Helen Henningham School of Psychology
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Transcript of Helen Henningham School of Psychology
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Using Government Services to Improve the Development and Behaviour of Young Jamaican
Children: Interventions for the Home, the
Clinic and the School
Helen HenninghamSchool of Psychology
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Why is early childhood important?
Brain development most rapid and vulnerable from conception to 5 years.
Experiences in early childhood can have lasting effects on children’s ability to learn and their behaviour.
Interventions are more cost-effective than at other ages.
Without quality early childhood care children arrive at formal schooling with deficits in cognitive and social skills. This detrimentally affects their school progress.
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Millions of children < 5y not fulfilling their potential in development (WHO, 2006; UNICEF 2006)
Stunted Poverty Disadvantaged< -2z scores < $1/day (Poor &/or stunted) HAZ
156m
126m
219m (39% of children <5y)
Stunted +Poverty not stunted
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1. Deficit in grades attained (Brazil)
2. Deficit in learning per grade (Phillipines,
Jamaica)
3. Estimate total deficit (1+2)
20 % loss of yearly adult income
Loss of yearly adult income
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Conclusion
Loss of children’s potential is an enormous problem affecting >200million
It has economic and social costs both to individual and nations
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Interventions for the Home
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Importance of stimulationUnstimulating environments and lack of quality
parent-child interaction are major risk factors for poor development
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Stimulation: Weekly 1hr home visits by community health aides. Play session with mother and child. Focus on:• Enhancing
maternal-child interactions
• Language• Praise• Showing mother
how to promote development through play
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In Jamaica, we have shown benefits of psychosocial intervention to children’s development as well as mothers’ child rearing knowledge and practices
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Children enrolled at age 9-24 months received 2 years of intervention
Followed up at age 22 years
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Benefits of Stimulation at age 22y: IQ
p=0.003p=0.004
p=0.02
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Benefits of Stimulation at age 22y:Education
p=.004 p=.014
p=.005
Reading Maths General Knowledge
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Benefits of Stimulation at age 22y: Psychological Functioning
p=.03 p=.05
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Benefits of Stimulation at age 22y: Reduced violent behaviour
p=.04p=.06
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Interventions for the Clinic
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Parenting DVDs Developed
9 modules (3 minutes each) 1. Love2. Comfort3. Talk to baby4. Bath time5. Toys6. Praise7. Books8. Drawing9. Puzzles
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Health Centre Intervention• 3 modules were shown at each Child
Health clinic when the subjects: 3 months 6 months 9 months 12 months 18 months
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Group discussion & demonstration with mothers
1. Discuss the video with caregivers− What did they see on the video− What can they do with their baby− Practice− Praise caregivers and label what
they are doing2. Song or Game3. Homemade toy− How to make it− How to use it
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During Nurse ConsulationNurse asks mother what she saw on the video
and what she thinks she could tryGives mother a message card and reads it
through with herEncourage mother to try these behaviours at
homeIf the mother has not yet seen the video
encourage her to watch it
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Supplements to DVD –Message cards, Books and Puzzles
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Interventions for the School
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Children with social, emotional and behavioural problems
School entry
Primary school
• Poor relationships with teachers
• Peer rejection
• Poor parent-teacher relationships
•Low participation in the classroom
• Continuing behavior problems• Low level of bonding to school• Associate with deviant peers • Low academic achievement
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Primary school
Adolescence
Adulthood
Aggressive & disruptive behaviour
Juvenile delinquencyTruant / dropout from school
Substance abuseDepression & suicide ideation
Crime and violenceAntisocial personality disorderLow educational and economic
attainment
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Content1. How to create an emotionally supportive
classroom environment Praise, incentives, play, following child’s interests
2. How to be proactive to prevent problems Classroom rules and routines, keeping children
engaged, ‘with-it-ness’
3. Dealing with child misbehaviours Ignore, redirect, consequences
4. Teaching social skills to children Sharing, asking, waiting, trading
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Process
Video vignettes of Jamaican classrooms Group discussion Role plays Practical activities Small group work Classroom assignments In-class support: modelling, coaching & praising
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Build on Teachers’ Previous Knowledge Brainstorm at the beginning of each new topic:
Advantages, disadvantages, barriers
What are the advantages of attention, encouragement and praise: To children To teacher-parent relationships To teacher-child relationships
What are the barriers to praising children: In general For the more difficult children
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Small Group Activities Activities given to small groups:
e.g. Scenarios involving child misbehaviour and group must decide what strategies they would use
Groups role play their solutions for the whole group
Detailed feedback on strategies used by the group: What was good Why was it good
Whole group brainstorms other strategies that may be used
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Classroom Rules: Quiet hand up Walking feet Inside voice Eyes on teacher
Friendship Skills: Sharing Waiting Asking Taking turns
Teaching Skills to Children
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Explicitly teach children examples and non-examples of the skill
Have a visual aid Let children role play
the skill Practice the skill in different
contexts during the day Promote children’s use of the skill – e.g.
praise children who are using the skill throughout the regular school day
How to Teach a Skill
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In-Class Consultations Boost teacher confidence and
motivate them to use the strategies consistently
Help teachers to problem-solve Help tailor strategies to fit the
classrooms Promote continued use
of strategies over time
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Classroom Assignments Practice a specific skill taught
in workshop E.g. Labelled praise, ignore minor
misbehaviour
Record on prepared sheet What child was doing What teacher said / did
Observe and record the effect on child/ren What child did or said How child was feeling
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Results: benefits to children
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Observations
Baseline Final5
10
15Teacher Report
Baseline Final110
120
130
140
150
160
Parent Report
Baseline Final110
120
130
Change in conduct problems in intervened and control classrooms
Intervened Control
p<0.01 p<0.01
p<0.05
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Baseline Final2
4
6
8
10
12
Baseline Final60
65
70
75
80
Baseline Final7
8
Change in friendship skills in intervened and control classrooms
Parent Report
Observations Teacher Report
Intervened Control
p<0.001 p<0.001
p<0.05
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Results: benefits to teachers
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Baseline Final45
85
125
165
205
Baseline Final50
75
100
125
Teacher Positives Teacher Negatives
Change in observations of teachers’ classroom behaviours in intervened and control classrooms
Intervened Control
p<0.001 p<0.001
p < 0.001; Values are median frequency / 90 minutes of observation
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Change in observed teacher interactions to high risk children in intervened and control classrooms
Baseline Final5
10
15
20
25
Baseline Final4
6
8
10
Teacher Positives Teacher Negatives
Intervened Control
p<0.001 p<0.001
p < 0.001; Values are median frequency / hour of observation
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Percentage of teachers using physical punishment through observation
Baseline Final0
10
20
30
40
50
60
70
Control
p<0.001
%ns
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New InitiativesDeveloping and evaluating an integrated
intervention to promote child development from conception to age 5 to be embedded in existing government services in rural Colombia
(with University de los Andes, Bogota & Institute of Fiscal Studies, London)
Developing and evaluating a combined intervention of CBT for depression and early stimulation for depressed mothers and their infants in rural Bangladesh
(with the International Centre for the Diarrhoeal Disease Research, Bangladesh)
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New Initiatives in JamaicaSimplify and scale-up teacher training
intervention for Jamaican preschool teachers
Pilot a consultative model of teacher training with Jamaican primary school teachers
Develop training materials and package the Jamaican home-visiting early stimulation curriculum for global dissemination on-line
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Thank you for your attention
Diolch yn Fawr Iawn