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SNAP® Girls Connection (SNAP® GC) An Evidence-Based Model Intervention for Girls Under 12 Years of Age with Disruptive Behaviour Problems: The SNAP® Girls Connection (SNAP® GC) is a specialized, family-focused program for young girls1 under the age of 12 years who display aggressive and antisocial behaviour problems. A multifaceted program, it draws on a range of theoretical canons including social learning, cognitive behavioural, ecological, feminist, and attachment theories. Core SNAP® GC components, structured concurrent parent and girl groups and a mother-daughter group, were developed to address key risks experienced by girls with an early aggressive history and to build on strengths and protective factors. The program continues to evolve, informed by the professional literature and our own ongoing qualitative and quantitative investigations. Background Prior to the development of the SNAP® GC, only a small number of girls were referred annually to SNAP® services. It was only when two girls were enrolled that they were then admitted to SNAP® Under 12 Outreach Project (SNAP® ORP) groups in which boys predominated. Our exploratory data analysis and clinical observations indicated that our male- dominated groups were not adequately addressing the needs of the girls. Anecdotal evidence suggested that in this group context the girls tended either to assume the more physically aggressive style of the boys or to withdraw. Searches of the etiology and intervention research literature related to girlhood aggression, which indicated that this was an understudied and underdeveloped area, led to our decision to construct a gender-specific intervention program for the girls. In 1996, the family-focused program was initiated admitting under 12 year old girls who displayed externalizing behaviour problems (Conduct, Oppositional and ADHD). The initial SNAP® GC incorporated what was known about the etiology and treatment of girlhood aggression and our own evidence-based interventions (SNAP® ORP). Over the past 12 years, the program has continued to develop and be enhanced, based on the advancing research in this field, including our own investigations. The volume and seriousness of SNAP® GC referrals support the development of this gender-specific program. With very limited resources, the program has, to date, served some 500 young girls and their families. The SNAP GC program is privately funded, relying on the generosity of the philanthropic community What Makes Us Gender Specific? Initially like most children’s mental health organizations we were placing girls in mixed sex treatment groups with boys. Clinical concerns related to a gender imbalance (1:3), contagion, and the different developmental and behavioural style of girls indicated that a treatment approach tailored to girls’ unique needs was required. The group format, pace and content reflect these unique factors. The format and pace are oriented to talking and relationship building and recognize that girls may be subjected to gender sensitive triggers that are distinctive to their socially constructed experiences. 1 ® The SNAP ORP served both boys and girls between 1985 to 1996. As a result of our research findings, the program became gender ® specific in 1996, serving boys only. Girls are served by our SNAP Girls Connection which was launched in October 1996. The SNAP® GC incorporates what is known about girlhood aggression into treatment. There is a focus on unique forms of aggression such as social aggression. We recognize that there may be a unique context for girls’ aggression, as well strained relationships and ambivalent mother-daughter relationships are themes present in the lives of aggressive girls. The SNAP® GC also understands that there are unique risk factors that contribute to aggression in girls and that different trajectories across the life span for boys and girls with an early aggressive history exist, including teen pregnancy, depression and unemployment. Program Goals Primary Goal: To keep girls in school and out of trouble Secondary Goals: Teach girls effective anger management skills by using SNAP® (Stop Now And Plan; Self-Control and Problem Solving Technique) Teach parents effective child management skills by using SNAPP (SNAP Parenting) Teach effective ways of recognizing and coping with social forms of aggression Facilitate positive relationships with primary attention to the mother/daughter relationship and same sex modeling Teach girls to engage in pro-social peer relations Facilitate school success Prevent teen pregnancy SNAP® GC Components The SNAP® GC is a multifaceted intervention that is client responsive, delivered in a timely fashion and based on individual need and risk. Generalization activities including role-play, individualized goals and home practice are key learning modalities across treatment components. The following treatment components are offered to the girls and their families, with the first three being considered core components: 1) SNAP® Girls Club -12 weekly self-control and problem-solving SNAP® groups (girls clustered by age) 2) Parent Training Groups (SNAP® Parenting). 12-weekly concurrent SNAP® Parent Group that focuses on teaching parents effective child management strategies 3) Girls Growing Up Healthy (GGUH) - eight session mother -daughter groups focusing on relationship building, and physical and sexual health 4) Problem-Solving Group – extended service 6 session parent support group focusing on problem-solving skills 5) Leaders in Training (LIT) - 9 month leadership and life skills training group for 12-15 year old girls who have completed the core components. 6) Family Counseling based on SNAPP (Stop Now And Plan Parenting) (Levene, 1998) 7) Academic Tutoring 8) Homework Club 9) School Advocacy and Teacher Consultation 10) Individual Befriending (IB) links girls with a worker for individual counselling to strengthen skill-building, address issues such as co-morbidity and to engage girls in structured community-based activities. Girls may also be connected to a volunteer IB who may act as a mentor 21/07/2008 11) Victim Restitution 12) Specialized Risk Assessments; The Arson Prevention Program for Children (TAPP-C) for children with fire-specific problems and 13) Trauma assessment and treatment based on the Trauma Focused CBT model. Salient Research Findings In a retrospective case file study (90 files) it was found that at 6 and 12 months follow-up: o SNAP® GC girls showed significant positive change across a range of externalizing behaviours o Social relations scale - significant improvement found at 6 months and remained stable at 12 months o Medium to large effect sizes o Clinical significance was evidenced in the proportional shift of girls moving into a non- clinical range in comparison to the number of girls remaining in the clinical range o Majority of girls who remained within a clinical range at post treatment also suffer from depression and/or trauma symptoms. In a qualitative study of 16 families several important themes emerged: o Early separation and hospitalization o Idealization of the absent father o Intergenerational strained mother-daughter relationships o Diffused parent-girl boundaries o Conflict with siblings o Academic difficulties o Difficult peer relationships o Family isolation o History of abuse of the girl In a prospective Random Control Trial study of 81 girls referred to the program between 2002 and 2004, significant treatment effects were found for the following: o parents’ CBCL reports of girls’ aggression including o rule breaking o conduct disorder o social and internalizing problems o parents’ reports of parenting practices o girls’ reports of relationship quality with their parents o teacher’s report of girls’ aggression at 6-month follow-up In a retrospective and prospective case file study (162 files) it was found that at 6, 12, and 18-month follow-up: o Total EARL-21G scores predicted behaviour problems at admission and treatment outcomes o Girls with high total risk scores showed greater rates of change during treatment than girls with low total risk scores o Supports, Parenting Style, Caregiver-Daughter Interaction, Antisocial Values & Conduct, Abuse/Neglect/Trauma, Hyperactivity/Impulsivity/Attention Deficits, Peer 21/07/2008 Socialization, Academic Performance, Sexual Development, and Coping Ability risk factors significantly predicted elevated behaviour problems at admission. o Three risk factors, Abuse/Neglect/Trauma, Coping Ability, and Sexual Development, were indicators of slower rates of change for girls who were rated as high risk on these factors o For girls who showed elevated levels of problem behaviours at admission positive change was associated with overall treatment intensity, the more treatment components the greater the improvement Published Manuals SNAPP (Stop-Now-And-Plan Parenting) (1998) Early Assessment Risk List for Girls (EARL-21G) – Version 1 (2002) SNAP® girls group manual: The girls club (2003) SNAP® Parenting (SNAPP) Group manual. SNAP® Girls Connection Draft Girls Growing Up Healthy Draft Published Booklets and Videos Stealing (2000) SNAP™ (2000) Bullying (2000) Brothers and Sisters Learn SNAP™ (1995) Lying (2000) Tips For Troubled Times (2000) Videos SNAP™ Video (2000) Stopping Stealing Video (2000) Ingredients for Success Multifaceted intervention Intervention aimed at the child, the parents, the school and the community Cognitive-Behavioural Model SNAP® (Stop Now and Plan) Client Responsiveness Timely Based on Risk and Need Community Partnerships Related Publications “The Earlscourt Girls Connection: A Model Intervention” Kathryn Levene, Canada’s Children, Volume 4, Number 2, Summer 1997 “Girls’ Issues: Growing Up Angry” Kathryn Levene, OASW Newsmagazine, Vol, 25, No. 1, Spring 1998 ”Behaviour Problems: Issues for Girls and Their Families” Kathryn Levene, Ontario Association of Parents for Children’s Mental Health Newsletter Spring 1998 21/07/2008 “SNAPP Stop-Now-and-Plan Parenting: Parenting Children with Behaviour Problems” Kathryn Levene, Toronto: Earlscourt Child and Family Centre, 1998 “Special Feature: Aggressive Behaviour in Girls” Kirsten Madsen, Youth Update, Spring 2000 “Earl 21-G: Early Assessment Risk List for Girls” Kathryn Levene, Leena Augimeri, Debra Pepler, Margaret Walsh, Christopher Webster, Christopher Koegl, Toronto: Earlscourt Child and Family Centre, 2001 “The Development and Treatment of Girlhood Aggression” Debra Pepler, Kirsten Madsen, Kathryn Levene, Christopher Webster (Eds.), Hillsdale, NJ: Erlbaum (2004) “A Model Intervention for Girls with Disruptive Behaviour Problems: The Earlscourt Girls Connection. “ Margaret Walsh, Debra Pepler., & Kathryn S. Levene, (2002). Canadian Journal of Counselling. “Isolating Early Risk Factors for Female Delinquency: The EARL-21G” Kathryn S. Levene, Margaret M. Walsh, Leena K. Augimeri (in press) “Interventions for Aggressive Girls: Tailoring and Measuring the Fit” Pepler, D., Levene, K., & Walsh, M. (2004). In M. M. Moretti & C. L. Odgers (Eds.). Girls and Aggression: Contributing Factors & Intervention Principles, Perspectives in Law & Psychology Series, Volume 19 (pp. 41-56). New York: Kluwer Academic/ Plenum. “Early Assessment Risk List for Girls (EARL-21G): Predicting Antisocial Behaviours and Clinical Implications” Walsh, M., Yuile, A., Jiang, D., Augimeri, L.K., Pepler, D. (Manuscript in preparation, 2007). “Risk factors and intervention outcomes for aggressive girls in the SNAP™ Girls Connection: A prospective replication” Yuile, A., Walsh, M., Jiang, D., Pepler, D., & Levene, K. Risk factors and intervention outcomes for aggressive girls in the SNAP™ Girls Connection: A prospective replication. (Manuscript in preparation, 2007). Pepler, D., Walsh, M., Yuile, A., Levene, K., Vaughan, A. & Webber, J., (2008). Bridging the Gender Gap: Interventions with Aggressive Girls and Their Parents. Unpublished Manuscript. “Girls growing up angry: A qualitative study” Levene, K., Madsen, K., & Pepler, D (2005). ). In D.J. Pepler, K. Madsen, K.S. Levene, C.D. Webster (Eds.), The Development and Treatment of Girlhood Aggression (pp.169-190). Hillsdale, NJ: Earlbaum. “Linking identification and treatment of early risk factors for female delinquency” Levene, K. S., Walsh, M. M., Augimeri, L. K. & Pepler, D. J. (2004). In M. M. Moretti, C. L. Odgers & M. A. Jackson (Eds.), Girls and Aggression: Contributing Factors and Intervention Principles. Perspectives in Law & Psychology Series, Volume 19 (pp. 41-56). New York: Kluwer Academic/ Plenum. Research Grants “Girls Growing Up Angry: A Qualitative Study” Kathryn Levene and Debra Pepler, Investigators 21/07/2008 The Hospital for Sick Children Foundation Grant No. XG 98-049, $23,163.00 “Bridging the Gender Gap: Understanding and Treating Girlhood Aggression” Debra Pepler, Kathryn Levene, and Wendy Craig, Investigators The Hospital for Sick Children Foundation Grant No. XG 02-061, $130,000.00 “Bridging the Gender Gap: Understanding and Treating Girlhood Aggression” Debra Pepler, Kathryn Levene, and Wendy Craig, Investigators The Ontario Trillium Foundation Grant No. 9914085, $78,300 Training and Program Resource Materials Program resource materials, training and consultation are available by contacting the Centre for Children Committing Offences (CCCO) at Child Development Institute. Since 2001, more than 9000 healthcare, policing and other professionals have attended training sessions and presentations. The SNAP® trademark is owned by Child Development Institute (CDI) and is available through the CCCO at CDI. For more information contact: Kathy Levene, M.S.W. Director, Early Intervention Services/ Associate Director T 416.603.1827 ext. 3107 firstname.lastname@example.org Margaret Walsh, B.A. Researcher Co-ordinator for Bridging the Gap Evaluation Study T 416.603.1827 ext. 3121 E email@example.com Leena K. Augimeri, Ph.D. Director, Centre for Children Committing Offences 46 St. Clair Gardens, Toronto, Ontario, M6E 3V4 CANADA T 416.603.1827 ext. 3112 E firstname.lastname@example.org 21/07/2008
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