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					Integrating specialized mental health
 services into child welfare settings


 Mary Dozier              Carole Shauffer
 University of Delaware     San Francisco
               Research support

• NIMH R01 52135
• NIMH K02 74347
• NIMH Network grant (Gunnar PI)
             Dissemination support

• Foundations (Casey, Skillman, Stewart, Pierce)
• Youth Law Center
 Attachment and Biobehavioral Catch-up

• 10 session intervention delivered in foster parents’ homes

• Targets issues identified empirically as challenging

• Videofeedback central
   – Critical issues
       • Identifying times when parents are motivated
       • Strength based
       • Talented interventionists
         Targets several key issues

1. Babies in foster care especially need nurturing
   care
  a. Babies in foster care often push caregivers away
  b. Caregivers’ own issues often get in the way of their
  providing nurturing care


2. Babies in foster care need help developing self-
   regulatory capabilities
Issue 1a: Babies in foster care behave in
    ways that push caregivers away
Sequential analyses reveal that child’s behavior
  reliably elicits complementary behavior from
  parent
           Targeting issue 1a:
      Re-interpreting children’s cues
• Child needs you even though he or she may not
  appear to need you
              Issue 1b:
Caregivers’ own issues get in the way
          Targeting Issue 1b:
  Caregivers’ own issues get in the way
• Over-ride issues
• Become aware of “voices from the past”
  Issue 2: Foster children have difficulty
    regulating behavior and physiology
Behavior
  Problem behaviors
  Deficits in inhibitory control

Physiology
  Atypical production of cortisol
                 Cortisol production

Preschoolers and infants/toddlers differ from
  comparison children

Among preschoolers in foster care:
• Many have low levels in the morning
• Some have high levels at one or more times
  (Fisher et al., Dozier et al.)

Among infants in foster care:
• Many have high levels at one or more times
  (Dozier et al.)
Wake-up and bedtime cortisol levels of
infants and preschoolers in foster care
                    1.2




                     1




                    0.8
   cortisol ug/dl




                                                            Infants
                    0.6
                                                            Preschoolers


                    0.4




                    0.2




                     0

                          wake-up                 bedtime
                                    Time of day
Targeting issue 2: Help young children
  regulate behavior and physiology




•Following the child’s lead in play;
attending to child’s signals
(Barnard, 1998; Van den Boom, 1994)
Targeting issue 2: Help young children
  regulate behavior and physiology




•Touching, holding child (Field, 1994)
Targeting issue 2: Help young children
  regulate behavior and physiology




•Facilitating expression of emotions (Izard, 2003)
              Efficacy data

Randomized clinical trial
   150 children randomly assigned to:

   Attachment and Biobehavioral Catch-up
   Educational intervention
         Attachment quality among Attachment and
             Biobehavioral Catch-up and control
                   intervention children
                    70


                    60


                    50


                    40
 Percentage with
secure attachment
                    30


                    20


                    10


                     0
                            Attachment and        Control intervention   NICHD Early Child C are
                         Biobehavioral Catch-up         (n=45)                (n=1131)
                                (n=41)
                                                        Group
Problem behaviors among children in Attachment and
Biobehavioral Catch-up and treatment control children


0.45                       Attachment and Biobehavioral Catch-up
 0.4                       Treatment control
0.35
 0.3
0.25
 0.2                                           *
0.15
 0.1
0.05
  0
           0 - 18 months                  18 - 36 months
                       Cortisol production among children in Attachment and
                       Biobehavioral Catch-up and treatment control groups
                  1
                 0.9                           Attachment and Biobehavioral Catch-up
                 0.8
                                               Treatment control
Cortisol ug/dl




                 0.7
                 0.6
                 0.5
                 0.4
                 0.3
                 0.2
                 0.1
                  0
                                AM                         PM
                                         Time of Day
                   Cortisol production among children in Attachment and
                 Biobehavioral Catch-up, treatment control, and non-foster
                                     comparison groups
                  1
                                                    Attachment and Biobehavioral Catch-up
                 0.9
                                                    Treatment control
                 0.8

                 0.7                                Comparison
Cortisol ug/dl




                 0.6
                                         *
                 0.5

                 0.4

                 0.3

                 0.2

                 0.1

                  0
                              AM                        PM
                                      Time of Day
 Attachment and Biobehavioral Catch-up

Effective, efficient prevention program
There’s a need for it

“If you build it, they will come” (Field of Dreams)
Why Sell The Program
The Need
     Who are the decision
          makers?
• Child Welfare Administrators
• Political Figures
• Community leaders
• Foundations
• Advocates
• Staff
   Reasonable time frames

• Change takes time
  – but
• Times change
• Permanency for Youth
• Teens leaving care
• Education
The Time for Babies is Now

				
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posted:9/22/2011
language:English
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