. Participants included seven families (four randomized to the parenting intervention and three randomized to receive Internet resources). Parenting skills were observed and child behavior was rated at baseline and intervention completion. At completion, parents who received the parenting skills intervention showed significantly more positive parenting behaviors and fewer undesirable behaviors during play than parents who received access to Internet resources. Additionally, during play, children in the parenting skills intervention group were more compliant following parent commands than children in the Internet resources group. Lastly, parents who received the parenting intervention reported less intense oppositional and conduct behavior problems in their children post-intervention than did parents in the Internet resources group. These findings provide preliminary evidence for the use of this web-based positive parenting skills intervention to improve parenting skills and child behavior following abusive head trauma.     

Approaching child abuse treatment from the perspective of empathy

Research identifies empathy as a moderating variable in the display of aggression. Research further suggests that empathy is a significant variable in the effective parenting of children. Studies in child abuse show that abusive parents score significantly lower on empathy measures as compared to their nonabusive counterparts. The purpose of this theoretical article is (1) to suggest based on the literature that empathy training should be a core component in treatment strategies with abusive parents. A variety of approaches to empathy training will be suggested; (2) to encourage the implementation of empathy training in interventions with abusive parents and the measurement through research of the effectiveness of this approach to treatment on a short and long-term basis.     

Violence towards children in the United States and Sweden

This paper reports the results of a cross-cultural comparison of violence towards children in the United States and Sweden. Data from the United States are based on interviews with a nationally representative sample of 1,146 households with at least one child between the ages of 3 and 17 years living at home. Data from Sweden are based on interviews with a nationally representative sample of 1,168 households with a child 3 to 17 years of age at home. Violence and abuse were measured using the Conflict Tactics Scales. In general, Swedish parents reported using less violence than did parents in the United States. There was no significant difference between the two countries in the rate of reported severe or abusive violence. The paper compares factors found associated with violence towards children in the two countries, including age, marital status, education, and parents' background. The results are analyzed by considering methodological and cultural factors that explain the similarities and differences in the use of violence towards children in the two countries.     

Parent involvement in early intervention: what role does setting play?

This study compared levels of parent involvement in early intervention services for children under three which were delivered in community settings (children’s homes and child care programs) and specialized settings (early intervention centers and provider offices) in the USA. Respondents reported the highest levels of parental involvement in the home. However, level of involvement in the home was not significantly higher than the provider’s office for parent attendance, quality and content of parent-provider communication, and effective instruction; level of provider communication and instruction to parents was not significantly higher in the home than in the early intervention center. Early intervention services in the child care setting were associated with the lowest levels of parent involvement. With the exception of child care, these results suggest that specialized and natural settings are associated with similar levels of parent involvement.     

Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development

OBJECTIVE: To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. METHOD: We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. DATA ANALYSIS: Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time. RESULTS: Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. CONCLUSION: Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.     

Essential elements of successful child abuse and neglect treatment

Not all child abuse is preventable. Society faces an ongoing need to support programs that treat the members of families in which abuse occurs. There is little systeamatically generated knowledge on the most efficient and effective ways to assist parents and children faced with abuse. The purpose of our 40-month study of eleven child abuse and neglect demonstration service programs in the United States was to expand the knowledge base in this area by determining, through evaluative research, the essential elements of successful treatment programs. This paper highlights our findings that pertain to more effective delivery of services to abusive and neglectful parents.     

Child maltreatment reporting in the general population: Examining the roles of community,collective efficacy,and adverse childhood experiences

According to bystander theory, factors such as the community environment, collective efficacy, and history of adverse childhood experiences could be related to likelihood of reporting or intervening against maltreatment. An online survey was conducted with 946 general population Californians obtained through mixed-mode random probability and quota-based recruitment methods. Using an experimental vignette design, participants were randomly assigned to two scenarios: a) potential child abuse occurring in their neighborhood; b) potential child abuse in an unfamiliar neighborhood. Weighted multivariate logistic regression models assessed relationships between the vignette condition, collective efficacy, appraisal of the behavior, and likelihood of reporting or intervening. The results suggested that perceiving the vignette as occurring in your own neighborhood was associated with lower odds of viewing the behavior as appropriate and considering it abusive. Higher collective efficacy scores were associated with lower odds of viewing the incident as inappropriate but higher odds of personally intervening. Adverse childhood experiences were positively related to reporting the incident to child protective services and intervening. Bystanders may be more likely to give parents in their own neighborhood "the benefit of the doubt" by viewing their abusive behaviors as less severe, potentially leading to underreporting. Neighborhood collective efficacy might increase willingness to personally intervene, but not contact systems such as child protective services or police, suggesting that enhanced trust in communities does not extend to these institutions. Our findings have implications for neighborhood and education interventions to enhance understanding of and willingness to intervene on behalf of children.     

Circle house residential treatment program

In summary, the Circle House Residential Treatment Program for abusive families did meet its goals of protection of the child without separation from the family. The program was also effective in making and executing permanent plans for children in a relatively short period of time, but at huge financial cost.Residential care tor abusive families may be feasible if planned for 12–18 families at a time, thus utilizing staff fully. Also, in the Circle House program the single-parent families were clearly able to utilize the program to deal with their child-care techniques. Because the program was primarily geared to improving child-rearing patterns, some fathers in two-parent families, who viewed themselves as only occasional disciplinarians, never really participated in the program. Some were successful in learning new techniques, others were not.Residential care may also be more feasible if utilized as a diagnostic and prognostic facility with enhanced opportunity for long-term relationships to be formed, rather than as a primarily treatment facility, with the expectation of improvement and “cure.” Treatment of abusive families then becomes long-term supportive care no matter how intense the initial intervention. Even with the multitude of services of Circle House at the beginning phase of diagnosis and treatment of a family, this does not reduce or remove the need for ongoing long-term services. The true results of present intervention will be measured in future generations.     

Change trajectories for parent-child interaction sequences during parent-child interaction therapy for child physical abuse

ObjectiveParent-child interaction therapy (PCIT) has been found to reduce future child abuse reports among physically abusive parents. Reductions in observed negative parenting behaviors mediated this benefit. The current study examined session-by-session interaction sequences in order to identify when during treatment these changes occur and how much the trajectory varies from case-to-case.MethodSession-by-session parent-child interaction sequences, using the Dyadic Parent-Child Interaction Coding System-II (DPICS-II) categories, were coded for 22 child welfare involved parent-child dyads undergoing PCIT for child physical abuse. A total 5,436 interactions across PCIT were coded and analyzed using growth curve analysis.ResultsAt pre-treatment baseline, negative and positive parental responses were about equally likely to follow a child positive behavior. This pattern changed rapidly during PCIT, with rapid increases in positive parental responses and decreases in negative parental responses to appropriate child behavior. A quadratic growth pattern accounted for 70% of observed variance and virtually all change occurred during the first three sessions.ConclusionChanges in observed abusive parent-abused child interaction patterns can occur early in PCIT, a parenting intervention that involves direct coaching and practice of skills. These benefits sustained throughout treatment.Practice implicationPrior to receiving behavioral parent training (PCIT), parents who have physically abused their children failed to match their parental response to their children's behavior. This pattern of interaction improved rapidly and substantially during the first three sessions of PCIT. The changes in the patterns of interaction also remained relatively stable for the remainder of treatment while parents continued to practice positive parental responses as well as began practicing effective discipline techniques. This suggests that use of immediate parent feedback through coaching, explicit directions to parents in how to respond to child behavior, and customization of the application of skills to the problems that arise in session are important components to effective parenting programs with physically abusive parents. Targeting these behaviors with PCIT has been found to reduce rates of recidivism, further supporting clinical application of PCIT in these cases.     

Full circle or forward

In the early 70s when a parent with abuse problems named Jolly K. sought help to stop her abusive behavior, there were no services for parents. Today, nearly two decades later, there has not been much improvement with regard to the provision of services for parents. Our belief is that the dichotomy which occurred early in the field's development between those who were for the child, and those (such as Parents Anonymous) who sought to provide services to parents and were presumed to be for the parent and implicitly against the child is largely responsible for an ever more punitive approach to the problem. The solution lies in shifting our focus away from the exclusive mandate to protect the child towards support for the family unit. Such a shift should include expanding the knowledge base of the field by the inclusion of information from fields such as alcoholism, spouse abuse, and eating disorders, as well as by advocating for services which support the family. Research into the part that neuro-chemistry plays in violence should also be undertaken. The impetus for change within the field cannot come from the child protective services (CPS) system, which, as a creature of the law, can only be reactive, not pro-active. Professionals working outside the CPS system must take responsibility for change if it is to occur.     

The Effects of Parent-Implemented Enhanced Milieu Teaching on the Social Communication of Children Who Have Autism

This study examined the effects of training six parents to use Enhanced Milieu Teaching (EMT) with their preschool children with autism or pervasive development disabilities. A modified single subject design across the six families was used to assess the parents' acquisition and generalized use of the EMT strategies. The parents learned to use the naturalistic language intervention strategies during 24 individual training sessions in the clinic and generalized their use of the strategies to home interactions at the end of the intervention. Follow- up observations in the clinic and home observations six months after the intervention indicated that parents maintained their use of the newly-learned procedures throughout the follow-up period but at levels lower than those achieved during the clinic training. Positive effects were observed on the use of communication targets for all children and on the complexity and diversity of productive language for most children. Child effects generalized and maintained for four of six children and there was evidence of change on developmental assessments of language for five of six children. Parent satisfaction with the intervention procedures and child outcomes was high.     

The Effects of Parent-Implemented Enhanced Milieu Teaching on the Social Communication of Children Who Have Autism

This study examined the effects of training six parents to use Enhanced Milieu Teaching (EMT) with their preschool children with autism or pervasive development disabilities. A modified single subject design across the six families was used to assess the parents' acquisition and generalized use of the EMT strategies. The parents learned to use the naturalistic language intervention strategies during 24 individual training sessions in the clinic and generalized their use of the strategies to home interactions at the end of the intervention. Follow- up observations in the clinic and home observations six months after the intervention indicated that parents maintained their use of the newly-learned procedures throughout the follow-up period but at levels lower than those achieved during the clinic training. Positive effects were observed on the use of communication targets for all children and on the complexity and diversity of productive language for most children. Child effects generalized and maintained for four of six children and there was evidence of change on developmental assessments of language for five of six children. Parent satisfaction with the intervention procedures and child outcomes was high.