The Best for Every Child - Public Health Agency · A consensus has development amongst...
Transcript of The Best for Every Child - Public Health Agency · A consensus has development amongst...
A report on the potential to transform disadvantaged communities in Lisburn through early intervention
The Best forEvery Child
Researched and written by Barnardo’s NI, commissioned by Resurgam TrustDr Roger Courtney
Public HealthAgency
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Contents
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i. ExecutiveSummary 2
1. Introduction 6
2. TheNeedsofDisadvantagedCommunitiesinLisburn 10
3. WhyEarlyIntervention? 37
4. PublicPolicyContext 46
5. TheoryofChange 75
6. OperatingModel 95
7. ImplementationPlan 102
8. Bibliography 108
Appendices
1. TermsofReference 114
2. MembershipoftheEarlyInterventionSteeringGroup 116
3. Summariesofprovenearlyinterventionprogrammes 117
4. EarlyInterventionSites&programmesintheUKandIreland 198 (Nottingham,youngballymunandWestTallaghtCDI)
Thetitleofthisreport,“Thebestforeverychild”isaquotefromoneoftheparentswhoparticipatedintheconsultationsduringtheresearchphaseindevelopingthisreport
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1. IntroductionThisfeasibilitystudyandconsultationwascommissionedfromBarnardo’swithfundingfromthePublicHealthAgency,byResurgamDevelopmentTrustrepresentingcommunityandyouthorganisationsindisadvantagedcommunitiesintheCityofLisburn,includingOldWarren,Hilden,Hillhall,Tonagh,KnockmoreandLaganValley.Itinvolvedconsultationswithaverywiderangeofcommunityorganisations,schoolsandprofessionalagenciesworkinginLisburn.Italsoincludedresearchinto:theneedsofthetargetareas;thedesiredoutcomesforchildrenandyoungpeople;theevidenceandargumentsfortakinganearlyinterventionapproachtotheissues;thepublicpolicycontextandtheextentthatitmightsupportanearlyinterventionapproach;andtheevidenceofthepotentialimpactofdeliveringparticularprovenprogrammesinthetargetareasofLisburn.
2. TheneedsofdisadvantagedcommunitiesinLisburnResearchintotheneedsofdisadvantagedareasofLisburncomplementedbyconsultationswithlocalcommunitygroupsandprofessionalsworkinginthetargetareasidentifiedverysignificantissuesconcerningthehealth,wellbeing,safetyandsecurityofthepopulationintheseareas,whichhaveaverydetrimentaleffectonthelivesofmanyfamilies.Concernsaboutparentingwerealsoveryprominentinmostoftheconsultations.Thesefindingsareconsistentwiththeinternationalliteratureoninequalityanddeprivationonarangeofwellbeingindicators.
Whatwasmoreshockingwastheverypooreducationaloutcomesofthechildrenandyoungpeople,rightfromprimaryschool.Ofthoseattendingthethreepost-primarycontrolledandintegratedsecondaryschoolsinLisburn,three-quartersleaveschoolwithout5+GCSEswithEnglishandMathsandveryfewgoontouniversityorcollege.Therewassignificantevidenceofeducationalunder-achievementbeingreplicateddownthegenerations.Thenatureofemploymentinthe21stCenturywouldsuggestthat,asaresultofpooreducationalachievement,thelevelofdeprivation,andtheextentofpoorhealthandwellbeing,intheseareaswill,ifnotarrestedbyamajorintervention,increasefurtherinfutureyears.Itwasclearfromtheresearchthattinkeringattheedgesoftheproblemwillnotbeenoughtotacklethischronicproblem:asubstantialandcomprehensiveinitiativeisurgentlyrequiredifthenextgenerationoflivesofchildrenandyoungpeopleisnottobeblighted.
3. WhyEarlyIntervention?Aconsensushasdevelopmentamongstneuro-scientists,psychologists,economistsandothersconcernedwiththedevelopmentofchildrenandyoungpeoplethat:■ 80%ofbraindevelopmenthappensbeforeachildisthreeyearsoldandsothese
arethemostcriticalyearstoinvestinthedevelopmentofthechild;
Executive Summary
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■ investingintheseearlyyearsandintheearlystageswhenchallengesinachild’slifearebecomingevidentarebothmoreeffectivethaninvestingindealingwiththechroniclaterphasesoftheseproblems;
■ investingintheearlyyearsofachild’slifeandtheearlystagesofsocialproblemsbeforetheybecomechroniccanproduceverysubstantialsavingstothepublicpurseinlateryears;
■ preventionscienceiscriticallyimportantindemonstrating,throughrobustresearch,usuallyinvolvingrandomcontroltrials,whatinterventionsactuallywork;and
■ beingclearaboutthespecificoutcomesthatanyinterventionisdesignedtoimpactonisvitallyimportant.
4. PublicPolicyContextAlthoughtheconceptsaroundanearlyinterventionapproachhaveonlybecomecommonlydiscussedinternationallyinthelastdecade,theyhavenowhadasignificantimpactonthestrategicthinkingofarangeofgovernmentdepartmentsandagenciesinNorthernIreland,whichnowemphasiseprevention,earlyinterventionandevidence-basedpractice,althoughactualimplementationoftheapproachisstillataveryearlystage.Itrequiresalonger-termperspectiveinrealisingthesavingstothepublicpurseofsuchanapproachandthebreakingdownofdepartmentalsilos,asthepositiveoutcomesofaninvestmentfromonedepartmentmayaccruetoanotherdepartment.
5. TheoryofChangeThereportoutlinesalogicmodelwhichdemonstratesthelinksbetweentheinvestmentofresources;theprogrammestobedelivered;theoutputsfromtheseprogrammes;theoutcomesintermsofchangedlives;andhoweachofthesecanbemeasured.Thelogicmodelsuggeststhatthefollowingoutcomesshouldbeaddressed:■ Reducednumberofteenagepregnancies■ Reducedlevelofsmokingduringpregnancy■ Improvedparentingskillsandconfidence■ Improvedparent-childattachmentfor0-2yearolds■ Improvedschoolreadinessamongst3&4yearolds■ Improvedliteracyandnumeracyinchildrenaged4-11■ Improvedsocialandemotionalskillsandresilienceof4-11yearolds■ Improvedschoolattendance■ Improvededucationalaspirationsandattainmentonleavingschool■ Reducedbehavioural/conductproblems■ Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ Reducedcrimeandanti-socialbehaviouramongstyoungpeople
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Effectiveinterventionsneedtocommencewithafamilybeforeachildisbornandcontinueatleastthroughprimaryschoolage.Theyneedtoincludeuniversalprogrammesaswellastargetedservices.
Inordertoaddressthis,theapproachproposedhastwokeyelements:
1) AlthoughLisburnisunder-servedinrelationtosupportforchildrenandfamilies,asitdoesnotreceiveregenerationfundingsuchasNeighbourhoodRenewal,despitehavingareaswithinthe10%mostdeprivedinthe2010MDMfiguresandhasmuchworseeducationaloutcomesthanareaswithintheworst10%,thereisstillaneedimprovetheco-ordination,effectivenessandintegrationofexistingservicesforchildren,youngpeopleandfamiliesintheLisburnareabydevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured),creatingasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother.Inaddition,allexistingorganisationswillneedtoworktogethertotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation).
2) ThescaleoftheprobleminLisburn,whereby75%ofpupilsfromallofthethreecontrolled/integratedschoolsleavewithouttheminimum5CGSEwithMathsandEnglish,issuchthatsignificantnewsustainableinvestmentisneededinnewinterventionstobreakthecycleofpooroutcomes,whichislikelytoonlygetworse.TheseneworenhancedinterventionsmustcomplimentandworkalongsideexistingcommunityserviceswithinLisburnsothatallservicesareworkingtogetherunderacommonoutcomesframework.Theneworenhancedinterventionsshouldalsohaveclearlydemonstratedeffectivenesssothatconfidencecanbegainedthattheywilldeliverthelevelofimprovementrequired.
Specificinterventionswillbeidentifiedbythemulti-agencyEarlyIntervention
LisburnConsortiumoncefundingisinplace,butarelikelytoincludeinterventionsbasedon:■ intensivehomevisiting;■ parentingtraining;■ pre-schoolearlyyearschilddevelopment;■ additionalliteracysupportintheprimaryyears;■ socialandemotionaldevelopment;and■ mentoringsupport.
Executive Summary
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6. OperatingModelThereportoutlinesanoperatingmodelfordeliveringtherecommendedprogrammesinLisburnwhichwillbebothownedbythelocalcommunity;fullyengageallthekeystakeholderswhohaveaninterestinoutcomesforchildrenandyoungpeopleinthetargetareasinacollaborativeapproach;andbedeliveredbyanagencywithstrongexperienceindeliveringearlyinterventionprogrammesforchildrenandfamilies.
TherearealsoconsiderableadvantagesindevelopingacloserelationshipwithotherareasthathavedevelopedanEarlyInterventionapproach.ApartnershipwiththeEarlyInterventioninitiativeinDerry-Londonderry,whichisatasimilarstagewouldhaveparticularadvantages.
7. ImplementationPlanThereportoutlinesamedium-termimplementationplaninphasesfortakingforwardtherecommendationsinthereport.ThephasedapproachedallowsforthepotentialfindingsfromthelargenumberofRCTevaluationsthatwillreportoverthenextfouryearsinfuturephasestobetakenonboard.
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CHAPTER ONE
Introduction
ThisreporthasbeencommissionedbyResurgamDevelopmentTrustandfundedbythePublicHealthAgencytoexplorethefeasibilityofanearlyinterventioninitiativetobreakthecycleofunder-achievementamongstchildrenandyoungpeopleindisadvantagedcommunitiesinLisburn.TheconceptofEarlyInterventionLisburnhasbeenpioneeredbytherecentlycreatedResurgamDevelopmentTrustrepresentingawiderangeofcommunityandyouthorganisationsindisadvantagedareasinLisburn.
Lisburnisarecentlydesignatedcitytothesouth-westofBelfastontheRiverLagan.Ithasagrowingpopulationof117,836.Itisanareaofsharpcontrasts.ItcontainssomeofthemostprosperousareasinNorthernIreland(includingWallacePark–themostprosperous),aswellasaseriesofdisadvantagedhousingestatesbuiltinphasesbetweentheendofWWIIandthe1970stoencouragepopulationgrowthawayfromBelfast.TheseestatesincludethepredominatelyProtestant/Unionist/LoyalistOldWarren,Hillhall,HildenandthemoremixedKnockmoreand
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1 Knockmore2 Old Warren3 Tonagh4 Lagan Valley5 Hilden6 Hillhall
7 Ballinderry8 Maghaberry9 Maze10 Ballymacross11 Ballymacash12 Lisnagarvey
13 Wallace Park14 Magheralave15 Harmony Hill16 Lambeg17 Drumbo18 Blaris
1 2 34
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Tonaghestates.TherearealsosignificantsmallerpocketsofdeprivationaroundLisburn,includinginBallymacashandMilltown/Derriaghy.
Twinbrook,Poleglass,KilweeandColinGlen,whilecurrentlywithintheLisburnLocalGovernmentArea,identifymorewithWestBelfast;willbecomepartofBelfastCouncilareafollowingtheimplementationoftheReviewofPublicAdministration;andarealreadypartofthesuccessfulColinEarlyInterventionCommunityandsohavenotbeenincludedinthisstudy.Theprocessofdevelopingthisreporthasinvolved,inadditiontoextensivedeskresearch,aseriesofconsultationmeetingsandworkshopswithcommunities,schoolprincipals,voluntaryorganisationsandstatutoryagenciesworkingwithindisadvantagedareasinLisburn.Participantsinconsultationworkshopsandinterviewshaveincludedthefollowingwhohavemadeavaluablecontributiontothedevelopmentofthestrategy:
AdrianArbuthnot–DepartmentofEducationNIAnnieArmstrong-ColinNeighbourhoodPartnershipAdieBird–ChairoftheEarlyInterventionLisburnSteeringGroup/ResurgamOwenBrady–NorthernIrelandHousingExecutiveSoniaBrown–HildenCommunityAssociationCaitlinBurns-HillhallRegenerationGroupTonyCanavan–DepartmentofJusticeNILouiseClarke–HildenCommunityAssociationRosieColquhoun–KnockmoreCommunityAssociationPatriciaConnelly–TonaghWomen’sGroupJonathonCraigMLA–MemberoftheNIAssemblyEducationCommitteeEvelynCurran-EasternChildcarePartnershipMichaelDevine–SouthEasternEducationandLibraryBoardMartinDevlin–SouthEasternHealth&SocialCareTrustSharonDickson–LisburnYMCAKieranDrayne-ColinEarlyInterventionCommunityFrancisFerris–TrainingForWomenNetworkandHillhallCommunityAssociationSharonGibson–Resurgam/LisburnPSPPaulGivanMLA–ChairofAssemblyJusticeCommitteeSamHamilton-OldWarrenCommunityAssociationAnnHardy–Children&YoungPerson’sStrategicPartnershipJulieHealy–Barnardo’sSharonHeazley–NorthernIrelandHousingExecutiveHildenWomen’sGroupFionaIrvine–TonaghWomen’sGroupIngridIrvine–TonaghWomen’sGroup
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PamelaJames-KnockmorePrimarySchoolMaureenJamison–SouthEasternHealth&SocialCareTrustMauraJohn-OldWarrenCommunityAssociationSheenaKerr–TonaghWomen’sGroupTommyKynes-OldWarrenCommunityAssociationAliceLennon-SouthEasternEducationandLibraryBoardJulieLenaghan–TonaghWomen’sGroupHelenLewis-BrownleePrimarySchoolMonicaMcCann–Barnardo’sEamonMcCarthy–DerryHealthyCitiesPatriciaMcCormick–HildenCommunityAssociationJimMcLaughlin–DerriaghyCommunityAssociationMargaretMcCormick-FortHillCollegeNeilMcGivern–SEELBPaulineMcMillan-LisburnYMCAJamesMartin-LaurelhillCommunityCollegeMonicaMeehan–SouthEasternEducationandLibraryBoardYouthServiceEdwardMilliken–HillhallRegenerationGroupLawrenceMilliken–HillhallRegenerationGroupJasonMilliken–HillhallRegenerationGroupTonyMorgan–UniversityofUlsterGailMullan-HillhallRegenerationGroupAshleyMulligan-KillowenPrimarySchoolOldWarrenWomen’sGroupDenisPaisley–OldWarrenYouthInitiativesSarahJanePatterson–CommunityworkerKnockmore/TonaghHeatherPhillips–HildenCommunityAssociationPaulPorter–LisburnCityCouncilorTanyaPorter–HildenCommunityAssociationMarianQuinnandotherstaff–TallaghtWestChildhoodDevelopmentInitiativeSeamusQuinn-StPatrick’sAcademyGordonRea–HildenCommunityAssociationJimRose–LisburnCityCouncilMabelScullion–PublicHealthAgencyJimSheerin-LisnagarveyHighSchoolDavidSmith-SouthEasternRegionalCollegeClaireSpiers-TonaghPrimarySchoolJulieStephenson–DepartmentofEducationNIHarryStewart-LargymorePrimarySchoolIanSutherland-SouthEasternHealth&SocialCareTrustFionaTeague–DerryHealthCitiesJohnTodd–DepartmentofJusticeNI
CHAPTER ONE
Introduction
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ChrisTotten–PublicHealthAgencyLisaTucker–RaggedyBapLauraTurner–Ballymacoss/NorthLisburnAnneWatsonKnockmoreCommunityAssociationJasonWhite–SouthEasternHealth&SocialCareTrustAndrewWilliamson-OldWarrenPrimarySchool
TheresearchandconsultationswereguidedbytheEarlyInterventionLisburnSteeringGroup(listofmembersofthesteeringgroupareshowninAppendix1).
Thereportisinsixmainsections:
Section 2 looksattheneedsofdisadvantagedcommunitiesinLisburninrelationtohealth,wellbeing,parenting,safety,securityandeducation.
Section3explorestheconceptofEarlyInterventionandwhyithasbecomecriticalinthedevelopmentofthinkingaboutsocialprogrammesinternationallyaswellasintheUKandIreland.
Section 4explorestherelevantNorthernIrelandpublicpolicycontextanditsrelevancetotheEarlyInterventionevidence-basedapproach
Section 5outlinesaTheoryofChangeandLogicModelandassessesandhighlightstheevidence-basedprogrammesthathavebeenshowntomakeasignificantimpactontheoutcomeswhichareappropriateforEarlyInterventionLisburn
Section 6exploresthemostappropriateoperatingmodelforengagingallthekeystakeholdersindeliveringtheEarlyInterventionLisburnvision
Section 7providesasuggestedimplementationplanfortakingforwardtheearlyInterventioninitiative.
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CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
2.1IntroductionThefollowingsectionoutlinestheissuesofconcernthatwerehighlightedincommunityconsultations,alongwithananalysisandsummaryoftheavailabledataonvariousformsofdisadvantageinthetargetareasinLisburnwhichpreventchildrenandyoungpeopleachievingtheirpotential.
TheNorthernIrelandStatisticsandResearchAgency(NISRA)gathersdataonallwardsandSuperOutputAreas(SOAs)inNorthernIrelandfromavarietyofsources,whichitdisseminatesthroughitsNINISdatabase.ThisdataprovidesarangeofimportantinformationaboutthetargetdisadvantagedcommunitiesinLisburn.
SomeoftheanalysisbelowreferstoelectoralwardsandotherstoSuperOutputAreas(SOA),wheretheinformationisavailable.SomeSOAsareco-terminuswiththeelectoralwards(e.g.OldWarrenandTonagh).InHillhall,HildenandKnockmorewards,however,therearetwoSOAsineachward.TheboundariesofwardsorSOAsmaynotbethesameastheboundariesofacommunityasperceivedbytheresidentswithinthoseboundaries.TheKnockmoreestate,forexample,isinOldWarrenratherthantheKnockmoreward.PartoftheOldWarrenestateisinLaganValleyward.
SignificantpocketsofdeprivationcanalsobecontainedwithinawardorSOAthatalsocontainscomparativeaffluence,sothatthescores/rankingsfortheward/SOAmaymasktheexistenceofthesesmallerpocketsofdeprivationaroundLisburn,includinginBallymacoshandMilltown/Derriaghy.
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Population(bywardandSOAs)*Theestimatedpopulations(andreligiousbreakdown)ofeachofthetargetwardsandSOAsin2011areasfollows:
OldWarren(70.4%Protestantand24.9%Catholic) 2,401
Tonagh(62%Protestantand35.4%Catholic) 2,537
Hillhall(90.2%Protestantand5%Catholic 2,815
Hillhall1(88.7%Protestantand5.9%Catholic) 1,412
Hillhall2(76.1%Protestantand18.4%Catholic) 1,403
Knockmore(76.1%Protestantand18.4%Catholic) 3,537
Knockmore1(73.4%Protestantand22.8%Catholic) 1,862
Knockmore2(79.2%Protestantand13.6%Catholic) 1,675
Hilden(89.5%Protestantand5.4%Catholic) 2,826
Hilden1(84.2%Protestantand8.7%Catholic) 1,351
Hilden2(94.4%Protestantand2.4%Catholic) 1,475
LaganValley 2,967
LaganValley1SOA(84.6%Protestant;8.9%Catholic) 1,379
Totalpopulation 17,083
NumberofChildren(under16)*Theestimatedtotalnumberofchildreninthetargetareasin2010areasfollows:
Ward SOA Totalno.ofchildren
0-2yearolds 3-5yearolds
OldWarren OldWarren 600 116 128
Tonagh Tonagh 512 79 97
Hillhall 611 122 115
Hillhall1 296
Hillhall2 316
Knockmore 757 157 242
Knockmore1 329
Knockmore2 427
Hilden 588 110 112
Hilden1 293
Hilden2 294
LaganValley 573 98 119
Alltargetareas 3,641 682 717
*NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
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Births*Therewerethefollowingnumberofbirthsinthetargetareasduring2009/10:
Derryaghy1 119(2010/11)
Knockmore 73
Hilden 57
Tonagh 44
OldWarren 41(46in2010/11)
Hillhall 37(23inHillhall1SOAin2010/11)
LaganValley 36
Totalnumberofbirths: 288
2.2MultipleDeprivationThissectionlooksattheNINIScompositemeasureofdeprivation*andsomeoftheviewsthatemergedfromthecommunityconsultations.
Multi-deprivation2010rankings*ThefollowingaretheMDMrankingsforthetargetareasofLisburnoutof582wardsand890SOAs:
Ward MDM ranking CommentsOldWarren 32nd Withinthe10%mostdeprivedwards
Tonagh 103rd Withinthe20%mostdeprivedwards
Hilden 154th Withinthe30%mostdeprivedwards.Hilden1SOAisranked299thoutof890SAOs;Hilden2isranked227th
LaganValley 156th Withinthe30%mostdeprivedwards;SOALaganValley1isranked231stoutof890,justoutsidetheworst25%mostdeprivedSOAs
Hillhall 203rd SuperOutputAreaHillhall1isoneofthe20%mostdeprivedSOAsinNI–ranked145th
Knockmore 285th SOAKnockmore1isranked550thoutof890;Knockmore2SOAisranked310th
*NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
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Economicwellbeing–incomesupport(2011)*
OldWarren ConsistentlymuchworsethantheNIaverageonallincomesupportindicators.ItismorethantwicetheNIaverageforthenumberofchildrenlivinginincomesupporthouseholds.Itistwoandthree-quarterstimestheNIaverageforloneparentsclaimingincomesupport
Tonagh WorsethantheNIaveragefornumberofchildreninincomesupporthouseholdsandnumberofloneparentsclaimingincomesupport
Hilden ConsistentlyworsethantheNIaverageonallincomesupportindicators
Hillhall WorsethantheNIaverageonthenumberofchildreninincomesupporthouseholdsandloneparentsclaimingincomesupport
Knockmore 18%abovetheNIaverageofnumberofincomesupportclaimantsandincomesupportclaimantswithadisabilitypremium
LaganValley 20%abovetheNIaverageforincomesupportclaimants;athirdabovetheNIaveragefornumberofchildreninincomesupporthouseholds;and57%abovetheNIaverageforloneparentsclaimingincomesupport
CommunityConsultationsConsultationswithcommunitiesandprofessionalsworkinginthetargetareas(seethelistofconsulteesintheIntroduction)highlightedtheseriousimpactofsocio-economicdisadvantageonfamiliesinthetargetcommunities.
Onecommunityrepresentativedescribedthesenseofeconomicexclusionfromlocalfacilities,suchasthenearbyleisurecentreandactivitycentre,whichareunaffordabletomanyfamiliesonlowincomes.Thesamerepresentativealsodescribedthechallengesforlowincomefamilieswhohaveachildwhogainsaplaceinagrammarschoolwhichexpectsparentstopaya“voluntary”fee,plusthecostoftheuniform,schooltrips,tuition,etc.Middleclassfamiliescanaffordtopayforspecialtutorstohelpensurethechildpassesthe11+tests,andgainsextrahelpwithkeysubjectsiftheyrequireit,aswelltheotheradditionalcontributionsexpectedbygrammarschools.
Thecommunityconsultationshighlightedconcernsaboutincreasinglevelsofunemployment(althoughlowerthanmanyotherareasofsignificantdeprivation);theincreasingnumberofjobswhicharetemporary,part-timeand/orlowpaid;andproblemsofunemployabilityduetothelowlevelsofeducationalachievement,discussedbelow.
Theconsultationsalsohighlightedtheimpactofa“benefitsculture”particularlyforfamilieswhereno-oneisworking,where,toenhancetheirmeagreincomes,theireffortsareoftenfocusedonmaximizingbenefitsclaimsformedical
*NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
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conditionsordisabilitiesamongsttheparentsandchildren.Thebenefitstrapwhichmakesitdisadvantageousforparentstotakeuplowpaidemploymentbecausetheywillbeworseoffwasalsohighlighted.
Thelackofaffordablechildcarewasalsocitedasanotherbarrierinparentsgainingpaidemploymentduringvariousoftheconsultationswithcommunityandwomen’sgroupsinthetargetareas.Itissupportedbythelackofidentifiableall-daychildcareprovisionintheareas.
2.3EducationThissectionexplorestherelevantdataoneducationalperformance(basedon2009/10statisticsfromDENI).IthighlightstheinadequateeducationaloutcomesformanychildrenindisadvantagedcommunitiesinLisburn,muchofitreflectingtheenvironmentalfactorsinthelivesofthechildren.
PleasenotethatstatisticalinformationbywardprovidedbyNINISisfromtheyear2009/10.StatisticalinformationfromtheDepartmentofEducationonschoolperformanceisfortheyear2010/11
Percentageofpost-primarypupilsentitledtofreeschoolmealsMostlyconsistentwiththeMultipleDeprivationMeasuresforeachward,highlightedabove,thefollowingarethepercentageofchildrenentitledtofreeschoolmealsineachward:
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hilden
Hillhall
Lagan Vallet
Tonagh
Old Warren 39.9%
(a much lower % than would be suggested by the ward’s multiple deprivation ranking)
26.4%
23.8%
17.6%
17.6%
11.1%
NI average 16.7%
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
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Percentageofpupilsstatemented/SENyears1-7AllthetargetwardsareabovetheNIaverageof18.9%,intermsofthepercentageofpupilsinschoolyears1to7,whohavebeenstatementedasaresultoflearningdifficultiesordesignatedashavingspecialeducationalneeds,exceptforKnockmorewhichisbelowaverage(15.4%):
Atpost-primarylevel,morethanonequarter(27.7%)ofstudentsatLaurelhillCommunityCollegehavespecialeducationalneeds;20.9%atFortHillCollege.and13.3%atLisnagarveySecondarySchool.
SpeechandlanguagedifficultiesThenumberofspeechandlanguagereferralsforchildrenagedunder16atthetimeofreferralinthetargetareasareshowninthetablebelow:
LISBURN WARD New Review Group Contact
Can C Did not respond /attend
Grand Total
Multiple Deprivation Ranking
BALLYMACOSS 45 705 353 112 46 1261 395
DERRYAGHY 64 667 289 89 68 1177 198
HILDEN 17 315 254 36 30 652 154
LAGANVALLEY 16 375 194 35 19 639 156
TONAGH 15 318 230 31 15 609 103
BALLYMACASH 20 371 146 28 25 590 575
BLARIS 12 376 156 25 15 584 470
OLDWARREN 17 243 261 31 19 571 32
HILLHALL 17 282 220 22 25 566 203
KNOCKMORE 27 239 92 47 35 440 285
TWINBROOK 12 243 116 19 34 424 10
POLEGLASS 30 213 90 39 42 414 80
WALLACEPARK 11 174 54 15 14 268 582
LISBURN(allwards)Total
619 9230 4736 1191 753 16529
Twinbrook,PoleglassandWallaceParkwardshavebeenincludedbywayofcontrast.
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hillhall
Hilden
Tonagh
Lagan Valley
Old Warren 41.8%
28.8%
26.2%
23.9%
21.8%
15.4%
NI average 18.9%
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Itmighthavebeenexpectedthatchildrenfrommoredeprivedwardsarelikelytoexperiencegreaterproblemswiththeirspeech/language.Thistable,however,doesnotconfirmanyrelationshipbetweenthelevelofdeprivationofawardandthenumberofreferralsofchildrenwithspeechandlanguagedifficulties.Thelackofanyexpectedrelationshipmaybetodowiththeconfidenceofmoremiddle-classparentstoaccesstheservicestheyfeeltheirchild,whoisexperiencingspeechorlanguagedelays,requires,counterbalancinganyrelationshipwithdeprivation.
Percentageofpoorattendance(lessthan85%)atprimaryschoolAllthetargetwardsareworsethantheNIaverageof5.5%intermsofchildrennotachieving85%attendanceatprimaryschool:
Sub-domain for primary school rankingNINIScalculatesasub-domainscoreandranking,basedindatafrom2006/7-2007/8.Itiscalculatedusingthreesetsofindicators:■ The%ofchildrenachievinglevel4orhigheratkeystage2■ The%ofchildrenwithspecialeducationalneeds■ Thelevelofabsenteeism
ThegeneralrelationshipbetweentheSOANINASprimaryschoolsub-domainrankingsandtheMultipleDeprivationrankingsishighlightedinthetablebelow.However,theHildenSOAs(withamultipledeprivationrankingsof227and299)haveprimaryschoolsub-domainrankingsof117thand119th,whicharemuchworsethanwouldbeexpected.Tonagh,LaganValley1,Knockmore1andHillhall2arealsoworsethanwouldbeexpectedfromtheMultipleDeprivationRankings.OldWarrenandHillhall1arebetterthanwouldbeexpected.
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Tonagh
Hillhall
Old Warren
Lagan Valley
Hilden
NI average 5.5%
12.1%
11.6%
8.4%
7.0%
6.9%
5.5%
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
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SOA Primary School Ranking MDM Ranking CommentsHilden2 117th 227 Withintheworst15%ofSOAs
Hilden1 119th 299 Withintheworst15%ofSOAs
OldWarren 129th 85 Withintheworst15%ofSOAs
Tonagh 138th 192 Withintheworst15%ofSOAs
LaganValley1 187th 231 Withintheworst25%ofSOAs
Knockmore2 312th 310
Knockmore1 383rd 550
Hillhall1 397th 145
Hillhall2 430th 612
PrimarySchoolPerformanceatKeystage1and2(EnglishandMaths)1
Theexpectationisthatallprimaryschoolpupilswillachieveatleastlevel2EnglishandMathsatkeystage1andlevel4inEnglishandMathsatKeyStage2.
ThetablebelowshowsthenumberofprimaryschoolsinLisburnthatdonotenable90%oftheirpupilstoachievethesestandards,outofapossiblemaximumof14schools.Theyarepartlybasedonsubjectiveteacherassessmentssotheyneedtobetreatedwithsomecaution.
Stage and Level
The number of primary schools not achieving 90% of the target
The number of primary schools in Lisburn achieving below the NI average for that band of free school meal entitlement
Comments
KeyStage1Level2English
5 6 3oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+.ThreearecurrentlyExtendedSchools2,twoofwhichhavenurseryclasses.Twoarebelowtheirtargetintake
KeyStage1Level2Maths
3 8 Only1oftheschoolsnotachieving90%hasafreeschoolentitlementof30%+.ItiscurrentlyanExtendedSchoolwithanurseryclass.Itbelowitsintaketarget
KeyStage2Level2English
8 6 4oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+,allofwhicharecurrentlyExtendedSchools,twoofwhichhaveanurseryclassandoneareceptionclass.Twoarebelowtheirtargetintake.
KeyStage2Level2Maths
8 7 4oftheschoolsnotachieving90%haveafreeschoolentitlementof30%+,allofwhicharecurrentlyExtendedSchools,twoofwhichhaveanurseryclassandoneareceptionclass.Twoarebelowtheirtargetintake.
1 FromKeyStageOne&TwoAssessmentsforschoolsintheLisburnAreain2010/11–DepartmentofEducation
2 The2012/13ExtendedSchoolentitlementwillbedeterminedpriortoSeptember2012.
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TheseprimaryschoolKeyStage1&2findingswouldsuggestseriousconcernsabouttheStage1resultsinfiveoftheprimaryschools(fiveinEnglishandthreeinMaths)andKeyStage2resultsinsevenprimaryschoolsinbothEnglishandMaths.Surprisingly,fouroftheseschoolshavelessthan20%ofpupilsentitledtofreeschoolmeals.
Twooftheprimaryschoolslistedsend70%+oftheirpupilstoagrammarschool.Fiveprimaryschools(includingtheabovetwo)sendmorethanhalfoftheirpupilstoagrammarschool.Sixoftheschoolssent20%orlessoftheirpupilstoagrammarschool.ThefindingsalsoshowthatgoodresultsatKeyStage1donotnecessarilymeangoodresultsatKeyStage2andvisa-versa.
Thesestatisticsonprimaryschoolperformanceareveryinteresting,becausethereisaweakerlinkbetweentheassessmentscoresandthepercentageofpupilsentitledtofreeschoolmeals(ameasureofdeprivation)thantheliteraturewouldsuggest.Thisimpliesthat,inadditiontotheroleofparents,theroleoftheschoolisveryimportantinincreasingtheaspirationsandachievementofchildren.
Byward,thenumbers(notpercentage)ofpupilswhoareresidentinthetargetareasandattendagrammarschoolareasfollows:
Bywayofcontrast,thefigureforWallaceParkis175andthefigureforPoleglassis125.
Theresultssuggestthat,onaverage,atKeyStage2,aboutonequarterofpupilsinLisburnExtendedSchoolsarenotachievingtheminimumacceptablestandardatKeyStage2EnglishorMaths.However,theactualpercentagevariesbetweenschoolsandsubjects:from19.45%to53.55%.These25%ofprimaryschoolpupils(andtheworstperformingschools)shouldbeanimportantfocusofanyEarlyInterventioninitiativeandthegenerationswhicharelikelytofollowintheirfootsteps,unlessdecisiveactionistaken.
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hillhall
Lambeg
Lagan Valley
Tonagh
Hilden
Old Warren 21
31
36
59
68
72
88
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 19
Theseprimaryschoolresultswouldsuggest,subjecttotheoutcomeoftheauditofschoolsthatiscurrentlytakingplace,whichmayresultinfurtherschoolclosures,anyprimaryschoolsinitiativeshould,perhaps,beconcentratedontheschoolsdesignatedasExtendedSchools(3ofwhichhavenurseryclassesand1whichhasareceptionclass),oronthefouroftheExtendedSchoolswiththelowestkeystageresults(twooftheExtendedSchoolshaveimpressiveKeyStage1&2results).
TheevaluationoftheExtendedSchoolprogrammedidnotdemonstratearelationshipbetweenExtendedSchoolfundingandPrimarySchoolperformance,butrecommendedacloserrelationshipbetweentheactivitiesfundedundertheExtendedSchoolprogrammeandtheeducationalaimsoftheschool.
Post-PrimaryPerformance
Percentageofpoorattendance(lessthan85%)atpost-primaryschoolAllthetargetwardsinLisburnareworsethantheNIaverageof12.7%fornotachieving85%attendanceatpost-primaryschools:
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hillhall
Hilden
Lagan Valley
Tonagh
Old Warren
NI average 12.7%
30.0%
25.6%
25.1%
23.7%
21.2%
20.3%
Page 20
Leavingschoolwith5+GCSEsatgradeA*-C(2009/10)*AllthetargetwardsareconsistentlywellbelowtheNIaverageof72%foryoungpeopleleavingschoolwithatleast5GCSEsatgradeA*toC,includingthemoreaffluentLambegward:
AveragenumberofpupilsleavingcontrolledandintegratedschoolsinLisburnin2010/11with5+GCSEs(DeptofEducation)
Average and Range 2010/11
Comment
%ofcontrolledandintegratedsecondaryschoolpupilsinIisburnachieving5+GCSEsA*-CwithEnglishandMaths(2010/11)
Average:24.27%
Range:19.6–26.7%
TheaverageforallNIschoolsis60%.(and36%forallNInon-grammarschools).TheNIgovernment’sPfGtargetisanaverageof66%forallpupilsand49%fordisadvantagedpupilsby2014/15
%ofcontrolledandintegratedsecondaryschoolpupilsinLisburnachieving5+GCSEsA*-C(2010/11)
Average:44.57%
Range:43.5–46.4%
TheaverageforallLisburnschoolsis75.1%.(96.8%forLisburngrammarschools)Theaveragefornon-grammarschoolsinNorthernIrelandis57.3%.
OneoftheLisburnsecondaryschoolscurrentlyhasExtendedSchoolsfunding.Anotherhadthefundingunderapreviousround.TwoofthesecondaryschoolsarecurrentsubjecttoFormalIntervention.
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hilden
Hillhall
Lagan Valley
Lambeg
Old Warren
Tonagh
NI average 12.7%
20%
40%
48%
53.1%
55%
57%
58%
* NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 21
Leavingschoolwith2ormoreAlevelsAllthetargetwardsareconsistentlylowerthantheNIaverageof53.6%foryoungpeopleleavingschoolwith2ormoreAlevels(56%inLisburn).EventhemoreaffluentLambegWardhasapoorrecordintermsofAlevelresults:
A level results of post-primary schools TheNIaverageforallpost-primaryschoolsAlevelresultsin2010/11is51.5%leavingschoolwith3+AlevelsA*-C(DepartmentofEducation).TheaverageforthesecondaryschoolsinLisburnis35.1%(48.4%achieved5+GCSEs).
Percentageofschoolleaversinhighereducation*AllthetargetwardsareworsethantheNIaverageof42%foryoungpeoplegoingontohighereducationi.e.university:
TheNIaverageforyoungpeopleleavingnon-grammarschoolsandgoingontouniversityorequivalentis19.2%.TheNIaverageforyoungpeopleentitledtofreeschoolmealsgoingontouniversityorequivalentis18.3%.Againboystendtodomuchworsethangirls.
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hillhall
Lagan Valley
Hilden
Tonagh
Lambeg
Old Warren
NI average 53.6% Lisburn average 56%
12%
14%
20%
32%
34%
38%
44%
0 10 20 30 40 50 60 70 80 90 100
Knockmore
Hilden
Tonagh
Old Warren
Hillhall
Lagan Valley
NI average 42%
9.4%
10%
12%
20%
29%
30%
* NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
Page 22
Percentageofschoolleaversinfurthereducation*AllthetargetwardsareworsethantheNIaverageof33%(andtheNInon-grammaraverageof43.7%)foryoungpeoplegoingontofurthereducation(i.e.college):
Education,skills&trainingdeprivationdomainrankingforSOAs*TheoverallNINIS2010education,skills&trainingrankingsforallthetargetSOAsareasaremuchworsethantheiroverallmultipledeprivationranking.Someofthedifferencesarestriking.
CommunityConsultationsThefindings,above,fromthestatisticsoneducationalachievement,wereechoedbythefindingsfromthecommunityconsultations.Muchofthediscussionaroundeducationalunderachievementhighlightedaviciouscircleinvolving:
0 10 20 30 40 50 60 70 80 90 100
Hillhall
Knockmore
Lagan Valley
Tonagh
Old Warren
Hilden
NI average 33%
11%
12%
20%
25%
30%
31%
0 100 200 300 400 500 600 700 800 900 1000Hillhall 2
Knockmore 1
Knockmore 2
Laganvalley 1
Tonagh
Hilden 1
Hillhall 1
Hilden 2
Old Warren 5995109
128134
173181
393512
within the worst 10% of SOAs (MDM ranking of 85)
within the worst 15% of SOAs (MDM ranking of 227)
within the worst 15% of SOAs (MDM ranking of 145)
within the worst 15% of SOAs (MDM ranking of 299)
within the worst 15% of SOAs (MDM ranking of 192)
within the worst 20% of SOAs (MDM ranking of 231)
within the worst 25% of SOAs (MDM ranking of 310)
(MDM ranking of 550)
(MDM ranking of 612)
* NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 23
■ parentswhooftenthemselveshadpoorexperiencesintheeducationsystemandthereforedonotvalueeducation;
■ povertyrestrictingtheabilityofmanyfamiliestoencouragetheirchildrentogotoagrammarschool,getextratuitionwhentheyneedit,and/orgoontouniversityinsteadofgettingajob;
■ parentsfacingoverwhelmingpersonaldifficulties(mentalhealth,physicalhealth,carerresponsibilities,addiction,domesticviolence,etc)themselves;
■ parentshavinglowambitionsforthemselvesandtheirchildren;■ parentswithpoorliteracyandnumeracy;■ parentsnotreadingtotheirchildren;■ thetendencyofchildrentofollowinthefootstepsoftheirparents,older
siblingsand/orfriends,includingthosewhohavelesspotential;■ lackofconsistentboundariessetforchildrene.g.lettingchildrenstayuplate
andarelateortiredthenextdayinschool,ornotensuringthechildrenattendschool;
■ lackofconsistentpositivediscipline,orveryharshdiscipline,leadingtopoorbehaviour/conduct;
■ lackoffocusedsupportforchildrenwithlearningdifficulties/developmentdelay,butnotstatemented;
■ thelackofcommunityrolemodelschampioningtheimportanceofeducation;■ thelackofavailablejobswhichcouldcreateamotivatortoobtain
qualifications;■ lackofparentalengagementwithschoolsparticularlyafterP1&P2;and■ parentsandteachersviewingmanychildrenas“notacademic”andtreating
themaccordingly(incontrasttomiddle-classparentswhowilltendtoseekoutandpayforappropriateprivatetuitionorsupportservice,toensuretheirchildwillfulfilltheirambitions/potential.
Parentsconsultedwhoareworkingtendedtoresenttheprioritygiventoparentsonincomesupportorjobseekersallowanceinobtainingplacesinnurseryschools;aswellasnurseryplacesbeingallocatedtomiddle-classchildrenfromoutsideofthearea.
Theconsultationsalsohighlightedtheparticularchallengesfacedbytheincreasingnumberofloneparents.Oneteacherhighlightedaparticularclassintheirschoolwhichhadnofatherslivingwiththeirchildren.Thevastmajorityofprimaryschoolteachersarealsowomen,raisingconcernsaboutthelackofpositivemalerolemodelsinthelivesofboys.
Page 24
ConsequencesofpooreducationaloutcomesLeavingschoolwithfewornoqualificationshasverysignificantimplicationsfortheoutcomesforthatchildinlaterlife.OfthosewholeftschoolwithnoqualificationsinNorthernIreland,only45%arecurrentlyinanyformofemployment.Thequalificationsgainedalsohaveamajorimpactontheincomeoftheindividual,asshownbythegraphbelow.
WageRatesbyQualificationLevel
Thosewithathird/tertiary(degree)levelqualificationearnedmorethan40%abovetheaverage.Thosewithnoqualificationsearnedonlyc.75%oftheaverageandthereforeareathighriskofpoverty.
CommentoneducationaldisadvantageThesefindingsshowclearlythatonalleducationalindicatorsthemajorityofchildrenandyoungpeopleinthetargetareasarefailingtoachievetheirpotentialintermsofeducationaloutcomes.Evenattendanceatschoolisasignificantproblem,rightfromprimaryschool(andmuchworseatpost-primary).Outcomesintermsofgoingontoagrammarschool,achievingGCSEs,AlevelsandgoingontocollegeoruniversityareverysignificantlylowerthantheNIaverage.
Theextentofeducationaldisadvantageismuchworsethanwouldbeanticipatedfromthedataoneconomicdisadvantage(seeabove)aloneandcomparespoorlywithothermoreeconomicallydisadvantagedpredominantlyCatholic/Republicanareas.
0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
2011201020092008200720062005
Tertiary A-level No Quals
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 25
IftheevidenceinrelationtogenderforNorthernIrelandasawholeisthesameinLisburn,itisalsolikelythatboysinLisburnareperformingmorepoorlythangirls.
ThesefindingsareconsistentwiththefindingsofthePWCNI-widestudycommissionedbytheDepartmentofEducationin2008,whichshowedthatatKeyStage2EnglishandMathematics,proportionatelyfourtimesasmanycontrolledschoolswereunderperforminginNIcomparedtomaintainedschools.AtGCSEEnglishandMathematics,14%ofcontrolledschoolsinNIwereunderperforming,comparedwith4%ofmaintainedschools.TheyalsosupporttheconclusionsofthePurvisReviewinrelationtounder-achievementofProtestantworking-classchildren.
Itiscommonforschoolstobeblamedforthisunder-achievement.However,theresearchevidenceshowsthat75-90%ofthedifferencebetweenchildrenwhoachieveandunder-achieveisduetofactorsoutsideofthecontrolofschools,particularlyinrelationtoparentswhothemselveshaveunder-achievededucationallyand,asaresult,donotvalueeducation.
2.4Health&WellbeingThissectionlooksatsomeofthemeasurableindicatorsofhealthwithinthetargetdisadvantagedcommunitiesinLisburnandtheviewsofthoseinvolvedinthecommunityconsultations.
Dentalregistrationsofyoungchildren1Thelevelsofdentalregistrationsof0-2and3-5yearoldsin2011areconsistentlylowerthantheNIaverage(27.8%for0-2yearoldsand63.6%for3-5yearolds)inallthetargetareas,exceptfor0-2yearoldsinHillhall.
Ward Dental registrations of 0-2 year olds
Dental registrations of 3-5 year olds
Comment
OldWarren 19.6% 43.2% 68%and70%respectivelyoftheaverage
LaganValley 17.9% 46.7% 64%and73%respectivelyoftheaverage
Tonagh 21.6% 40.2% 78%and63%respectivelyoftheaverage
Hilden 24.8% 49.5% 89%and78%respectivelyoftheaverage
Knockmore 24.4% 54.3% 88%and85%respectivelyoftheaverage
Hillhall 27.9% 51.8% ThesameastheNIaveragefor0-2yearoldsbutonly81%oftheaveragefor3-5yearolds
NIAverage 27.8% 63.6%
1 DentalRegistrations2011CSA
Page 26
SmokingduringpregnancyMothersinmostofthetargetareasaremuchmorelikelytosmokeduringpregnancythantheNIaverageof16%:
Percentageofbirthstounmarriedmothers2
MostofthetargetareasaresubstantiallyabovetheNIaverageof39.8%forthepercentageofbirthstounmarriedmothersin2009,exceptforKnockmore1.TheSOAswiththehighest%ofbirthstounmarriedmothersareOldWarren,LaganValley1andHillhall1.
0 10 20 30 40 50 60 70 80 90 100
Hillhall
Hilden
Lagan Valley
Tonagh
Knockmore
Old Warren
NI average 16%
34%
29%
25%
24%
19%
16%
(more than twice the NI average)
(87% above the NI average)
(56% above the NI average)
(50% above average)
(19% above the NI average)
Hillhall is the same as the NI average
0 10 20 30 40 50 60 70 80 90 100
Knockmore 2Knockmore 1
KnockmoreHillhall 2Hillhall 1
HillhallTonagh
Hilden 2Hilden 1
HildenLagan Valley 1
Old Warren 72.5%63.2%
52.9%55.6%
50%48.7%
43.5%60.9%
26.1%33%
29.2%42.3%
(82% above the NI average)
(58.8% above the NI average)
(33% above the NI average)
(40% above the NI average)
(26% above the NI average)
(22% above the NI average)
(11% above the NI average)
(53% above the NI average)
(below the NI average)
(below the NI average)
(below the NI average)
(11% above the NI average)
2 NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 27
Medianageofmothersofnew-bornbabies(notavailablebySOA)TheNIaverageageformothersofnew-bornbabiesis29.TheaverageinOldWarren,HillhallandHildenisyoungerthantheNIaverage.
LifeExpectancyLifeexpectancy(seemedianageatdeath,below)isbelowtheNIaverageforbothmenandwomeninOldWarrenandTonagh.ItisalsobelowtheNIaverageformeninHillhallandforwomeninKnockmore.
Medianageatdeath(notavailablebySOA)MostofthetargetwardshaveanaveragelifespanbelowtheNIaverageof79.OfparticularconcernisOldWarrenwherethedifferenceis6years.
0 10 20 30 40 50 60 70 80 90 100
Tonagh
Knockmore
Lagan Valley
Hilden
Hillhall
Old Warren
NI average 29
26
27
27
27
29
30
(3 years below the NI average)
(2 years below the NI average)
(2 years younger than the NI average)
(2 years below the NI average)
(same as the NI average)
(1 year older than the NI average)
0 10 20 30 40 50 60 70 80 90 100
Lagan Valley
Knockmore
Hilden
Tonagh
Hillhall
Old Warren
NI average 79
73
77
78
78
81
82
(6 years below the NI average)
(2 years below the NI average)
(1 year below the NI average)
(1 year below the NI average)
(above the NI average)
(above the NI average)
Page 28
Percentagedeathsunderage75*OldWarrenandKnockmore2arewellabovetheNIaverageof38.4%forthepercentageofdeathsin2009forpeopleundertheageof75.
CommunityConsultationsThecommunityconsultationsalsohighlightedarangeofphysical,mentalandsexualhealthrelatedissuesofconcern,which,intheresearchliterature,areoftenassociatedwithgeographicalareasofsignificantdisadvantage.Theseinter-relatedissuesincludethefollowing:
■ Smoking(includingsmokingduringpregnancy)■ Heavydrinking(includingdrinkingduringpregnancy)■ Druguse,especiallyprescriptiondrugs■ Depressionandothermentalhealthdifficulties■ Self-harmandsuicide■ Unhealthyeating■ Obesity■ Lackofexercise
CommentsonhealthandwellbeingissuesThestatisticsandcommunityconsultationsraisesignificantconcernsabouthealthandwellbeingissuesinthetargetareas.ThelevelofearlydeathinOldWarrenandKnockmore2isparticularlydisturbing.Thefactthatthemajorityofbirthsaretounmarriedmothersreflectschangesinsociety,butismuchhigherthanotherpartsofNorthernIreland(andLisburn).Itreinforcestheevidencefromschoolsofthehighlevelofloneparents,whichcanhavesignificantimplicationsforparenting.Thehighlevelofsmokingduringpregnancyisonecontributing
0 10 20 30 40 50 60 70 80 90 100
Lagan Valley 1Lagan Valley
Hilden 2Hilden 1
HildenKnockmore 2Knockmore 1
KnockmoreTonagh
Hillhall 2Hillhall 1
HillhallOld Warren 52%
37.5%36.4%
40%
35%38.5%
27%20%
57.1%26.1%
15.4%17.5%
41.7%
(35% above the NI average)
(just below the NI average)
(just below the NI average)
(the same as the NI average)
(below the NI average)
(70% of the NI average)
(half the NI average)
(almost 50% above the NI average)
(two-thirds of the NI average)
(4% above the NI average)
(40% below the NI average)
(less than half the NI average)
(9% above average)
* NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 29
factortopassingondisadvantagetothenextgeneration.Thelevelofdentalregistrationsisafurtherindicationofsomeparents’knowledgeorlackofconcernforthehealthandwellbeingoftheirchildren.
2.5SafetyandStabilityThissectionexploresissuesofsafetyandstabilityindisadvantagedcommunitiesinLisburn,includingprotectionofchildren,anti-socialbehaviourandcrime.
ChildProtectionThefollowingtableshowsthenumberofchildrenwhowerereferredtosocialservicesinrelationtochildprotectionissueslastyearand,aschildrenmoveinandoutoftheChildProtectionRegisterovertime,thenumberofchildrenwhoarecurrentlyonthechildprotectionregisterineachofthetargetSOAs:
SOA Number of children referred (2011)
Number of children currently on the child protection register (a
particular point in time in 2012)Derryaghy1 113(the2ndhighestSOAin
theSEHSCTarea)10
OldWarren 78 15
Tonagh 53 18(thehighestofanySOAintheSEHSCTarea
Hilden1 34 *
Hilhall1 33 10
LaganValley1 30 7
LaganValley2 27 *
Hilden2 5 *
*Lessthan5
ThesestatisticssuggestparticularchildprotectionconcernsinDerryaghy1,OldWarren,TonaghandHillhall1.
Page 30
Numberofanti-socialbehaviourincidentsAllthetargetwardsarewellabovetheNIaverageof141forthenumberofanti-socialbehaviourincidentsreported,exceptforHillhall(91):
Numberofcriminaloffencesper10,000ofthepopulation(2010/11)1
AllthetargetwardsarewellabovetheNIaverageforcrime,exceptforHillhallandKnockmore.ViolentcrimesaremorethantwicetheNIaverageinHildenandTonagh.
Violent crimes
Criminal damage
Burglary Other theft offences
Vehicle offences
Totals
Hilden 502.4 303.6 150 376.8 41.9 1573.6
Tonagh 477 278.9 32.3 319.3 68.7 1321.7
Laganvalley 310 330 73.3 190 40 1126.7
OldWarren 252.5 332.7 80.2 64.1 36.1 853.7
Hillhall 126.6 94 32.5 94 36.2 470.2
Knockmore 110 107.7 60.9 67.9 70.2 461.1
NIaverage 165.6 138.9 65.9 102.8 38.5 583.8
0 100 200 300 400 500 600 700 800 900 1000
Hillhall
Knockmore
Old Warren
Laganvalley
Hilden
Tonagh
NI average 141
(two and a third times the NI average)
(two and a third times the NI average)
(two and a quarter times the NI average)
(one and a half times the NI average)
(a third above the NI average)
(below average)
331
330
316
220
190
91
1 NINISwardandSOAprofiles(www.ninis.nisra.gov.uk–lastupdatedOctober2011)
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 31
NumberofdomesticabuseoffencesAllthetargetwardsareabovetheNIaverageof17forthenumberofdomesticabusecasesreportedin2010:
CommunityConsultationsTheconsultationswithlocalcommunities,schoolsandprofessionalsworkinginthearea,alsohighlightedconcernsinrelationtosafetyandstability,inparticular:■ youngpeopleengaginginanti-socialbehaviourandcriminalactivity,
includingviolence■ domesticviolence
However,insomeareastherealsoseemstohavebeenimportantimprovementsinrelationshipswiththepoliceinstartingtotrytotacklesomeoftheseissues.
CommentsonsafetyandstabilityThestatisticsfromthetargetareasreflectverysignificantconcernsaboutchildprotectionissues,anti-socialbehaviourandcrime,includingdomesticviolence,inmanyofthetargetareas,whichwerereinforcedduringthecommunityconsultations.
2.6ParentingAkeyunderlyingissueinallthecommunityconsultationswasamajorconcernaboutparenting,which,initself,hasanimpactontheotherissueshighlightedaboveof:educationalunder-achievement;lackofambition;unhealthylifestyles,etc.ensuringthatthecycleofdisadvantageandunder-achievementispassedongenerationtogeneration.
Parentingissuesarehardertoquantifyinstatisticalinformationandcanoftenonlybequantifiedindirectlye.g.throughissueslikethelevelofdental
0 10 20 30 40 50 60 70 80 90 100
Hillhall
Laganvalley
Knockmore
Hilden
Tonagh
Old Warren
NI average 17
36
36
34
33
32
20
(more than twice the NI average)
(more than twice the NI average)
(twice the NI average)
(twice the NI average)
(88% above the NI average)
(18% above the NI average)
Page 32
registrations(highlightedunder“health”above),childaccidentsorhospitaladmissions,orchildrenontheriskregister,orincare.
However,parentingcameupasthemajorthemeinnearlyallthecommunityconsultations.Someofthekeyissueshighlightedintheconsultationswereasfollows:
■ Havingchildrenwhentheparentsweretooyoung■ Parentingskillsnolongerpasseddownthroughthegenerations■ Lackofparentingknowledge■ Lackofaparentingculture■ Lackofownershipoftheeducationanddevelopmentoftheirchildren(theyare
perceivedasotherpeople’sresponsibilities)■ Lackofambitionfortheirchildren■ Wanttobetheirchildren’sfriends–lackofdiscipline■ Lackofengagementoffathers■ Lackofmalerolemodels
Otherissuesparticularlyconcernedwithparentingandhealth,alreadyhighlightedabove,wereasfollows:■ Feedingtheirchildrenunhealthyfood■ Obesity■ Smokinganddrinking■ Exercise■ Mentalhealthissuesforparentsaffectingthechildren■ Medicalproblemsforparentsaffectingthechildren
Otherissuesconcernedprimarilywithparentingandeducation,alreadyhighlightedabove,wereasfollows:■ Badexperienceofeducationthemselves■ Notreadingtotheirchildren■ Parentsnotstakeholdersinoureducationsystem■ Notengagingenoughwithschool■ ParentsonlyinterestedinbeinginvolvedinP1&P2andloseinterestafterthat■ Nothelpingchildrenwiththeirhomework■ Lackofambitionorexpectationfortheirchildren■ Childrenbeingallowedtostayuplate–childrentiredandlatethenext
morning■ Thereareparentswhoinotherwaysaregoodparentsbutdon’tvalue
education■ Poordisciplineathomeleadingtoconductproblemsatschool
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
Page 33
2.7ProvisionforChildrenandYoungPeople
OldWarrenThereisoneplaygroup(asatelliteoftheColinSurestart)inOldWarren,withamorningcrèchefor10children,whiletheirparentsparticipateinaprogrammeandanafternoonprogrammefor2yearolds.
RaggedyBapplaygroupforchildrenaged2yearsand10months,inaformerNIHEhouseinAvonmoreParkOldWarren,ismanagedbyOldWarrenCommunityAssociation.Therearemorningandafternoonsessions.RaggedyBapisamemberofEarlyYears.
OldWarrenPrimarySchoolhasaNurseryClass.
KnockmoreThereisaplaygroupeachmorninginGroveActivityCentreforchildrenbetween2yearsand10monthsto4yearsold.StAloysiusPrimarySchoolinKnockmoreestate(OldWarrenward)hasanurseryclass.
TonaghTonaghPrimarySchoolhasareceptionclass.ThereisamotherandtoddlersgroupinachurchhallinTonagh.ThereisacrècheinStColumbasPresbyterian-MethodistChurch.
HilhallTheColinSureStarthasanoutreachprogrammebasedinanoldshopunitinHillhall,butwillbemovingintoanewcommunityfacility.Thereisanursery(BarbourNursery)inHilhallEstate.Localresidentshaveconcernsaboutthecriteriaforprioritizingadmissiontothenurserywhich,intheirview,favoursthechildrenofmiddle-classfamiliesfromoutsidethearea,andtheunemployedfromwithinthearea.ThereisalsoastatutorynurseryinLargymorePrimarySchool.
HildenBarnardosrunaParentInfantProgrammeinHilden.ThereisamothersandtoddlersagroupmintheGospelHall.After-schoolsprogrammesareruninthecommunityhousefor5-11,12-18and14/15yearolds.SomeyoungpeopletendtheFusionYouthProgrammeinLisburnCathedral.
LaganValleyInLaganValleythereisoneplaygroup,1daynursery(intheHospital)and1After-schoolclub.
Page 34
BallymacashThereisaplaygroupinBallymacashPrimarySchool(memberofEarlyYears)andanurseryclassinKillowenPrimarySchool.
Incontrasttotheaboveprovision,thereare3playgroups,1after-schoolscluband1crecheinWallacePark;3playgroupsinTwinbrook;and3creches,2daynurseriesand1after-schoolsclubinPoleglass.
YouthWorkSEELBisfundingaqualifiedyouthworkertoprovide6contactsessionswithyoungpeopleinOldWarren,throughOldWarrenYouthInitiativesandStreetsAhead(inOldWarren,HillhallandHilden).TheStreetsAheadfundingendsin18months.
AqualifiedyouthworkerisalsofundedbytheBoardtoprovide6hoursyouthworkinOldWarrenand6hoursinHillhall.TheBoardalsofundsasecond6houryouthoutreachpostinHillhallandoneinHilden.
SEELBisalsofundingfullandpart-timeyouthworkersintheYMCAincentralLisburn.TheBoardYouthServicehasaskedthemtofocusonKnockmore.
Thereisafull-timeyouthcentreaspartofLaurelhillCommunityCollege,withamaincatchmentareaofKnockmoreandBallymacash,plusLaurelhillschoolstudentsfromotherareas.
FollowingtheclosureofDerriaghyPrimarySchool,thesiteisbeingturnedintoayouthandcommunityfacility,withafull-timeyouthworker.
SEELByouthworkersdelivertheschool-based“NewBeginnings”programmefornewyear1pupils.
ManychurchesareinvolvedinyouthworkinLisburn.SixLisburnchurcheshavefull-timeyouthworkers.LisburnYMCA,inadditionto1.1familyworkandwrap-aroundsupport,providesyouthprovisionincentralLisburnfournightsandoneafternoonaweek,inadditiontoworkwithyoungpeopleatriskofschoolexclusion,inpost-primaryschools;analcoholprogrammeinpost-primaryschools;adviceonsexualandmentalhealth;andtrainingandemploymentforNEETS.
TheDepartmentofEducationplantoissuethelong-awaited“PrioritiesforYouth”draftyouthworkstrategyforNorthernIrelandbeforethesummer2012.
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
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2.8ConclusionsinrelationtoindicatorsofneedinthetargetcommunitiesinLisburn
Thestatisticsinrelationtoneedsinthetargetcommunities,insomerespects,showapatternthatiscommontomanyworkingclasscommunitiesandconfirmedbymanyresearchstudies,withlowincomes;dependenceonbenefits;youngunmarriedmothers;smokingduringpregnancy;emotionalandmentalhealthdifficulties;anddifficultieswithanti-socialbehaviourandcrime,includingdomesticviolence.
Thefindingsthatarebothshockingandunexpectedfromanacademicperspective,aretheverypooreducationaloutcomesofaverysignificantnumberofchildrenandyoungpeople,thevastmajorityofwhomdonotevenachieve5GCSEswithEnglishandMaths,andthereforedonotachieveAlevelsorgoontheuniversityorcollege.Concernsaboutattendanceatschoolandunder-achievementareevidentfromprimaryschoolonwards.
Cycleofdeprivationandunder-achievementThesefindings,inadditiontotheviewsexpressedduringtheconsultationswithcommunitiesandprofessionalsinthetargetareas,suggestaviciouscycleofdeprivationandunder-achievement,that,astheliteraturewouldsuggest,ispasseddownthroughthegenerationsandwhichisnotbrokenbythecurrentsetofagencies,servicesandprogrammesworkingintheareas.Thiscyclepresentsmajorchallengesintryingtobringaboutchange.Intermsofinterventions,discussedlater,itispossibletoattempttointerveneatanypointinthecycle.
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CycleofDeprivationandUnder-Achievement
Difficult transition to nearest secondary school; poor nutrition; poor numeracy and literacy; low aspirations; behavioural problems; poor attendance at school; poor test results; lack of parental engagement with the school or homework; anti-social behaviour; drinking; smoking; early sexual experiences.
Poor nutrition; poor numeracy and literacy; low aspirations; behavioural problems; poor attendance at school; poor test results; lack of parental engagement with the school or homework; poor transfer test results or not entered in transfer test.
Educational under-achievement (leave school early with few or no
qualifications); unemployed or in low paid employment; low aspirations; poor
relationships with parents; anti-social behaviour and/or crime; engagement
with the criminal justice system; risky sexual experiences – multiple
partners; increasing experience of alcohol and drugs;
teenage/unplanned pregnancy; smoking
and/or drinking during pregnancy.
Lack of breast-feeding;
poor parenting; poor infant brain
development; poor parental attachment; parents
not talking to, playing with, or reading to children; lack of
boundaries established; behavioural problems; poor early
cognitive abilities; parents experiencing mental health difficulties
and/or problems with alcohol and/or drugs (including prescription drugs); children not ready for primary school.
AGE 11-14
AGE 5-11
AGE 14-18
AGE 0-4
CHAPTER TWO
The needs of disadvantagedcommunities in Lisburn
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3.1IntroductionTheCentreforExcellenceandOutcomesforChildrenandYoungPeople(CE04)definesEarlyInterventionas“interveningearlyandassoonaspossibletotackleproblemsemergingforchildren,youngpeopleandtheirfamiliesorwithapopulationatriskofdevelopingproblems.Earlyinterventionmayoccuratanypointinachild’slife”(GraspingtheNettle’Report2009).Anearlyinterventionapproachsuggestsinterventions:
■ intheearlyyearsofachild’slife,where,theevidencesuggests,manyproblemsinlaterlifearecreatedandatwhichstagebraindevelopmentismoulded;
■ attheearlystageofdifficulty,whenachildmaybevulnerabletopoordevelopmentaloutcomes;
■ basedonwholesocietyapproachtoearlyinterventionthroughanetworkofsupportsandservicesandmulti-agencyworking;
■ whichareevidence-basedthroughrigorousevaluation(eitheradoptingevidence-basedprogrammeswhichhavepreviouslybeenrigorouslyevaluated,orinnovatingevidence-informedprogrammeswhicharethenrobustlyevaluated;
■ arefocusedonclearlymeasurableoutcomes;■ supportingandempoweringparents,familiesandinformalsupportnetworks;■ whicharelong-term/sustainable(notshort-termfundedprojectswhichend
whenthefundingends);■ whichcombineuniversal(allchildren)preventionprogrammesandnon-
stigmatisingtargetedearlyinterventiononthosemostatrisk;■ areaccessibleandflexible;and■ promoteparticipationandinclusion.
3.2WhyisEarlyInterventionImportant?Theinternationalevidencefromaverywiderangeofsourcesanddisciplinesisallpointingtowardsthecrucialimportanceofearlyinterventionintacklingdisadvantageandunder-achievement.Themainreasonsareasfollows:
■ Aseriesofnationalandinternationalstudieshaveshownthatproblemsinchildrenasyoungasthreecanpredictmoreseriousproblemsintheteenageyearsandtwenties.
■ Agapincapabilitiesofachildagedthreeyearsoldfromalowsocio-economicgroup,comparedwithonefromahighsocio-economicgroup,willtendtoincreasecontinuallythroughoutthechild’sschoolyears.
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Why early intervention
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■ Brainstudieshaveshownthatthemajorityofthedevelopmentofthehumanbraintakesplaceinthefirstthreeyears.Howthebraindevelopshashugeimplicationsforthedevelopmentofthechild.
■ Itismorecost-effectivetointerveneatayoungage.NobeleconomistJimHeckmanhasshownthatresourcesinvestedintheearlyyears(0-4)islikelyonaveragetoresultinseventimesthatamountinthelaterlifeofthechildintermsofreducedmentalhealthcosts,justicesystemcosts,etc.
3.3TheLinkbetweenPovertyandEducationalDisadvantageintheUKIn2010theJosephRowntreeFoundationpublishedastudyofchildren’seducationalattainment(AlisaGoodmanandPaulGregg26March2010),basedonfourlarge-scalelongitudinalsourcesofdataonchildrengrowingupintheUKtoday.TheseweretheMillenniumCohortStudy(UK-wide),theAvonLongitudinalstudyofParentsandChildren,theLongitudinalStudyofYoungPeopleinEnglandandtheChildrenoftheBritishCohortStudy.Thechildreninthesestudiesrangedfromearlychildhoodthroughtolateadolescence.
Theresearchshowedthateducationaldeficitsemergeearlyinchildren’slives,evenbeforeentryintoschool,andwidenthroughoutchildhood.Evenbytheageofthreethereisaconsiderablegapincognitivetestscoresbetweenchildreninthepoorestfifthofthepopulationcomparedwiththosefrombetter-offbackgrounds.Thisgapwidensaschildrenenterandmovethroughtheschoolingsystem,especiallyduringprimaryschoolyears.
AnalysisoftheMillenniumCohortStudyshowedbigdifferencesincognitivedevelopmentbetweenchildrenfromrichandpoorbackgroundsattheageofthree,andthisgapwidenedbyagefive.Thereweresimilarlylargegapsinyoungchildren’ssocialandemotionalwell-beingattheseages.Childrenfrompoorerbackgroundsalsofacedmuchlessadvantageous‘earlychildhoodcaringenvironments’thanchildrenfrombetter-offfamilies.Forexample,comparedwithchildrenfrombetter-offbackgrounds,thereweresignificantdifferencesinpoorerchildren’sandtheirmothers’:
■ healthandwell-being(e.g.birth-weight,breastfeeding,andmaternaldepression);
■ familyinteractions(e.g.mother–childcloseness);■ thehomelearningenvironment(e.g.readingregularlytothechild);and■ parentingstylesandrules(e.g.regularbed-timesandmeal-times).
Differencesinthehomelearningenvironment,particularlyattheageofthree,haveanimportantroletoplayinexplainingwhychildrenfrompoorerbackgroundshave
CHAPTER THREE
Why early intervention
Page 39
lowertestscoresthanchildrenfrombetter-offfamilies.However,alargeproportionofthegapremainsunexplained,orappearsdirectlyrelatedtootheraspectsoffamilybackground(suchasmother’sage,andfamilysize).
Thissuggeststhatpoliciestoimproveparentingskillsandhomelearningenvironmentscannot,ontheirown,eliminatethecognitiveskillsgapbetweenrichandpooryoungchildren.Ontheotherhand,manyaspectsoftheearlychildhoodcaringenvironmentdohaveapositiveeffectonchildren’ssocialandemotionaldevelopmentandresilience,meaningthatpoliciesaimedatimprovinghealth,parentingskillsandthehomelearningenvironmentcouldstillbeveryimportant.
AnalysisoftheAvonLongitudinalStudyofParentsandChildrensuggestedthatthegapinattainmentbetweenchildrenfromthepoorestandrichestbackgrounds,alreadylargeatagefive,grewparticularlyfastduringtheprimaryschoolyears.Byageeleven,onlyaroundthree-quartersofchildrenfromthepoorestfifthoffamiliesreachedtheexpectedlevelatKeyStage2,comparedwith97percentofchildrenfromtherichestfifth.PoorerchildrenwhoperformedwellinKeyStagetestsatagesevenweremorelikelythanbetter-offchildrentofallbehindbyageeleven,andpoorerchildrenwhoperformedbadlyatsevenwerelesslikelytoimprovetheirrankingcomparedwithchildrenfrombetter-offbackgrounds–animportantfactorbehindthewideninggap.
Someofthefactorsthatappeartoexplainthewideninggapduringprimaryschoolare:■ parentalaspirationsforhighereducation;■ howfarparentsandchildrenbelievetheirownactionscanaffecttheirlives
(self-efficacy);and■ children’sbehaviouralproblems,includinglevelsofhyperactivity,conduct
issuesandproblemsrelatingtotheirpeers.
Parentalaspirationsandattitudestoeducationvarystronglybysocio-economicposition,with81percentoftherichestmotherssayingtheyhopedtheirnine-year-oldwouldgotouniversity,comparedwithonly37percentofthepoorestmothers.Suchadverseattitudestoeducationofdisadvantagedmothersareoneofthesinglemostimportantfactorsassociatedwithlowereducationalattainmentatageeleven.Thefindingssuggestthatgovernmentpoliciesaimingtochangemothers’andchildren’sattitudesandbehaviourduringprimaryschoolingcouldbeeffectiveinreducingthegrowthintherich–poorgapthattakesplaceduringthistime.
AnalysisoftheLongitudinalStudyofYoungPeopleinEnglandfoundthatattainmentgapsatageelevenwerealreadylargeandfurtherwideningwasrelativelysmallintheteenyearscomparedwithearlierinchildhood.Bythetime
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youngpeopletaketheirGCSEs,thegapbetweenrichandpoorisverylarge.Forexample,only21percentofthepoorestfifthmanagedtogainfivegoodGCSEs(gradesA*-C,includingEnglishandMaths),comparedwith75percentoftherichestfifth(seethepreviouschapterforsimilarfindingsinNorthernIreland).
Itbecomeshardertoreversepatternsofunder-achievementbytheteenageyearsbuttherearesomewaysthatdisadvantageandpoorschoolresultscontinuetobelinked.Evenaftercontrollingforlong-runfamilybackgroundfactorsandpriorattainment,youngpeoplearemorelikelytodowellatGCSEiftheirparents:■ thinkitlikelythattheyoungpersonwillgoontohighereducation;■ devotematerialresourcestowardseducationincludingprivatetuition,
computerandinternetaccess;■ spendtimesharingfamilymealsandoutings;and■ quarrelwiththeirchildrelativelyinfrequently.
ThestudyalsofoundthatyoungpeoplearemorelikelytodowellatGCSEiftheyoungpersonhim/herself:■ hasagreaterbeliefinhis/herownabilityatschool;■ believesthateventsresultprimarilyfromhis/herownbehaviourandactions;■ findsschoolworthwhile;■ thinksitislikelythathe/shewillapplyto,andgetinto,highereducation;■ avoidsriskybehavioursuchasfrequentsmoking,cannabisuse,anti-social
behaviour,truancy,suspensionandexclusion;and■ doesnotexperiencebullying.
Sinceyoungpeoplegrowingupinpoorfamiliesdolesswellinalltheserespectscomparedwiththoseinbetter-offfamilies,thisprovidessomeexplanationfortheirpoorereducationalattainmentbytheendofcompulsoryschooling.Whileinterveningearlierinchildhoodislikelytobemosteffective,policiesaimedatimprovingattitudesandbehaviouramongteenagerscouldalsohavesomebeneficialeffectsinpreventingchildrenfrompoorbackgroundsfallingyetfurtherbehindduringthesecondaryschoolyears.
TheanalysisofchildrenoftheBritishCohortStudyfoundthatchildren’stestscoreswerelowestwhenpovertyhadpersistedacrossthegenerations,and,attheotherendofthespectrum,highestwhenmaterialadvantagewaslong-lasting.
Parents’cognitiveabilitiesandotherchildhoodcircumstancesplayaveryimportantroleinexplainingthegapbetweenthetestscoresofricherandpoorerchildrentoday.Nearlyone-fifthofthegapintestscoresbetweentherichestandpoorestchildrencouldbeexplainedbyanapparent‘direct’linkbetweenthechildhoodcognitiveabilityofparentsandthatoftheirchildren.Thiswasfound
CHAPTER THREE
Why early intervention
Page 41
evenaftercontrollingforawiderangeofenvironmentalfactors,andaftertakingintoaccountmanyofthechannelsthroughwhichcognitiveabilitymightoperate,suchasparents’subsequenteducationalattainment,adultsocio-economicpositionandattitudestoeducation.Overfour-fifthsofthegapinthetestscoresofricherandpoorerchildren,however,isnotexplainedbythedirectlinkbetweenthecognitiveabilityofparentsandthatoftheirchildren.
Ontheotherhand,whilegoodsocialskillsalsoappearedtobelinkedacrossgenerationsi.e.parenttochild,thesedonotmakeasignificantdirectcontributiontothecurrentgapincognitivetestscoresbetweenrichandpoorchildren.
Therewasalsoastrongintergenerationalcorrelationbetweenawidevarietyofotherattitudesandbehaviours,suchaswhetheraparentreadstotheirchildeveryday,andparentalexpectationsforadvancededucation.Thepassingofsuchtraitsacrossgenerationsalsohelpstoexplainthepersistentdisadvantagethatchildrenfrompoorbackgroundsfaceintheireducationalattainment.
Thesefindingssuggestthatattitudesandbehaviourarepotentiallyimportantlinksbetweensocio-economicdisadvantageandchildren’seducationalattainmentandhaveshowntwomajorareaswherepolicymighthelptoreduceeducationalinequalities.
Parentsandthefamilyhome:■ Improvingthehomelearningenvironmentinpoorerfamilies(e.g.booksand
readingpre-school,computersinteenyears).■ Helpingparentsfrompoorerfamiliestobelievethattheirownactionsand
effortscanleadtohighereducation.■ Raisingfamilies’aspirationsanddesireforadvancededucation,fromprimary
schoolonwards.
Thechild’sownattitudesandbehaviours:■ Reducingchildren’sbehaviouralproblems,andengagementinrisky
behaviours.■ Helpingchildrenfrompoorerfamiliestobelievethattheirownactionsand
effortscanleadtohighereducation.■ Raisingchildren’saspirationsandexpectationsforadvancededucation,from
primaryschoolonwards.
Therehasbeenamarkedshiftingovernmentpolicyemphasisinrecentyearsawayfromanarrowerfocusoneducationaloutcomes,andtowardsthewideremotionalandsocialwell-beingofchildren(atleastinEngland,WalesandScotland).
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However,someoftheareashighlightedbytheJRFstudyabove(GoodmanandGregg2010)arebettercoveredbyexistingpolicyandevidencethanothers.Forexample:
■ Therehasbeenincreasingemphasisonparentingprogrammesandimprovingchildbehaviourintheearlyyearsbeforeschoolingstarts,butmuchlesssointheprimaryschoolyears(andevenlessinsecondary).TheJRFresearch(GoodmanandGregg2010)suggeststhatreachingfamilieswhilechildrenareofschoolagemightcontinuetobeuseful.
■ Intensiveprogrammesthatfocusonhelpingsmallnumbersofchildrenmostinneedtendtohavethestrongestevidencebehindthem.However,educationaldisadvantageaffectsaverylargenumberofchildrenfromlow-incomefamilies,butwithlowerintensitythanthoseattheextreme,anditmaybethatpolicyneedstofocusmoreonthese.
■ Programmestoraiseeducationalaspirations(suchasAimHigherinEnglandandWales)typicallystartinthesecondaryschoolyears,whilethisresearchsuggeststhatsuchinterventionscouldbeworthwhileatayoungerage–forexampleinprimaryschools.
■ Theevidenceonschoolandlocal-basedinterventionstoimproveyoungpeople’ssocialandemotionalskills,behaviour,andparticipationinpositiveactivitiesneedstobestrengthenedthroughrobustevaluation.
■ Educationalbodiesandschoolshaveasignificantroletoplayintacklingmanyoftheissuesraisedhere.Relevantpoliciesarelikelytoincludehowfundsareallocatedtowardspupilsfromthepoorestbackgrounds,andthedirectteachingsupportprovidedtochildrenwhentheystarttofallbehind.Ifsuccessful,thesesuggestedchangesmightatleasthelptopreventchildrenfrompoorbackgroundsfromslippingfurtherbehindtheirbetter-offpeersthroughouttheirschooling,andindeedcouldgosomewaytowardsclosingtherich–poorgap.
ThefindingsoftheJRFstudy(GoodmanandGregg2010)maybeparticularlyimportantintryingtounderstandwhythedataforworkingclassProtestant/LoyalistcommunitiesinLisburn(andNorthernIrelandmoregenerally)showssuchpooreducationaloutcomes,comparedtoevenmoredeprivedCatholic/Republicanareas.Akeyissuemaybeparentalattitudesandaspirations.
TheindependentreportfromDawnPurvisMLA(Purvis2011)suggeststhatitmaybearesultofdifferentattitudestoeducationwithinworkingclassProtestant/
CHAPTER THREE
Why early intervention
Page 43
Loyalistcommunitiesthathistoricallyreliedonchildrenfollowingtheirparentsfootstepsintolarge-scaleindustrialemployment(e.g.linenmills,threadmills,ropeworks,shipyard,aircraftmanufacture,etc),atrade,orthesecurityservices,forwhicheducationalrequirementswerelow.Whilemuchofthesekindsofjobshavegoneandtheroutesintoemploymentarenowbasedonpublicadvertisementswithclearselectioncriteriaincreasinglybasedonqualificationsandexperienceobtained.However,thecultureandattitudesthatexistedinpreviousgenerationsmaybestillinfluencingattitudestowardseducationandaspirationsinProtestant/Loyalistworkingclasscommunities.
3.4AllenReportsWorkinEnglandbyGrahamAllenMPandIanDuncanSmithMPin2008(EarlyIntervention:GoodParents,GreatKids,BetterCitizensAllen&DuncanSmith2008)andGrahamAllenin2011(EarlyIntervention–theNextStepsAllen2011)hashighlightedtheneedforanemphasisonearlyinterventiontomakesurechildrengetthebeststartinlife.Forexample,theirreviewoftheinternationalliteraturefoundthat:
■ Achild’sdevelopmentscoreatjust22monthsofagecanserveasanaccuratepredictorofeducationaloutcomesatage26
■ Boysassessedasbeing“atrisk”bynursesattheageof3were2.5timesaslikelytohavecriminalconvictions(55%forviolentoffences)attheageof21asthosedeemednotatrisk
TheAllenreportshighlighttheinternationalevidencewhichshowsthatbraindevelopmentintheearlyyearsisacriticalfactorinthedevelopmentofchildren.Babiesarebornwithone-quarteroftheirbraindeveloped.Thereisthenveryrapiddevelopmentofthebrain,sothatbytheageofthree,80%oftheirbrainshavebeendeveloped.Duringthiscriticalperiod,neglect,thewrongtypeofparentingorotheradverseexperiencescanhaveaprofoundeffectonhowchildrenareemotionally“wired”,whichwilldeeplyinfluencefutureresponsestoeventsandtheirabilitytoempathisewithotherpeople.
TheAllenreportsdemonstrate,fromtheliterature,thatearlyinterventiontopromotesocialandemotionaldevelopmentcansignificantlyimprovementalandphysicalhealth,educationalattainmentandemploymentopportunitiesandthatitcanalsohelppreventcriminalbehaviour(especiallyviolentbehaviour),drugandalcoholmisuseandteenagepregnancy.
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Allenconcludesthattherightkindofparentingisabiggerinfluenceonchildren’sfuturethanwealth,socialclass,educationoranyothersocialfactorandsoparentsneedtobegiventheinformationandsupportthattheyneedtohelptheirchildren.
Thereportsalsorecommendtheintroductionofearlyinterventionprogrammeswhichhavebeenshowntoworkinimprovingoutcomesforchildren.Helists72ofthemostpromisingearlyinterventionprogrammes,19ofwhichalreadyhaveverysignificantevidencefortheireffectiveness.
Hisreviewoftheliteraturealsodemonstratesthecosteffectivenessofinterveningearlyinachild’slifetotackleasocialproblemasopposedtointerveninglateron.Economicevaluationsofsomeofthemosteffectiveearlyinterventionprogrammeshaveshownthatinvestinginthefirstfewyears(frompregnancy)ofachild’slifecansavemultiplesofthatinvestmentinlatercostsofprison,welfarebenefits,justiceservices,treatmentprogrammes,mentalhealthservices,etc.Ithasbeenshown,forexample,thatLifeSkillsTrainingprogrammescanproducesavingsof25timesthecostoftheprogramme.
ResearchontheConsequencesofChildhoodDisadvantageinNorthernIrelandSullivanetal(2010)publishedaresearchreport*ontheConsequencesofChildhoodDisadvantageinNorthernIrelandatage5,basedontheNIpartoftheUKMillenniumCohortStudy,in2010.Theresearchfoundthat:
■ Health-relatedindicatorsamongparents,suchassmoking,breastfeedingandBMIwerelessfavourableinNIthaninGB
■ Parents’BodyMassIndex(BMI)islinkedtothechild’sBMIandalsotothechild’seducationalandbehaviouralscores
■ Povertyislinkedtoalltheoutcomes.However,cognitiveandeducationaloutcomesaremorestronglystructuredbypovertythanthehealthandbehaviouraloutcomes.Parentaleducationandsocialclassareparticularlypowerfulpredictorsofeducationalandcognitiveoutcomes.Theirimpacthowevercanonlypartiallyaccountedfordespitethelargenumberofpotentialmediatorsincludingrichinformationonparentingpractices
■ Variablesreflectinggoodparentingpractices,regularityandastronghomelearningenvironmentpredictpositivecognitive,educationalandbehaviouraloutcomes.Father’sinvolvementhasexplanatorypowerforcognitiveandeducationaloutcomes
CHAPTER THREE
Why early intervention
* Sullivan,A.,Cara,O.,Joshi,H.Ketende,S.andObelenskaya,P.(2010)The Consequences of Childhood Disdvantage in Northern Ireland at Age 5OFMDFM
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■ Parents’longstandingillnessesandmentaldistressarelinkedtopoorercognitive,educationalandbehaviouralassessmentsandgeneralhealthinthechild
3.5ConclusionsinrelationtoEarlyInterventionAlltheevidencefromtheUKandinternationalsourcespointstotheimpactofparents’educationandsocialclassontheoutcomesfortheirchildren.Thegapbetweenchildrenofdifferentbackgroundsisevidenteveninthefirsttwoyearsoflifeandwidenscontinuouslythroughouttheirchildhood.
Theevidencedemonstratesboththeeffectivenessandcost-effectivenessofinterveninginthefirstcoupleofyearsofachild’slife.Thereareconsiderablesavingsforthestateininvestinginearlychildrenratherthantryingtotacklethesocialproblemsthatemergelaterinlife.
Theliteraturealsohighlightstheimportanceofbasinginterventionsonrealevidenceofwhatworks,especiallyevidencegatheredfromwellrunlargescaleRandomControlTrials.
Theresearchonearlyinterventionalsohighlightsvariousotherissues,includingthefollowing:
■ Parents’obesity,physicalillnessandmentalhealthproblemscanhaveasignificantimpactontheoutcomesfortheirchildren.
■ Parentingiscriticaltothedevelopmentofchildrenandyoungpeople.Effortstoimproveparentingneedtostartfrombeforebirthandcontinueinprimaryschool.
■ Interventionsneedtobeprioritizedonthe0-12agegroup,especiallythe0-2yearoldsandtheirparents
■ Increasingeducationalaspirations,sothateducationisvalued,iscriticaltoimprovingeducationalachievement.
■ Programmesthattargetaverysmallnumberofvulnerablefamiliese.g.thosefocusedonchildprotection,missthelargenumberofchildrenindisadvantagedcommunitieswhoarelikelytounderachieveandinturnfacearangeofeconomic,personalandsocialproblems
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CHAPTER FOUR
The Northern Ireland public policy context that supports the need for change
4.1IntroductionThefollowingsectionhighlightssomeofthekeypublicpolicydocumentsthatarehelpingtodrivethechangeinemphasistowardspreventionandearlyintervention.Thesepublicpolicydocumentscomeunderthebroadheadingofpublichealth;children,youngpeopleandfamilies;education;area-basedinitiatives;andtheProgrammeforGovernment.However,itisimportantnottoreinforcethefragmentationofpolicyandservicesthathasdevelopedfromsilothinkinginpolicydevelopment.
Relevantquotesthatspecificallysupportanearlyinterventionapproachareunderlinedbelow.
4.2PublicHealth
InvestingforHealthIn2002theDHSSPSpublisheditsInvestingforHealthstrategywhichrecognisesthathealthandwellbeingarecruciallydeterminedbythesocial,economic,physicalandculturalenvironmentandseekstoshifttheemphasisfromaconcentrationonthemedicaltreatmentofill-healthtowardstacklingthefactorswhichadverselyaffecthealthandperpetuatehealthinequalities.Thestrategyhighlightstheconsistentinternationalevidencethatthelowerthesocio-economiccircumstancesoffamilies,theworsethehealthandwellbeingofmembersofthefamilyarelikelytobe.Itstatesthat“investinginthecrucialearlyyearsandeducationcanbreakthecycleofdeprivation”.
Thestrategysetouttwooverarchinggoals:■ Toimprovethehealthofourpeoplebyincreasingthelengthoftheirlives
andincreasingthenumberofyearstheyspendfreefromdisease,illnessanddisability
■ Toreduceinequalitiesinhealthbetweengeographicareas,socio-economicandminoritygroups
Italsoestablishedanumberofobjectivesincluding:■ Toreducepovertyinfamilieswithchildren■ Toenableallpeopleandyoungpeopleinparticulartodeveloptheskillsand
attitudesthatwillgivethemthecapacitytoreachtheirfullpotentialandmakehealthychoices.
Thestrategyrecognisesthat■ responsibilitiesforachievingthesegoalsrestswitharangeofdifferent
governmentdepartments■ Actionsneedtobecarriedinpartnershipsbetweenalltherelevantbodies
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■ Thatcommunitiesneedtobeengagedthroughacommunitydevelopmentapproach
AHealthierFutureIn2005theDHSSPSpublisheda20yearvisionforhealthandwellbeinginNorthernIreland2005–2015entitled,AHealthierFuture,to“improvethephysicalandmentalhealthandsocialwellbeingofthepeopleofNorthernIreland”.
Thevisionexplicitlyrecognisesthat“themostimportantfactorsindeterminingthehealthandsocialwellbeingofthepopulationaredeterminedbythecircumstancesinwhichweliveandwork,suchas:• disadvantageandsocialexclusion• poverty• unemployment• loweducationalachievement• socialandcommunityenvironment• housingandlivingconditions• workingconditions• thewiderenvironment.
Ithighlightsthatpoorersocio-economicgroupsarelikelytohavehigherincidenceofcancer,diabetesandotherlong-standingillnesses.
TheVisionrecognisesthatthereneedstobe“anewemphasisonreducingsmoking(esp.amongstchildren),reducingalcohol-relatedharm,tacklinglevelsofobesity,increasinglevelsofphysicalactivityandpromotinggoodmentalhealth.
Itsetsanoutcometo“reducebytwothirdsthegapinlifeexpectancybetweenthoselivinginthemostdeprived20%ofelectoralwardsandtheaveragelifeexpectancyhereforbothmenandwomenbetween2000and2015.
MarmotReviewInNovember2008,ProfessorSirMichaelMarmotwasaskedbythethenSecretaryofStateforHealthtochairanindependentreviewtoproposethemosteffectiveevidence-basedstrategiesforreducinghealthinequalitiesinEnglandfrom2010.Thefinalreport,‘FairSocietyHealthyLives’,waspublishedinFebruary2010,andconcludedthat
■ Reducinghealthinequalitiesisamatteroffairnessandsocialjustice.Themanypeoplewhoarecurrentlydyingprematurelyeachyearasaresultofhealthinequalitieswouldotherwisehaveenjoyed,intotal,between1.3and2.5millionextrayearsoflife.
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■ Thereisasocialgradientinhealth–theloweraperson’ssocialposition,theworsehisorherhealth.Actionshouldfocusonreducingthegradientinhealth.
■ Healthinequalitiesresultfromsocialinequalities.Actiononhealthinequalitiesrequiresactionacrossallthesocialdeterminantsofhealth.
■ Focusingsolelyonthemostdisadvantagedwillnotreducehealthinequalitiessufficiently.
■ Toreducethesteepnessofthesocialgradientinhealth,actionsmustbeuniversal,butwithascaleandintensitythatisproportionatetothelevelofdisadvantage.(proportionateuniversalism).
■ Actiontakentoreducehealthinequalitieswillbenefitsocietyinmanyways.Itwillhaveeconomicbenefitsinreducinglossesfromillnessassociatedwithhealthinequalities.Thesecurrentlyaccountforproductivitylosses,reducedtaxrevenue,higherwelfarepaymentsandincreasedtreatmentcosts.
■ Economicgrowthisnotthemostimportantmeasureofourcountry’ssuccess.Thefairdistributionofhealth,well-beingandsustainabilityareimportantsocialgoals.Tacklingsocialinequalitiesinhealthandtacklingclimatechangemustgotogether.
Thereportrecommendsthatreducinghealthinequalitieswillrequireactiononsixpolicyobjectives:■ Giveeverychildthebeststartinlife■ Enableallchildren,youngpeopleandadultstomaximisetheircapabilitiesand
havecontrolovertheirlives■ Createfairemploymentandgoodworkforall■ Ensurehealthystandardoflivingforall■ Createanddevelophealthyandsustainableplacesandcommunities■ Strengthentheroleandimpactofill-healthprevention.
Itarguesthat:deliveringthesepolicyobjectiveswillrequireactionbycentralandlocalgovernment,theNHS,thethirdandprivatesectorsandcommunitygroups;nationalpolicieswillnotworkwithouteffectivelocaldeliverysystemsfocusedonhealthequityinallpolicies;andeffectivelocaldeliveryrequireseffectiveparticipatorydecision-makingatlocallevel,byempoweringindividualsandlocalcommunities.
CHAPTER FOUR
The Northern Ireland public policy context that supports the need for change
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PHACorporateStrategyThisreporthashadasignificantimpactonthecorporatestrategyofthePublicHealthAgency(PHA)inNorthernIreland,Realising the health and wellbeing potential of people,whichhasfourprioritiesforimprovinghealthandwellbeing:
■ Giveeverychildthebeststartinlife■ Workwithotherstoensureadecentstandardofliving■ BuildsustainableCommunities■ Makehealthierchoiceseasier
Actionstopromotetheseprioritiesinclude■ CommissioningFamilyNursePartnershipsandotherevidence-basedfamily
supportforfamilieswhodonotqualifyforFNP■ Reviewingantenataleducationtopromoteparentchildinteractionandinfant
brainandemotionaldevelopment■ Breastfeedingpeersupportprogrammes■ RootsofEmpathyprogrammesinschools■ Supportingsocialeconomybusinessesandcommunityskillsdevelopment■ Supportincrementalexpansionofprogrammestodevelopthetop20%most
disadvantagedcommunities■ ImplementtheFitterFuturesforAllframeworktoaddressobesity■ StopSmokingSupportservicesespeciallyforpregnantwomen■ Putinplaceintegratedplanstopreventsuicideandpromoteemotionalhealth
PHACommunityDevelopmentThematicActionPlanThePublicHealthAgencyrecognizesthecrucialimportanceofusinganasset-basedcommunitydevelopmentapproach,whichlooksbeyondthemedicalmodelinimprovinghealthandwellbeingandclosinghealthinequalities.Therearefourmainstreams:
■ Directcommunitydevelopmentsupporttoorganizationsandcommunities■ Commisioningofserviceswhichpromotesustainablecommunities■ Commissioningofhealthandwellbeingimprovementservicesfrom
community-basedorganisations■ Innovationandtestingoutnewwaysofworking.
MentalHealthReviewIn2006acomprehensiveReviewofMentalHealthandLearningDisabilitywascarriedoutbyBamfordmakingawideRangeofrecommendationsforhowservicesinthisareacouldbeimproved.In2009theNIExecutivepublisheda2009-2011ActionPlaninresponsetotheReview,includinganaimtopromote“positivehealth,well-beingandearlyintervention”.Theseplannedactionsincluded:
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■ Publisharevisedcross-sectoralPromotingMentalHealthandWellbeingStrategy
■ Develop,consultonandimplementanEarlyYearsStrategy■ Introducearevisedcurriculumwhichprovidesopportunitiesthroughpersonal
developmentandotherareasforyoungpeopletodeveloptheskillstheyneedtocopewithchallengingpersonalsituationssuchasviolenceagainstwomenandchildren;self-harmetc.
■ Sustainindependentcounselingsupportserviceinpost-primaryschools■ Produceguidanceforpost-primaryschoolsonproactivelypromotingpositive
emotionalhealthandwellbeingamongstaffandpupils
SexualHealthPromotionInNovember2008DHSSPSpublishedaSexualHealthPromotionStrategyandActionPlan,inordertoimprove,protectandpromotethesexualhealthandwellbeingofthepopulationinNorthernIreland”.Itsobjectivesinclude:■ Toreducethenumberofunplannedbirthstoteenagemothers■ Topromoteopportunitiestoenableyoungpeopletomakeinformedchoices
beforeengaginginsexualactivity,especially,empoweringthemtodelayfirstintercourseuntilanappropriatetimeoftheirchoosing.
Theapproachofthestrategyincludesensuringthatservicesareaccessibleandresponsivetoneed,includetheneedsofdisadvantagedgroupsandthoseathighestrisk;andactiontotacklethedeterminantsofsexualhealthbasedonanevidencedbasedapproach.
TheStrategyacknowledgesthatthereisa“stronglinkbetweensocialdeprivationandSTIs,abortionsandteenagepregnancyandearlymotherhoodisassociatedwithpooreducationalachievement,poorphysicalandmentalhealth,socialisolationandpoverty”.ResearchinNorthernIrelandhasshownthat“respondentsfromapartlyskilledsocio-economicbackgroundweretwiceaslikelyasthosefromaprofessional/managerialbackgroundtohavehadsexualintercoursebeforetheageofsixteen”.
AcrucialaspectoftheSexualHealthPromotionStrategyisPrevention,including“everyonehavingthelifeskillsandaccesstoservicestoenablethemtomakeinformedchoicesandtodeterthedevelopmentofhealthcompromisingbehaviours.Thisisparticularlyimportantforyoungpeopleasthemajorityofparents,healthandeducationalprofessionalsagreethatsexualrelationsarebestdelayeduntilayoungpersonissufficientlymaturetoparticipateinamutuallyrespectfulrelationship”.
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Italsostressestheimportanceofparentsandcarershavingthe“skillsandknowledgetotalktotheirchildren,asgoodparent/childcommunicationandsexualhealthissuescanhelpdelayfirstsexualexperienceandlimitpoorsexualhealthoutcomes”IthighlightsthepotentialroleofSureStart,HealthySchools,HealthActionZonesandHealthyLivingCentresinpromotingpartnerships.
Thestrategyalsoacknowledgesthat“schoolshaveanimportantcontributiontomakeininfluencinganddevelopingyoungpeople’ssexualhealthandwellbeingthroughthedeliveryofeffectivePersonaldevelopment,includingRelationshipandSexualEducation”.
Thestrategysetsspecifictargetsincludingthefollowing:■ 92%of11-16yearoldsshouldnothaveexperiencedsexualintercourseby
2013■ Areductionof25%intherateofbirthstoteenagemothersunder17yearsof
ageby2013.
SpecificactivitiesintheActionPlanincludethefollowing:■ TocontinuetoimplementguidelinesonRelationshipsandSexualEducation■ Toprovideopportunitiestoyoungpeopleinschoolandyouthsettings
todeveloptheskillstheyneedforlifetosupporttheminappropriatelymanagingtheirrelationships,includingsexuallifestyles
■ Tofurtherdevelop,particularlyinareasofsocio-economicdeprivationandruralareas,communitybasedteenagepersonaldevelopmentprogrammesthatwillincorporatesexualhealthissuesandrisktalkingbehaviour
SuicidePreventionIn2006theDHSSPSissuedits5-yearSuicidePreventionStrategyandActionPlan,Protect Life,followingverysignificantconcernaboutthenumberofsuicidesinNorthernIreland,particularlyamongstyoungpeople.Actionstobedeliveredbyvariouspartnersincludedwere:■ Toprovidefamilieswiththeopportunitytoavailofnon-stigmatising
practicalinterventionstohelpconsolidateparenting,copingandlifeskills■ Topromotetheinclusionofpromotingpositivementalhealthasakey
elementofthe“HealthyScvhools”programmeandensurethatchildrenandyoungpeopleareprotectedfromallformsofbullying
■ Toraiseawarenessofandensureavailabilityandtimelyaccesstoappropriateinterventionservices(e.g.ChildandAdolscentMentalHealthServices,mentoringschemesandotherappropriatestatutoryandvoluntaryservices).
■ Encouragetheinclusionofcopingandlifeskills,emotionalliteracy,andprogrammesthatpromotepositivementalhealthintheschoolcurriculum
■ TodevelopenhancedlinkagesbetweentheHealthandSocalServicesandthe
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community/voluntarycounselingandsupportnetwork,particularlyinrelationtotransitionservicesandtobridgeanygapsinserviceprovision
■ Toenhancetheroleofthecommunity/voluntarysectorconcerningtheprovisionofmentoringsupportforyoungpeopleatriskofsuicideandself-harm
■ Toensurethatappropriatesupportservicesreachouttoallmarginalizedanddisadvantagedgroups,inparticularlesbian,gay,bi-sexual,andtrans-gendergroups,ruralcommunities,ethnicminorities,andthosepeoplewhoareeconomicallydeprived.
AlcoholandDrugsIn2006theDHSSPSpublisheda5-yearcross-sectoralstrategy,New Strategic Direction for Alcohol and Drugs,thatsoughttoreducetheharmrelatedtobothalcoholanddrugmisuseinNorthernIreland(seeoutlineofdraftPhase2below).
In2008theDHSSSPSpublishedaRegional Hidden Harm Action PlantorespondtotheneedsofchildrenborntoandlivingwithparentalalcoholanddrugmisuseinNorthernIreland.ThePlanhighlightssomeofthepotentialimpactsforachildoflivingwithparentalalcoholordrugabuse,including:■ Harmfulphysicaleffectsonunbornandnewbornbabies■ Impairedpatternsofparentalcareandroutineswhichmayleadtoearly
behaviouralandemotionalproblemsinchildren■ Higherriskofemotionalandphysicalneglectorabuse■ Lackofadequatesupervision■ Povertyandmaterialdeprivation■ Repeatedseparationfromparents…■ Childrentakingoninappropriatesubstitutecaringrolesandresponsibilities
forsiblingsandparents■ Socialisolation■ Disruptiontoschoolingandschoollife■ Earlyexposuretoalcoholanddrugmisusingcultureandassociatedillegal
activitiesandlifestyles■ Poorphysicalandmentalhealthinadulthood
Theprinciplesunderpinningtheactionplaninclude“Afocusonpreventionandearlyidentification”andthatservicesneedtobebasedon“evaluationofeffectiveness”,aswellaswhatchildrenandparents/carerssaytheyneed.
TheActionPlanoutlineswhatshouldbeincludedinacontinuumofspecialistservices,including:■ Familyplanningservices■ Maternityservices
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■ Post-natalandearlyYears■ Specialistservicesandsupportforchildren(andprovidessomeUKexamples)■ Confidentialhelpandadvice■ Parentinginterventions,including“well-evaluatedparentingprogrammes,
suchasWebster-Stratton,andspecificprogrammestargetedtosubstancemisusingparents(andgives3UKexamplesofservices)
■ Familyfocusedservices,includingfamilytherapies,parentingwork,1:1workincludingcounselingwithchildrenandwithparents
■ practicalsupport■ Art,dramaandplaytherapy
In2009theDepartmentissuedanActionPlan,Addressing Young People’s Drinking in Northern Ireland,tosupporttheNew Direction for Alcohol and Drugs.ThePlanaimstoreduceboththesupplyof,anddemandfor,alcoholamongstyoungpeople;preventandreducetheharmsfromalcoholuse;andidentifyandprovidetheappropriatesupportforthosemostvulnerableoratrisk.TheprincipleswhichunderpinthePlanincludetheroleoffamilies,theneedforevidence-basedinformation,theidentificationoflocalneeds,andafocusonthemostdisadvantagedareasthroughtheNeighbourhoodRenewalAreas.Actionsinclude:■ Delivery,inaconsistentmanner,alcoholeducationtoallyoungpeoplein
schools;develop,and/orenhancelocalpeerlearning/informationprojectsandinitiatives
■ Localcommunitiestoidentifyanddevelopsupport/diversionaryactivitieswhereyoungpeople’sdrinkingisidentifiedasanissue
■ Continuetoprovideinformation,interventionsandprogrammesonsafesexualpractices,promotingmentalhealth,suicideandself-harm,homeaccidents,trafficaccidents–particularlytargetingyoungdrinkersandthoseyoungpeoplelivinginNeighbourhoodRenewalAreas
■ Developaresearchprogrammeonyoungpeopleandalcohol,andensureallinitiativesarerobustlyevaluated
■ Commissionandpublisharangeofresearchandevaluationstouncoverwhichinterventionsmosteffectivelyaddressthisissue…
■ LocalHiddenHarmActionplansdevelopedandeffectivelyimplemented andthattakefullaccountofissuesrelatingtoalcoholmisuse…fromconception
to18
InJanuary2011theDepartmentissuedaconsultationdocumenttoreviseandextendtheoriginalstrategy(New Strategic Direction for Alcohol and Drugs Phase 2 2011-2016)ratherthanproduceanewstrategy.Objectivesintherevisedstrategyincludeto“promoteopportunitiesforthoseundertheageof18yearstodevelopappropriateskills,attitudesandbehaviourstoenablethemtoresistsocietalpressurestodrinkalcoholand/ormisusedrugs.
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SomeoftheemergingissueshighlightedbytheDraftNewStrategicDirectioninclude:■ Familiesandhiddenharm■ Mentalhealth,suicideanddrugsandalcoholmisuse■ Alcohol■ Linkswithsexualviolenceandabuse,anddomesticviolence.
Theprinciplessetoutintakingthestrategyforwardinclude:■ Evaluation,EvidenceandGoodPracticeBasede.g.informedbyevidenceof
theproblemsand“whatworks”andimprovingtheevidencebasethroughevaluation
■ Partnershipandworkingtogether■ Addressinglocalneed■ CommunityBased■ Long-termfocus
ThedraftNew Strategic DirectionhighlightsPreventionandEarlyInterventionasoneofthecriticalsupportpillars.Itstatesthat“PreventionandearlyInterventionislargelyconcernedwithencouraginganddevelopingwaystosupportandempowerindividuals,familiesandcommunitiesintheacquisitionofknowledge,attitudesandskills”.Itrecommendsthat“aparticularfocusshouldbeputontheimportanceofearlyintervention(especiallyyoungchildrenandfamilies)andtheadoptionoftargeted,aswellasuniversaltypesofpreventionwhichwillleadtothereductionofriskfactorsandthedevelopmentofprotectivefactorsassociatedwiththepreventionofalcoholanddrug-relatedharm”.Italsoarguesthat“interventionsmustbetailoredtoparticularsettingssuchastheschool,communityandworkplace…Theimportanceofformalandinformaleducationandcommunity-basedapproachesisacknowledged.”
ItrecommendsthatresourcestodelivertheNew Strategic Directionshouldbe“properlytargetedatactivitiesandprogrammesthathavebeenshownbypreviousresearchandevaluationtobeeffective”.
ThesuggestedKeyPrioritiesinclude:■ Targetingthoseatriskandvulnerable,includingvulnerableyoungpeople(e.g.
childrenandalcohol/drugusingparents;andschoolexcludees)■ Promotinggoodpracticeinrespectofalcoholanddrug-relatededucation
andprevention,basedon“soundconceptualprinciplesand…evidencedgoodpractice”
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TheDraftStrategyoutlinesshorttolongtemoutcomes,includingreducingtheproportionofyoungpeoplewhodrinkonaregularbasis;whogetdrunk;whotakedrugs.
MaternityStrategyIn2011DHSSPSissuedadraftMaternityStrategyforconsultation,whichrecognisesthat“disadvantagestartsbeforebirthandaccumulatesthroughoutlife”.Ithighlightsthefactthatthoseindeprivedcommunities,youngermothers,motherswhodonotbreastfeed,motherswhosmoke,drinkheavily,usedrugs,orareobesearemorelikelytohavepoorerpregnancyoutcomes.Itacknowledgesthatifhealthinequalitiescanbereducedbefore,duringandafterpregnancythiswillimpactonthefuturehealthofthepopulation.
TacklingHealthinequalityatasub-regionallevelTheSouthEasternHealth&SocialCareTrust(SEHSCT)hasitsownHealthInequalityActionPlan2011/12,whichfocusesonthemostdeprived20%ofareaswithintheTrust(whichincludesOldWarrenandTonagh)includingthefollowingobjectives:■ SupporttheEmotionalDevelopmentofyoungchildreninthe20%most
deprived(NeighbourhoodRenewal/SureStart)areas–• throughthedeliveryofRootsofEmpathyprogramme“withastrong
evidenceforeffectiveness”• Supportingparentsindevelopingtheirchildren’semotionalfoundations
throughtheNewParentProgramme,IncredibleYearsParentingProgrammeandMellowParents/MellowBabiesprogrammes
■ Reducesmokinginthe20%mostdeprivedareasincludingananti-natalincentiveandsupportscheme
■ Reducechildhoodobesityinthe20%mostdeprivedareas,throughMini-Mendfor2-4yearoldsinSurestart
■ Mentalhealth,Suicidepreventionandselfharmby• Deliveringamentalhealthprogrammeinsecondaryschoolsinthe20%
mostdeprivedareas• Acommunicationandtrainingprogrammeinthe20%mostdeprived
communities■ Drugsandalcoholbydevelopinganddeliveringanewprogrammeaimedatthe
familiesofteenagedrinkers■ Supportsocialenterprise/employmentschemesinneighbourhoodrenewal
arease.g.Kilkooley,ColinBridgeandBallymote■ Improveoutcomesforlookedafterchildren
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4.3Children,YoungPeople&Families
TheGovernment’s10-yearStrategyforChildrenandYoungPeopleIn2006,OFMDFMpublisheditsinter-departmental10-yearstrategyforchildrenandyoungpeople-Our Children and Young People – Our Pledge(OFMDFM2006)settingout6highleveloutcomesforchildrenandyoungpeoplethatallagenciesinNorthernIrelandshouldbeworkingtowards:Childrenandyoungpeopleshouldbe:
■ Healthy■ Enjoying,learningandachieving■ Livinginsafetyandwithstability■ Experiencingeconomicandenvironmentalwellbeing■ Contributingpositivelytocommunityandsociety■ Livinginasocietywhichrespectstheirrights
Thesupportingthemesofthe10yearstrategyincludethefollowing:■ Theneedtoadopta“whole-child”approach,whichgivesrecognitiontothe
complexnatureofourchildren’sandyoungpeople’slives■ Workinginpartnershipwiththosewhoprovideandcommissionchildren’s
services…■ Securingandharnessingthesupportofparents,carersandthecommunities
inwhichourchildrenandyoungpeoplelive■ Makingagradualshifttopreventativeandearlyinterventionapproaches
withoutcompromisingthosechildrenandyoungpeoplewhocurrentlyneedourservicesmost
TheStrategycontainsaspecificpledge“wewillpromoteamovetopreventativeandearlyinterventionpracticewithouttakingattentionawayfromourchildrenandyoungpeoplecurrentlymostinneedofmoretargetedservices.
Italsocontainsapledgeto“deliverimprovedoutcomesforallchildrenandyoungpeople,wewillensurethatallfuturepoliciesdevelopedandservicesofferedto,andaccessedby,childrenandyoungpeople,arebasedonidentifiedneedandonevidenceaboutwhatworks”.
Implementationandresourcingofthe10-yearstrategyhasbeendisappointingtomanyoftheorganisationsconcernedwithchildoutcomes.TheOFMdFMChildren’sUnithasbeenincorporatedintoawiderdepartment.
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ChildrenandYoungPeople’sStrategicPartnershipIn2011aChildrenandYoungPeople’sStrategicPartnership(CYPSP)wasestablishedtoimproveoutcomesforchildrenandyoungpeoplethroughintegratedplanning.
TheCYPSPisthefirstChiefExecutiveledcrossagency,crosssectoralintegratedplanningandcommissioningprocessforNorthernIreland.ThisincludesALLstatutorysectororganisationswithresponsibilityforchildrenandyoungpeopleandrepresentativesfromVoluntaryandCommunityandBMEsectors.WithafocusonearlyinterventiontheChildrenandYoungPeople’sPlanisthekeydriverforthiswork.
ThePartnershiphasdevelopeda“NorthernIrelandChildrenandYoungPeople’sPlan2011-2014,whichsetsouthowintegratedplanningandcommissioningarrangementswillbeputinplacetosecureimprovementsinthe6highleveloutcomesforchildrenandyoungpeople(highlightedabove).OneofthefourthemesofthestrategyisEarlyIntervention–inparticular,seekingdesignationofNorthernIrelandasasiteforearlyinterventionandsupportingallagenciestoworktogetherinrelationtotheintegratedplanningandcommissioningofearlyintervention.Theotherthemesare“CommunicatingwithGovernment”,“IntegrationofPlanning”and“OptimisationofResources”.
ApartfromthedefinitionofearlyinterventionandhowtheCYPSPhasagreedtotakeforwardearlyintervention.OneoftheactionswithintheChildrenandYoungPeople’sPlanincludesthedevelopmentofastandardisedresilienceframeworkfortheevaluationofearlyinterventionprogrammesacrossNorthernIreland.
Outcomegroupshavebeenestablishedineachsub-region.TheSouthEasternOutcomesGroup,whichawidemembershipfromthestatutory,voluntaryandcommunitysectors,hasbeenmandatedbythePartnershiptoimplementoutcomesbasedplanningforLisburn&DownandNorthDown&Ards.ThepurposeoftheSouthEasternOutcomesGroupisto“carryoutintegratedplanningandcommissioningforchildrenandyoungpeopleinthearea,withspecificemphasisonsharingresourcesacrossagenciestoimproveoutcomesforchildrenandyoungpeople”.TheOutcomesGroupiscurrentlylookingattheestablishmentordesignationofmorelocalLocalityGroups(suchasColinEarlyInterventionCommunityandEarlyInterventionLisburn)tocarryoutoutcomesbasedplanningatthelevelofgeographywhichmakessenselocally.
TheSouthEasternOutcomesGrouphasalsosetinplacethefoundationsforageographicallybasedFamilySupportHubtoengagewithfamilieswhodonotmeetthethresholdforstatutorysocialworksupportandimproveco-ordinationof
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servicedeliverytoindividualfamilies.Barnardo’shasbeencontractedtodeliverthefamilysupportservicethroughthreefamilysupportworkersinLisburn.Itiscurrentlydealingwithc.50referralspermonth.
DHPSSPSFamiliesMatter(2009)TheDHSSPSFamilysupportstrategy,Families Matterisbasedonthesixoutcomesinthe10yearstrategyforchildrenandyoungpeopleandafamilysupport(Hardiker)modelwithfourlevels:
Level1:AllchildrenLevel2:ChildrenwhoarevulnerableLevel3:ChildreninneedinthecommunityLevel4:Childreninneedofrehabilitation
Thestrategyacknowledgesthat“earlyinterventionproducespositivedividendsintermsofchildrenandfamiliesnotneedingmorespecialistservicesatalaterdate”andthe“currentinequityinresourcingearlyinterventionservicescomparedtothoseofhigherneedsandthismustbeaddressed”.
ThestrategyhighlightsfourprioritythemesforDHSSPS:■ Informationforparentsandserviceplanners■ Access,includingavoidingstigma,language,etc■ SupportingFamiliesandParents,includingParentingEducation,Positive
Parenting,localitybasedservicese.g.extendedschools,children’scentres,relationshipsupport/mediationandSurestart
■ WorkingTogetherforfamiliesandCommunities,includingmulti-agencyworkingandcommonassessment
HealthChild,HealthyFutureTheDHSSPSpublishedaFrameworkfortheUniversalChildHealthPromotionProgrammeinNorthernIrelandfrompregnancyto19years,in2010.Itisbasedontheconceptofprogressiveuniversalismi.e.everychild/familyreceivesastandarduniversalservicei.e.setcontactsbythemidwife,healthvisitorandschoolnurse,etc.tothestandardsintheframework.However,acomprehensiveassessmentofneed(UNOCINI)shouldidentifywhereadditionalearlyinterventionsupportandinterventionsaretobeofferedtoamelioratethepotentialearlynegativeimpactofanyphysical,socialoremotionalfactor,suchasSurestart,breastfeedingsupport,counseling,evidence-basedparenting,thusreducinginequalities.Wherethisearlyinterventionisunabletoaddresstheneed,children/familiesareescalatedtoamoreprogressivelevelofinterventiontosafeguardthewelfareofthechild.
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Thestrategyrecognisestheparticularimportanceofprovidingadditionalsupporttopregnantteenagersduetothehigherriskoflowbreastfeeding,lowbirthweight,highinfantmortality,highchildaccidents,highpostnataldepression.
TheFrameworkrecognisesthedevelopedunderstandingoftheneurologicaldevelopmentofachild’sbrain,theimportanceofparent-childattachmentinthefirstfewyearsoflife,andthenegativeimpactofmaternalstressinpregnancy.AmajoremphasisintheFrameworkisontheprovisionofparentingsupportandpositiveparentinge.g.usingagreedevidence-basedprogrammestosupportspecificworke.g.Solihullapproach,IncredibleYears,MellowParenting,theSocialBabyBook/Video,andBabyExpressNewsletters.
TheFrameworkaimstoachieve10specificoutcomes:■ Strongparent-childattachmentandpositiveparenting,leadingtobettersocial
andemotionalwellbeingamongchildren■ Carethathelpskeepchildrenhealthyandsafe■ Healthyeatingandincreasedactivity■ Preventionandreductionofsomeseriousdiseasesandcommunicablediseases■ Increasedratesofinitiationandcontinuationofbreastfeeding■ Readinessforschoolandimprovedlearning■ Earlyrecognitionofgrowthdisordersandriskfactorsforobesity■ Earlydetectionandactions(includingearlyintervention/referral)toaddress
developmentaldelayandillhealthandconcernsaboutsafety■ Identificationoffactorsthatcouldinfluencehealthandwellbeinginfamilies■ Bettershortandlongtermoutcomesforchildrenwhoareatriskofsocial
exclusion
TheFrameworkincludesthefollowingcoreelements:
■ Healthimprovement• Supportforparenting:EarlyInterventionandpreventionprogrammesfor
childrenandfamilies• Engagingfathers/partners• Healthpromotionincluding“stronglinksandclosercommunication
withcommunitydevelopmentprogrammesandotherinitiativesaimedatreducinginequalities,socialexclusion,eliminatingpovertyandimprovingeducationaloutcomes”
• PromotionofSocialandEmotionalDevelopment• Safeguarding
1 Theevidencebaseforsomeoftheseinterventionsisweakerthanothers
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• Schoolhealthprofiling,inorderto“developpreventionandearlyinterventionprogrammestoaddresstheneedsofthispopulationwiththeschoolsettingandwithinlocalcommunities”(Note:PHAtoleadtodeveloponetoolsupportedbyICT)
■ Healthprotection• Surveillance• Screening• Immunisation
DiscussionswithcommunitygroupsandthoseinvolvedinhealthvisitinghashighlightedthelackofresourcesavailableinNorthernIrelandtoeffectivelydeliverytheHealthy Child, Healthy Futureframework.Although,perhapsbetterintheSETrustareathanotherTrustareas,ahealthvisitorintheSETrustareaislikelytohaveacaseloadof300-400+families.Tobeabletoprovidemoreintensivesupportforthemostvulnerablenewmothers(fromthe20thweekofthepregnancytotwoyearsold)theTrusthasintroducedtheevidence-informedNew Parenting Programme.AnadditionalhealthvisitorisemployedinbothOldWarrenandHilhall,withacaseloadof25familieseach.ThedeliveryoftheserviceisbeingevaluatedbyQUB(notwithacontrolgroup).AsimilarmodelisbeingdeliveredintheColinarea,withahealthvisitorplustwosupportworkers.Theevidence-informed(butnotaprovenprogramme)10-14weekparentingskillsprogramme,Mellow Parents,developedinScotland,isalsobeingdeliveredinOldWarrenbytheTrust.
ChildPovertyStrategyTheChildPovertyAct2010placesastatutoryobligationontheNIExecutivetodevelopachildpovertystrategy.TheExecutive’sstrategyisdesignedtotryandbreakthecycleofpovertyandunderachievementby“raisingaspirations,increasingaccesstoopportunitiesthrougheducation,supportingparentsintowork,and,providingthenecessarysupporttothosemostinneedsuchaschildrenwithdisabilities,loneparentsandothers”.
Thecross-departmentalStrategysetsoutthekeyareasthattheExecutivebelievesarecrucialinaddressingthecausesandconsequencesofchildpovertyandinmeetingtheGovernment’sobligationsinTheAct.TheStrategyhastwokeystrandsofworkrelevanttothecausesandtheconsequencesofchildpoverty:
1. reducingworklessnessamongstadultswithchildren2. promotelongertermoutcomesthroughchildbasedinterventionswhichare
designedtotacklethecyclicalnatureofchildpoverty
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TheStrategyhighlightsanumberofprinciplesthatunderpinandshouldsupportthedeliveryofthestrategy:■ Ashifttowardstacklingtherootcausesofpovertyandnotjusttreatingits
symptoms.■ PuttingchildrenatthecentreoftheStrategyandtakingintoaccounttheir
viewswhendevelopingpoliciesandprogrammestotacklechildpoverty.■ AdoptingaLifeCycleapproach,breakingthecyclethatresultsinchildren
bornintopovertybecomingworkingageadultsinlowincome.■ Promotingexcellenceinsupportacrossarangeofkeypolicyareasincluding
employmentandskills,education,childcare,healthandfamilysupport,housingandneighbourhoods,andfinancialsupport.
■ Agradualshifttowardstheuseofpreventativemeasurestotacklechildpovertyand,whenfamiliesfacedifficulties,interventionatanearlystage,reducingthelikelihoodofmoreseriousproblemsdevelopinginthefuture
■ Applyinganevidencebasedapproach.■ Adoptingawholefamilyapproachwhichconcentratesonallmembersofthe
family-children,youngpeople,andtheirparentsandsupportingfamilylife.■ Empoweringandenablingparentsonlowincomeintoworkandmakework
payforthoseonlowpay.■ Promotingpartnershipworkingacrossallsectorsincludingpublic,private,
voluntary,andcommunitysectors.■ RecognisingthecurrenteconomicclimateandtheneedfortheStrategytobe
balancedagainstexistingfinanciallimits.
TheKeyStrategicPrioritiesintheStrategyareasfollows:■ Ensure,asfaraspossible,thatpovertyanddisadvantageinchildhooddoesnot
translateintopooreroutcomesforchildrenastheymoveintoadulthood.■ Supportmoreparentstobeinworkthatpays.■ Ensurethechild’senvironmentsupportsthemtothrive.■ Targetfinancialsupporttoberesponsivetofamilysituations.
SomeoftherelevantActionAreasundertwoofthesepriorities,whicharerelevanttoanearlyinterventionapproachareasfollows:
Ensure,asfaraspossible,thatpovertyinchildhooddoesnottranslateintopooroutcomesforchildrenastheymoveintoadultlife■ Provideallchildrenandyoungpeoplewithopportunitiestoreachtheir
educationalattainmentregardlessofbackgroundandaddressbarrierstopupilsachievingtheirfullpotential.
■ Supportdisadvantagedfamiliestopromotethephysical,social,intellectualandemotionaldevelopmentoftheirchildrensothattheyflourishathomeandwhentheygettoschool.
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■ Supportthedeliveryofanaccessible,flexibleandqualitychildcaresector,sothatitiseffectiveinreducingbarrierstoemployment,particularlythoseexperiencedbydisadvantagedgroups,andsupportschilddevelopmentandwellbeing”.
■ Improvehealthoutcomesandtargetthosegroupswhoareparticularlyatriskorvulnerable,inordertotacklehealthinequalitiesofchildrenandyoungpeople.
■ Strengthenandimprovepreventionandearlyinterventionforallchildrenandtheirfamilies,particularlyinthefirstthreeyearsoflifetomaximisefutureoutcomesinhealthandwellbeing.
■ Providefamilysupportandinterventionservicestochildreninvulnerablefamilies.
■ Improveschoolreadinessandincreaseparticipationinformalandnon-formaleducation,youthservicesandsportsthroughaccessibleandaffordableculture,artsandleisureservices.
■ Addresssocio-economicdisadvantageinchildrenandmaximiseaccesstokeyservicesforchildrenandyoungpeople.
Ensurethechild’senvironmentsupportsthemtothrive:■ Promoteaffordable,accessibleplayandleisureprovisionforallchildrenand
youngpeople.■ Providedifferentlearningenvironmentsthroughyouthserviceswhich
complementformallearningandarefocusedonthepersonalandsocialdevelopmentofchildrenandyoungpeople.
■ Toimproveopportunitiesforlowincomefamiliestoparticipateinarts,cultural,sportingandleisureactivities.
■ Ensurethatparentscanaccessinformationandservices,includingtheRegionalFamilySupportDatabaseintheirlocalareastosupportthemincarryingouttheirparentalresponsibilities.
■ Makepublictransportmoreaccessibleandaffordabletoallchildrenincludingthosewithadisabilityinbothurbanandruralareas.
■ Continuetotakeactiontoaddressfuelpovertyinvulnerablehouseholds.■ Ensurechildrenandyoungpeoplearelivinginhomeswhichachievethe
DecentHomesStandard.■ Supportstatutoryandvoluntaryagencies,includinglocalcouncils,to
provideservicesandprogrammeswhichmeettheneedsoflocalcommunities,particularlydisadvantagedcommunities.
■ Continuetoaddresstheunderlyingcausesofdisadvantageandimprovethephysicalenvironmentofthemostdeprivedneighbourhoods.
AnactionplantoimplementtheChildPovertystrategyisexpectedtobepublishedbytheSummer2012.
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4.4Education
Everyschoolagoodschool–apolicyforschoolimprovementTheDepartmentofEducationundertookareviewofthepreviousschoolimprovementpolicyandissuedthefindingsofthisreviewandproposalsforthewayforwardforpublicconsultationinJanuary2008.Followingconsultation,thefinalisedpolicydocument,EverySchoolAGoodSchool-APolicyforSchoolImprovementwaslaunchedbythethenEducationMinister,CaitrionaRuaneinApril2009.
TheDepartment’svisionis“toensurethateverylearnerfulfillshisorherpotentialateachstageofherorhisdevelopment”.
Thepolicyrecognisesthat“therearestilltoomanyyoungpeoplefinishingtheir12yearsofcompulsoryschoolingwithoutreaching”5+GCSEsgradeA*-C,especiallythosewhoareeconomicallyandsociallydisadvantaged,sothat“schoolsservingdisadvantagedcommunities,andcommunitieswherethevalueplacedoneducationmaynotbeashighasitmightbe,willneedmuchgreaterlevelsofsupport”.Inspectorshavereportedthatinone-thirdofprimaryschoolsinspectedthequalityofprovisionwasnotgoodenough(ChiefInspector’sReport2006-2008).
Thepolicyhighlightsthecharacteristicsandindicatorsofagoodschoolwitheffectiveperformance,inrelationto:■ Child-Centredprovision■ Highqualityteachingandlearning■ Effectiveleadership■ Aschoolconnectedtothelocalcommunity
TheDepartmentcommits,amongstarangeofthings,to“maintainingaparticularfocusontacklingthebarrierstolearningthatmanyyoungpeopleface”andinparticularto“continuetosupportworkthroughthedevelopingpupil’semotionalhealthandwellbeingprogrammeandthecounsellingprovisioninschoolsinordertobuildpupil’sresiliencetodealwithchallengesintheirlivesandimprovetheirreadinesstolearn”;andtoplanandtrackliteracyandnumeracybetterthroughcleareroutcomes.
ThePolicyalsorecognisestheimportanceof“increasingengagementbetweenschoolandparents,familiesandcommunitiestheyserve”,through■ TheExtendedSchoolsProgrammewhichsupportsover400schoolsin
disadvantagedcommunities,will“continuetoensurethatthoseschoolsservingthemostdisadvantagedcommunitiesreceiveadditionalsupportto
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provideactivitiesoutsideofnormalschoolhoursthatreflectandrespondtotheneedsoftheirpupilsandthelocalcommunity”
■ Fullserviceextendedschools(alreadybeingpilotedin3Belfastschool)–theDepartmentwill“publishastrategyforthefurtherdevelopmentofthisconcept”
■ Healthpromotingschools(200schoolsalreadyengaged)■ Identifyinganddisseminating“goodpracticewithaparticularfocuson
communityuseofschoolstohelpschoolsinbuildingstrongerlinkswiththeirparentsandlocalcommunities”
ExtendedSchoolsTheExtendedSchoolsconceptwasoriginallyintroducedinNorthernIrelandin2006,basedonExtended Schools: schools, families, communities – working togetherdocumentpublishedbytheDepartmentofEducation.ExtendedSchoolsweretobeschoolswhich:
■ viewsworkingwithitspupils,familiesandcommunityasanessentialelementinraisingthestandardofpupilsachievement;
■ buildspartnershipswithneighbouringschools,thefurthereducationsectorandotherstatutory,voluntary,businessandcommunityorganizationstodevelopanddeliverbetterservicesforthecommunityasawholeandforchildrenandyoungpeopleandtheirfamiliesinparticular;
■ helpstostrengthenfamiliesandcommunitiesthroughprovidingopportunitiesforlifelonglearningandpersonaldevelopment;and
■ usesitsaccommodationflexiblyandoutsideofschoolhoursforthegoodoflearnersandthecommunity.
Thedocumenthighlightsalargenumberofpotentialbenefitsforpupils,schools,familiesandcommunitiesfromengagementwithExtendedSchools.
ThecriteriaforreceivingExtendedSchoolsfundingforprimaryandnurseryschoolswasinclusioninaneighbourhoodrenewalarea;beinthe30%lowestrankingwardsorSOAsinrelationtotheEducationdomain;orFreeSchoolmealsentitlementof37%ofhigher.Intermsoffundingschoolsweretoreceiveablockallocation,plusanamountperpupil,basedonaslidingscale,plusanextraallowanceforbeingpartofacluster.SchoolswererequiredtosubmitaproposedExtendedSchoolactionplan.
FollowingETIevaluationsoftheExtendedSchoolsProgrammein2009and2010,whichshowedprogressbutrequiredbetterintegrationwithwhole-schoolimprovementplanningandmoreattentiontoraisingstandardsandtheachievementofspecifichighleveloutcomes,inNovember2010theDepartment
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issuedarevisedCircularonExtended Schools – Building on Good Practice.Itstatesthat“theprimaryfunctionofanExtendedSchoolmustbetoraisestandardsthroughtheprovisionoftargetedsupportserviceswhichhaveafocusonlearning,developmentandprogress”and“topromote,supportandsustainthedrivetomaximizelearningandachievementforthosechildrenandyoungpeoplemostinneedorwhoareatriskofloweducationalattainment”.Itstaesthat“Aboveeverythingelse,itmustberememberedthattheactivitiesandservicesprovidedbyExtendedSchoolsmustbefocusedonthecorepurposeofimprovingchildren’slearningandlevelsofeducationalattainment”.
TheCircularstatesthateffectiveExtendedSchoolsprogrammeshave:■ Mappedprovisioninrelationtodataandanalysisofneed;■ Joinedupplanswithotherprovisionsuchastheyouthservice,health,
neighbourhoodrenewal,andcommunityrelations;■ Activelyparticipatedinaclusterworkingtopromotethesharingofprovision
andexpertisebetweenschoolsandpromotedcrosscommunitycollaborationwherepossible;and
■ Engagedwiththevoluntaryandcommunitysectorinthedeliveryofservicesandactivitiesallowingschoolstobuildtheircapacity.
PuttingPupilsFirst:ShapingOurFutureInhisfirstpublicpolicystatement,inSeptember2011,whichwaspublishedasPuttingPupilsFirst:ShapingOurFuture’JohnO’Dowdsetouthisvisionforeducation.Thisincludedthefollowingstatement:
“Infocusingontheneedsofallchildren,wemuststartbylayingtherightfoundationsforlearninginthoseall-importantearlyyears”
ItalsoincludedacommitmenttofinalisingtheEarlyYearsStrategy.Thedraftstrategysetoutto,amongstotherobjectives,“promotingbetterlearningoutcomesforchildrenbytheendoftheFoundationstage,especiallyinlanguageandnumber;andinthechildren’spersonalandsocialdevelopment,emotionalwell-beingandreadinesstolearn”.Thedraftstrategyalsoidentifiesthefollowingissues:■ identifyingbestpractice■ earlyinterventionwherenecessary■ tacklingbarrierstolearning■ developingstronglinkswithfamiliesandcommunities
Thedraftstrategyalsoproposesreviewingthepre-schoolcurriculum,reflectingthecentralityofthecurriculumtoliteracyandnumeracy.Italsoproposessettingoutthemilestonestobeexpectedinachild’sdevelopment.
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In2012theDepartmentaskedtheEducationandLibraryBoards,inpartnershipwiththeothereducationalmanagementbodiestoproduceanauditofallschoolsandproduceplansforthefutureofthepost-primary(endofMarch2012)andprimary(endofJune2012)sectors.Thisislikelytoresultintheclosureofbothprimaryandpost-primaryschoolsinLisburn,andelsewhere.
LiteracyandNumeracyIn2011theGovernmentpublisheditsstrategytoimproveoutcomesinliteracyandnumeracy,Count,read:succeed.Amongstothermeasurestosupportpupils,teachers,schoolleadersandgovernors,includingthedevelopmentofguidanceforparentsrepre=schoolchildrenthestrategyhighlightstheimportanceof“earlyinterventionwherenecessaryforpupilsofanyage,informedbytheeffectiveuseofdata,toaddresstheneedsofthosewhoarestruggling”,especiallyintheearlyyearsand“ensuringearlyinterventiontoaddressactualorpotentialunderachievement”.TheActionPlanstatesthat“Extendedschoolswillensuretheirextendedschoolsactivitiesorservicesareintegratedintotheirplanningforraisingstandards.
ThestrategysaysthataDirectoratewillbecreatedinDElinkingwithparents,familiesandcommunitiestohelpthemsupporttheirchildren,particularlyinnumeracyandliteracy.
ChildcareTheDepartmentofEducationhasalsocommittedtoproducingaChildcareStrategyfor0-6yearsoldsandhascarriedoutaconsultationprocess.
4.5Area-basedInitiatives
NeighbourhoodRenewalInJune2003,GovernmentlaunchedPeopleandPlace–AstrategyforNeighbourhoodRenewal.Thislongterm(7–10year)strategytargetsthosecommunitiesthroughoutNorthernIrelandsufferingthehighestlevelsofdeprivation.NeighbourhoodRenewalisacrossgovernmentstrategyandaimstobringtogethertheworkofallGovernmentDepartmentsinpartnershipwithlocalpeopletotackledisadvantageanddeprivationinallaspectsofeverydaylife.Neighbourhoodsinthemostdeprived10%ofwardsacrossNorthernIrelandwereidentifiedusingtheNobleMultipleDeprivationMeasure.Followingextensiveconsultation,thisresultedinatotalof36areas,andapopulationofapproximately280,000(onepersonin6inNorthernIreland),beingtargetedforintervention.Theareasinclude:■ 15inBelfast,■ 6inLondonderryand
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■ 15inothertownsandcitiesacrossNorthernIreland(includingColinincorporatingPoleglassandTwinbrook).
NeighbourhoodPartnershipshavebeenestablishedineachNeighbourhoodRenewalAreaasavehicleforlocalplanningandimplementation.EachNeighbourhoodPartnershipincludesrepresentativesofkeypolitical,statutory,voluntary,communityandprivatesectorstakeholders.Together,theyhavedevelopedlongtermvisionsandactionplansdesignedtoimprovethequalityoflifeforthoselivinginthearea.
ThekeystrategicobjectiveofNeighbourhoodRenewalis:Totacklethecomplex,multi-dimensionalnatureofdeprivationinanintegratedway,throughthefollowing:■ CommunityRenewal-todevelopconfidentcommunitiesthatareableand
committedtoimprovingthequalityoflifeintheirareas■ EconomicRenewal-todevelopeconomicactivityinthemostdeprived
neighbourhoodsandconnectthemtothewiderurbaneconomy■ SocialRenewal-toimprovesocialconditionsforthepeoplewholiveinthe
mostdeprivedneighbourhoodsthroughbetterco-ordinatedpublicservicesandthecreationofsaferenvironments
■ PhysicalRenewal-tohelpcreateattractive,safe,sustainableenvironmentsinthemostdeprivedneighbourhoods.
NoneofthetargetareasinEarlyInterventionLisburnareconsideredtobeNeighbourhoodRenewalareas,basedonthe2001multipledeprivationdata.
AreasAtRiskTheAreas at RiskPilotProgrammewasestablishedin2006toidentifyandinterveneinareasconsideredatriskofslippingintoaspiralofdecline.TheDepartment,throughtheVoluntaryandCommunityUnit,inconjunctionwitharangeofotherpartners,willhelptosupportthesecommunities,whichperhapsfeelneglectedorisolatedinordertohelpbuildconfidenceandasenseofbelonging.Thetypesofareasthattheprogrammeoperateswithinincludeforexample:■ ‘Interface’areasthatlieoutsideofNeighbourhoodRenewalareas■ Areasineconomicdecline■ Areasat‘riskofdecline’forexample,thoseareasthatwithouttargetedsupport
maymoveintothetop10%asdefinedbyNoble■ Areasatriskof‘descendingintoinstabilityandcrisis’orareasinwhichthere
isadeclineincommunitycohesionwhichthreatenspeaceandstability■ Areaswherethelossoftheserviceprovidedbyorganisationswouldhavea
significantnegativeimpactonthelocalcommunity.
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ProgrammeObjectives-ThekeyobjectivesoftheProgrammeareto:■ reducethelevel,frequencyandimpactofinterfaceviolencewithinthe
community;■ increaselevelsofeconomicactivitywithinthetargetedareas;■ stabilisetargetedareastothepointthattheareaiseithernolongerconsidered
asan‘areaatrisk’,orthattheriskoftheareaslippingintodeclineisprevented;
■ increasecommunitycohesionandcapacity;■ strengthencommunityinfrastructureinthoseareaswhereitisweak;and■ achieveamoresustainableapproachtocommunityparticipationand
development.
Inordertoensurethatthecommunitiesparticipatinginthisprogrammemeetthecriteriaastrategicpartnershipwasestablished,chairedbytheVoluntaryandCommunityUnit.PermanentpartnersaretheDevelopmentOffices(BRO;RDO;NWDO)andtheNorthernIrelandHousingExecutive,inbothcasesinvolvementisdevolvedtolocaloffices.Otherstatutorybodiesareinvitedtojoinonanadhocbasisasandwhentheirexpertisewouldlendsignificancetotheprogramme.
Potentialareasforinclusionintheprogrammeweresoughtfromthepermanentpartners,whoalsohavetoprovideanevidentialbasisforinclusion.OthersourcesofreferenceincludedlocalpoliticiansincludingCouncillorsandMLA’s.EachnominatedareawasconsideredagainstcriteriabeforebeingsenttoMinisterforconsiderationandapproval.
Onceanareawasincludedalocalvoluntaryorganisationwasnominated(bythepermanentpartners)toactastheleadorganization,chargedwithassistingtocarryoutacommunityaudit.TheDepartmenttakestheleadinappointingaconsultanttocarryouttheauditwhichcanbesupportedthroughprogrammefunds,beforesubmittingaprojectproposal.Theprojectproposalwasconsideredbyallpartnerorganisationsandsubjecttounanimousagreement.
Thepilotprogrammeiscurrentlyoperatinginthefollowingareas:
Phase One: Sydenham(EastBelfast);Taughmonagh(SouthBelfast;Seacourt(Larne);WestPortadown;Rathenraw(Antrim);Dunclug(Ballymena;Limavady;DhuVarren(Portrush);Ballynashallog(Londonderry)
Phase Two: (Announced13November2007byMinisterMargaretRitchie):LowerWhitewell(NorthBelfast);Ballybeen(Dundonald);Gilford(Banbridge);Annadale(SouthBelfast);Scrabo(Newtownards);Killicomaine(Portadown);Alexander/Lisanally(Armagh);AshfieldGardens(Fintona);SeymourHill(Dunmurry);
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CraigyhillandAntivlle(Larne);Harryville(Ballymena);Caw/NelsonDrive/LincolnCourts(Derry/Londonderry)
Phase Three: (Announced28January2009byMinisterMargaretRitchie):Beechfield(Donaghadee);Lettershandoney(Derry/Londonderry);Strathfoyle(Derry/Londonderry);FerrisPark(LarneTown);DouryRoad(Ballymena).
NoneoftheEarlyInterventionLisburntargetareashavebeendesignatedasAreasAtRisk.
CommunitySafetyStrategyInJanuary2011thenewDepartmentofJusticeissuedforconsultation“Buildingsafer,SharedandConfidentCommunities–aconsultationonanewcommunitysafetystrategyforNorthernIreland”designedtohelpbuild:■ Safercommunities:withlowerlevelsofcrimeandanti-socialbehaviour,
includingsupportingearlyinterventionforlong-termcrimereduction■ Sharedcommunities:whereeveryone’srightsarerespectedinashared,and
cohesivecommunity■ Confidentcommunities:inwhichpeoplefeelsafeandhaveconfidenceinthe
justiceagenciesthatservethem
Thedraftprinciplesfordeliveringthestrategyincludeboth■ early intervention,“recognizingtheimportanceofearlyinterventionsto
helpaddresstheunderlyingriskfactorsthatcanleadtocrimeandanti-socialbehaviour”;and
■ Evidence-based solutions,“focusingonsolutionsthatpreventandreducecrimewhichareevidence-based,innovativeandresponsivetolocalneeds.
InordertobuildsaferCommunitiesthestrategywould“buildonwhatworksinreducingandpreventingcrime,andworkingreaterpartnershipwithotherExecutiveDepartmentstocreatesafercommunitiesoverthelongtermparticularlyintheareasofhealth,educationandaddressinginequalityandsocialdisadvantage”.
Section5.4outlinestherelationshipbetweencrimeandtheunderlyingcausesandriskfactorsandtherationaleforanearlyinterventionapproach.Itprovidestwoevidence-basedearlyinterventionapproachesincludingthePerryPreschoolProject.
ThedraftstrategycommitstheDepartmentofJusticeto“workwithotherExecutiveDepartmentstoconsiderhowwecansupportearlyinterventionandpromoteitatlocalpartnershiplevelwhereappropriate.Wewillcontinueto
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supportanddevelopearlystageinterventionprojects,andreviewwhatworksinearlystageprovision.
TheDepartmentofJusticehasdevelopedaStrategicFrameworkforReducingOffendingwhichwillbegoingoutforconsultationbeforetheSummer2012forapprovalbytheendoftheyear.Thisframework,amongstotherthings,highlightstheimportanceoftacklingsocialdeterminantsofcrimesuchasimprovingeducationalattainmentandreducingpoverty,aswellaspreventionanddiversionactivitiesincludingEarlyInterventions,tacklingdrugsandalcoholmisuseandrespondingtomentalhealthissues
4.6ProgrammeforGovernment2011–2016InMarch2012theGovernmentlauncheditsProgrammeforGovernment(PfG),followingaperiodofconsultation.TheProgrammehasfiveaims:■ Growingasustainableeconomyandinvestinginthefuture■ Creatingopportunities,tacklingdisadvantageandimprovinghealthand
wellbeing■ Protectingourpeople,theenvironmentandcreatingsafercommunities■ Buildingastrongandsharedcommunity■ Deliveringhighqualityandefficientpublicservices
TheProgrammecontainsthefollowingrelevantcommitments:■ Introduceandsupportarangeofinitiativesaimedatreducingfuelpoverty
acrossNIincludingpreventiveinterventions■ Provide£40milliontoimprovepathwaystoemployment,tacklesystemicissues
linkedtodeprivationandincreasecommunityservicesthroughtheSocialInvestmentFund(in8regionsofdisadvantageandpoverty)
■ Publishandimplementastrategyforintegratedandaffordablechildcare■ Deliverarangeofmeasurestotacklepovertyandsocialexclusion,throughthe
DeliveringSocialChangedeliveryframework■ UsetheSocialProtectionFundtohelpindividualsandfamiliesfacinghardship
duetothecurrenteconomicdownturn■ FulfillourcommitmentsundertheChildPovertyActtoreducechildpoverty■ Improvecommunitysafetybytacklinganti-socialbehaviour■ Increasetheproportionofyoungpeoplewhoachieveatleast5GCSEsatA*-C
orequivalentincludingGCSEsinMathsandEnglishbythetimetheyleaveschool
■ Improveliteracyandnumeracylevelsamongschoolleavers,withadditionalsupporttargetedatunderachievingpupils
■ Ensurethatatleastoneyearofpre-schooleducationisavailabletoeveryfamilythatwantsit
■ Allocateanincreasingpercentageoftheoverallhealthbudgettopublichealth
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■ Invest£7.8millioninprogrammestotackleobesity■ Provide£40milliontoaddressderelictionandpromoteinvestmentinthe
physicalregenerationofdeprivedareasthroughtheSocialInvestmentFund.
TheProgrammedoesnotspecificallyincludeacommitmenttoearlyinterventionortoevidence-basedapproaches.InFebruary2012theChildren’sCommissioner’s(NICCY)responsetotheDraftProgrammeforGovernmentrecommendedincludingaspecificcommitmentinthePfG“toearlyinterventionandpreventionforchildrenandyoungpeople,linkingfundingandjointworkingacrossdepartments”.
SocialInvestmentFundTheExecutiveagreedon22March2011totheestablishmentoftheSocialInvestmentFund(SIF)andmoniestotaling£80millionoverafouryearperiodweresubsequentlyallocatedintheBudget.thePfG,highlightedabove,includesarenewedcommitmenttotheFund.
ThehighlevelaimoftheSocialInvestmentFundistoreducepoverty,unemploymentandphysicaldeteriorationinareasthroughareabasedinterventionsofsignificantscalewhichwillbedeliveredinpartnershipwithcommunities.TheFundwilltoencouragecommunities,statutoryagencies,businessanddepartmentstoworktogetherinaco-ordinatedway,reducingduplication,sharingbestpracticeandenhancingexistingprovisionforthebenefitsofthosecommunitiesmostinneed.
TheSIF’sstrategicobjectivesaretosupportcommunitiesto:■ buildPathwaystoEmployment;■ tacklethesystemicissueslinkedtodeprivation;■ increasecommunityservices;and■ addressdereliction.
A“prediscussion”paperwaspublishedinMarch2011andoutlinesthehighlevelstrategicconcept,objectivesandoverallmethodologyoftheFund.AconsultationdocumentwaspublishedtoseekviewsontheproposedoperationoftheSocialInvestmentFund(SIF),includingoptionsforapplyingtotheFund,application/assessmentcriteria,howtheFundshouldbemanagedandthestructurestosupportitsdelivery.TheConsultationontheproposedoperationoftheSocialInvestmentFund(SIF)closedonthe23December2011.
SocialProtectionFundTheNIExecutivehasalsoestablishedaSocialProtectionFund(SPF)to“assistthosemostinneedinthewidercommunity”.Thisyear(2011/12)theyagreed
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toprioritisefuelpovertythroughthefund,andcommittedthefull£20millionbudgettoawinterfuelpovertypaymentschemethroughtheDepartmentforSocialDevelopmentandtheDepartmentofHealth,SocialServicesandPublicSafety(DHSSPS)undertheFinancialAssistanceAct(NorthernIreland)2009.Throughthescheme,aone-offpaymentof£75hasbeenmadetopersonsinreceiptofincome-basedmeans-testedbenefits,includingincomesupport,income-relatedemploymentandsupportallowanceandincome-basedjobseeker’sallowance.PensioncreditrecipientsandpeopleinreceiptofcancertreatmentinlinewithcriteriadeterminedbyDHSSPSarereceivingone-offpaymentsof£100.Althoughfundingfortheprogrammewassecuredforonlyonefinancialyear,theExecutivearecommittedtosecuringmoneysforfutureSPFprogrammesduringtheremainderofthecurrentBudgetperiod.
4.7ConclusionsinrelationtothePublicPolicyContextThepublicpolicycontextpresentsaconsistentsenseoftransitiontowardsanearlyinterventionandevidence-basedapproachtoaddressingmanyofthedifficultiesfacingchildren,youngpeopleandfamiliesinNorthernIreland.Thereisaclearunderstandingoftheimplicationsofdeprivationandwiderinequalitiesfortheoutcomesforchildrenandyoungpeopleandastatedcommitmenttotacklingtheseinequalities.Thepolicycontextsuggeststheprinciplesthatshoulddrivethisearlyinterventionapproachareasfollows:
Interventionsshould:■ focusontacklingrootcausesandnotjusttreatingsymptoms;■ takeplaceintheearlyyearsofachild’slife,where,theevidencesuggests,
manyproblemsinlaterlifearecreatedandatwhichstagebraindevelopmentismoulded,and/orattheearlieststageofdifficulty,whenachildmaybevulnerabletopoordevelopmentaloutcomes;
■ adoptawholechildapproach,whichgivesrecognitiontothecomplexnatureofourchildren’sandyoungpeople’slives;
■ adoptawholefamilyapproachwhichconcentratesonallmembersofthefamily-children,youngpeople,andtheirparentsandsupportingfamilylife;
■ adoptawholesocietyapproachtoearlyinterventionthroughanetworkofintegratedsupportsandservicesandmulti-agencyworking;
■ buildonthestrengthsandresilienceofchildren,youngpeopleandfamiliesandnotonlyrespondtotheirneeds;
■ beevidence-basedthroughimplementingprogrammeswhichhavebeensubjecttorigorousevaluation(esp.RCTs).Innovationsthathavenotbeenrobustlyevaluatedbeforeshouldberigorouslyevaluated;
■ befocusedonachievingclearmeasurableoutcomes;■ Beimplementedwithfidelitybyskilledandtrainedstaff;■ be“owned”bythecommunitythroughacommunitydevelopmentapproach;
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■ beaccessibleandpromoteparticipationandinclusion;■ besustainedandlong-term;■ combine
• Level1support:universal(allchildren);• Level2support:targetcommunitiesandgroups/categoriesoffamilies
whicharemostvulnerableduetodeprivation,etc.;and• Level3support:non-stigmatisingtargetedearlyinterventiononparticular
familiesassessedtobemostatrisk.
Thepolicycontextraisesotherimportantissuestobeconsidered:
IdentificationofareasofdeprivationTherecognitionoftheimportanceofdeprivationindeterminingoutcomesforchildrenandyoungpeoplehasresultedinthedevelopmentofthevaluableMultipleDeprivationMeasure(MDM)torankwardsandSuperOutputAreas.Thishasbeenusedbyarangeofinitiativestotargetthose“mostinneed”.NeighbourhoodRenewalhasfocusedawiderangeofservicesandresourcesinthe10%ofmostdeprivedcommunities(basedonthe2001MDM.Thisapproachhassignificantshortcomings,including:
■ ThemajorityofpoorfamiliesliveoutsideNeighbourhoodRenewalareas■ ManybetterofffamiliesliveinthemostdisadvantagedSOAs■ Resourcesavailabletocommunitieswhichrankjustoutsidethe200110%
rankinghavebeendivertedtowardsNeighbourhoodRenewalAreas■ Deprivationchangesovertime.Ifcalculatednow,OldWarrenwouldbea
NeighbourhoodRenewalArea■ MDMincludesproximitytoahospital,inthiscase,LaganValleyHospital
whichisveryclosetoTonagh/OldWarren/Knockmore,butisnolongerafullacutehospital
■ AveragingDeprivationthroughanaggregatemeasuresuchasMDMignorestheimportanceofindicatorswhichmayshowaverydifferentpicture.Forexample,theverylowlevelofeducationalattainmentinProtestantworkingclassareasinLisburn(andotherpartsofNorthernIreland)isverydisturbing,requiringurgentaction,butismaskedbyafocusedonMDM.
ResourcingandImplementationManyofthestrategiesaboveexpressagoodunderstandingoftheissuestobeaddressedverypositiveaimsandprinciples.However,thelong-termresourcingandimplementationhasbeenpoor.Despitethesepositivesoundingstrategydocuments,littlehaschangedfordisadvantagedfamiliesinthetargetareasofLisburncharacterisedbypovertyand,evenmoreso,byeducationalunderachievement.Manyevidence-basedinitiativeshavebeenintroducedina
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half-heartedwaywithinadequateand/orshort-termresources.Thereneedstobeaclearcommitmenttoeffectivelong-termresourcingofrobustlyevidence-basedprogrammes,otherwisetheinequalitieswillcontinuetowiden.
Theeconomicevidencethatearlyinterventionprogrammescan,ratherthancostmoney,overthelonger-term,saveconsiderableamountsofmoneyforthestate,butthenatureofshort-termfundingdecisionsmeansthatthecriteriausedtomakethesedecisionsdonottakeintoaccounttheselong-termsavings.
PartnershipworkingThemantraofcross-sectoralandintegratedpartnershipworking,basedonawholechildmodel,cannotbedeliveredthroughtraditionalsilomodelsandstructures.EarlyInterventionoftenmeansinvestmentsbyoneDepartmentoragencyinordertoproducedesiredoutcomesforadifferentDepartmentoragency.
Hopefully,thenewChildrenandYoungPeople’sStrategicPartnershipandthesub-regionalOutcomeandLocalityGroupspresenttheopportunitytomakeaseriouscommitmenttopartnershipworkinganddevelopingtrulyintegratedservices.
Thereisstillabiggapbetweentheworkofpublichealthandsocialcareagenciesandworkinschools.TheExtendedSchoolsinitiativehasmadeasmallcontributiontowardsmoreintegration,butthisisonlyattheearlystages.Forearlyinterventiontobesuccessfulthereneedstoseamlessworkingbetweenschools(whichnearlyallchildrenattend),community-basedinitiatives,andthehealthandsocialcaresector.
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5.1OutcomesTheprevioussectionshave:■ analysedtheneedsofthetargetcommunitiesinLisburn,asidentifiedbothby
deskresearchandthroughtheconsultationswithcommunityrepresentatives,schoolsandthosefromtherelevantprofessionalagenciesworkingintheareas;
■ examinedtheconcepts,andrationale,aroundearlyintervention;and■ summarisedtherelevantpublicpolicycontext.
These,together,suggestthatthespecificoutcomeswhichtheEarlyInterventionLisburnInitiativeshouldtarget,tohaveanimpactontheGovernment’shighleveloutcomesforchildrenofbeing:Healthy;Enjoying,learningandachieving;Livinginsafetyandwithstability;Experiencingeconomicandenvironmentalwellbeing;Contributingpositivelytocommunityandsociety;andLivinginasocietywhichrespectstheirrights,shouldbeasfollows:
■ Reducednumberofteenagepregnancies■ Reducedlevelofsmokingduringpregnancy■ Improvedparentingskillsandconfidence■ Improvedparent-childattachmentfor0-2yearolds■ Improvedschoolreadinessamongst3&4yearolds■ Improvedliteracyandnumeracyinchildrenaged4-11■ Improvedsocialandemotionalskillsandresilienceof4-11yearolds■ Improvedschoolattendance■ Improvededucationalaspirationsandattainmentonleavingschool■ Reducedbehavioural/conductproblems■ Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ Reducedcrimeandanti-socialbehaviouramongstyoungpeople■ Reducedchildhoodandteenageobesity■ Increasedengagementoffathersintheirchildren’slearning
Thereisbroadagreementthattheseareimportantoutcomestobeaddressedtoimprovethelivesofthepeopleofthetargetareas.However,thekeyquestionishowbesttoachievetheseoutcomes.Thisinturnsuggestsanumberofotherquestions,whichneedtobeaddressed,asfollows:
■ Whatimpactdocurrentprogrammesandservicesmakeontheseoutcomesandhowcouldtheymakeagreaterimpact?
■ Whatarethemosteffectiveinterventionstoachievetheseoutcomes?andhowrobustistheevidenceforthepotentialimpactoftheinterventions?
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■ Whatarethemostcost-effectiveinterventionsi.e.whichinterventionswillcreatethegreatestlong-termsavingstothepublicpurse?
■ Whichinterventionsshouldbeuniversal,targetedonparticularcommunities/populations,ortargetedonparticularfamilies?
■ Whereshouldinterventionstakeplace:inthehome,communityvenuesand/orschools?
■ Howcanprogressagainsttheagreedoutcomesbemeasured?
■ Whatresourcesarerequiredtoimplementtheevidence-basedprogrammesthatwillhaveasignificantimpactontheagreedoutcomes?
5.2AligningexistingprogrammesandservicesAlthoughLisburnisunderservedintermsofsupportforchildrenandfamilies,asitdoesnotreceiveregenerationfundingsuchasNeighbourhoodRenewal,despitehavingareaswithinthe10%mostdeprivedinthe2010MDMfiguresandconsiderablyworseeducationaloutcomesthanmanyotherareaswithintheworst10%,therearesomeexistingservicesandprogrammesthatoperateinoneormoreofthetargetareas,deliveredbydifferentstatutoryandvoluntaryagencies.Asafirststepitwillbeimportantto:■ increasetheawarenessof,andfocuson,preventionandearlyintervention;■ mapandimprovetheco-ordinationandintegrationofexistingservicesfor
childrenandfamilies,towardsachievingtheagreedoutcomes;■ supportexistingcommunityservicesforchildren,youngpeopleandfamilies
intheLisburnareabydevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured);
■ helpprogrammes/servicestosetandmeasurespecificoutcomes;learnfromtheinternationalliterature;andmanualiseprogrammes/services;
■ developasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother;and
■ encourageandsupportexistingorganisationstoworktogethertotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation).Thiscanbedonethroughlocalmedia,doortodoorconsultations,celebratinglocalchampionsetc.
5.3WhatWorks?Therehasbeenextensiveworkcarriedoutaroundtheworldtoevaluatewhichofthemanyearlyinterventionsocialprogrammesactuallyworki.e.havea
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significantpositiveimpactonthedesiredoutcomes.Thestrongestevidenceisfromevaluations,carriedoutbyexperiencedindependentevaluators,whichinvolvelargenumbersofchildren,familiesand/oryoungpeoplereceivingamanualised(standardised)programme;wherethereisaRandomControlTrial(RCT)witharandomisedcontrolgroupnotreceivingtheprogrammewhichisthereforeverysimilartothegroupreceivingtheprogramme;andtestingiscarriedoutbothbeforeandaftertheintervention,usingwell-establishedmeasurementinstruments.
Therearevariousorganisationsinternationallywhichspecialiseinanalysingthequalityandrobustnessofevaluationinformationfromsocialprogrammesaroundtheworldinordertohighlightprogrammeswhichare“proven”or“promising”,includingBlueprintsandtheWhat Works Clearing House.WorkisnowunderwaytodevelopanequivalentoftheBlueprintsdatabaseforEurope.DartingtonSocialResearchUnitinEnglandhaveworkedwithSteveAosfromWashingtonStateUSAtocreateacostbenefitmodelforEnglandwhichwillformpartofasoontobelaunched“BlueprintsforEurope”(seehttp://www.dartington.org.uk/investinginchildren).GrahamAllenMP,inhisreports,hashighlightedtheprogrammeswhichhehasbeenadvisedbyUKexpertshavethestrongestevidencebase.
Theimpactofsomeofthebestprogrammeshasalsobeenevaluatedintermsofthelong-termcostsandbenefits.Thesehaveshownthatinvestmentintherightevidence-basedearlyinterventionprogrammescanproduceverysubstantiallonger-termsavingsinissueslike:welfarebenefits,medicalandmentalhealthservices,prisonandotherjusticeservices,etc.ThismeansthatfortheGovernmentinNorthernIrelandtoinvestintherecommendedprogrammesinLisburnislikelytoresultinlong-termsavingsmanytimestheamountoftheinvestmentthatisrequirednow.
NobellaureateeconomistJimHeckmanhasanalysedalargenumberofcost-effectivenessstudiesandshownthattheyoungertheageofchildrenengagedintheprogrammesthemoreeffectivetheyareinreducinginequalitiesandmorecost-effectivetheprogrammesareingeneratinglong-termsavings.ThissuggeststhatthebedrockoftheEarlyInterventionLisburnprogrammeshouldbefamilyinterventionsfrompregnancytoage3.Hissubsequentwork,however,alsoshowsthattheseinterventionsneedtobesustainedasthechildrengetolder,particularlyduringtheirprimaryschoolyears,topreventinequalitiesbeingstrengthenedagain.Thisindicatestheimportanceofprogrammesthataddresstheneedsof3-11yearoldsandthosewhomakethedifficulttransitiontopost-primaryschool,aswellasthecrucialprogrammesforchildrenaged0-3andtheirparents.
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5.3ProvenEarlyInterventionProgrammesWhatworksinmeetingthecomplexneedsoffamiliesisarangeofapproaches.Inordertogiveanindicativelistofpotentialprogrammes,thefollowingaresomeofthemostrobustlyevaluated“proven”programmes(i.e.havebeensubjecttoatleasttworobustRCTevaluationswhichproducedstatisticallysignificantresults)mostofwhichhavebeenshowntoresultinsubstantiallatersavings,inrelationtoeachoftheimportantoutcomesforEarlyInterventionLisburn,highlightedabove:
Reducednumberofteenagepregnancies■ FamilyNursePartnership*(pregnancy–age2)–deliveredbyatrained
healthvisitororothernursetotargetedparentsinthehome–whichhasbeenshowntoreduceanddelaysubsequentbirths–ItiscurrentlybeingdeliveredinNorthernIrelandbytheWesternHealth&SocialCareTrustinDerry/Londonderryand,althoughPHAidentifiedLisburnasapriorityareaintheSouthEast,BelfastandtheSouthernTrustareashavebeenchosenfornewFamilyNursePartnershipprogrammes,ratherthanLisburn.ItisalsobeingdeliveredinScotlandinEdinburghandTaysideandinEnglandbyNottinghamlocalauthority.ThereiscurrentlyamajorRCTtrialbeingcarriedoutonFamily
0-3 4-5pre-school
School Post-school
Preschool programs
Schooling
Programmes targeted towards the earliest years
Age
Job training
Rat
e of
Ret
urn
to
Inve
stm
ent
in H
um
an C
apit
al
* KnownasNurseFamilyPartnershipsintheUSAwheretheprogrammeoriginated
CHAPTER FIVE
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The Hockman Curve
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NursePartnershipsinGB.Previousevaluationsshowthattheparentandchildprogrammescombinedaremoreeffectthaneitherdeliveredontheirown.
Reducedlevelofsmoking,drinkinganddruguseduringpregnancy■ FamilyNursePartnership(pregnancy–age2)–seeabove
Improvedparentingskillsandconfidence■ IncredibleYears(aged0-9)ParentsProgramme:Basic(12-14weeks);Advanced
(10-12weeks);andSCHOOLandDinaDinasaur(anhourtwiceaweek(ortwohoursonceaweekfor20-22weeks)forchildrenwithconductproblems)–Targetedonidentifiedfamilies–ItiscurrentlybeingdeliveredintheRepublicofIreland(Youngballymun/Archways)andvariousaspectsofIncredibleYearsisbeingdeliveredinvariousplacesinNorthernIreland(IFIarefundingacross-communityinitiativeintheSEELBareatodeliverIncredibleYearsin16schools,includinginOldWarrenPrimarySchool)
■ Parent-ChildInteractionTherapy(age2-7yearolds)–Targetedonpre-schoolchildrenwithevidenceofaconductdisorderandtheirparents
Improvedparent-childattachmentfor0-2yearolds■ FamilyNursePartnership(pregnancy–age2)–seeabove
■ IncredibleYears(aged0-12)–seeabove
Improvedliteracyandnumeracyinchildrenaged4-11■ DoodleDen–aliteracyprogrammefor5/6yearolds,withadditionalparent
andfamilysessions.Itisdeliveredfor90minutesthreetimesaweekafterschool(inschoolandcommunityvenues)byaspeciallytrainedteacherandyouthworkertoagroupof15children.TheRCTofthepilotinWestTallaghtDublinhasdemonstrateditsimpact.
■ SuccessforAll,includingCuriosityCorner(age3-11yearolds)–Universal-school-based-InstituteofEffectiveEducationUniversityofYork.Therearemodulesforeachkeystagefromfoundationtokeystage3
■ TimetoRead(age8–10yearolds)–developedinNIbyBusinessintheCommunity,usingvolunteersfromcompaniestoreadfor30minuteseachweekwithchildreninaprimaryschoolsetting.Arandomcontroltrialevaluationhasindicateditseffectiveness,esp.forthosechildrenwhosereadingdevelopmentisonlyslightlydelayed.ReadingRecoveryislikelytobemoreeffectiveforthelowest20%ofreaders.TimetoReadisfreetotheschools.ThekeyissueisBITCbeingabletoidentifyappropriatevolunteerstodeliverthe
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programme.ItisalreadybeingdeliveredinOldWarrenandKillowenPrimarySchools
Improvedsocialandemotionalskills,conductandresilienceof4-11yearolds■ PATHS(4/5-11yearolds)–Universal-school-based–Barnardo’sinNorthern
Ireland(aroundCraigavon)andlocalauthoritiesinBirmingham,NorfolkandManchester
■ IncredibleYearsforchildren,parents(seeabove)andteachers(6daytrainingworkshoponclassroombehaviourmanagement)–seeaboveandAppendixfordetails
Reducedbehavioural/conductproblems■ IncredibleYears(aged0-12)–childprogramme(incDinaDinosaur)–universal
preventionprogrammeandtreatmentprogrammeforsmallgroupsofparticularlyatriskchildren–seeaboveandAppendixfordetails
■ TripleP(aged0-16)–Bothuniversalandtargeted(4levels)–onlyprovenifthewholeprogrammeatthe4levelsisdelivered(onlya“promising”BlueprintsProgramme).IsbeingpilotedinLongfordWestMeathParentingPartnershipintheRepublicofIrelandandEngland
Improvedschoolattendance■ BigBrothers/BigSisters(6-18yearolds)–Targeted-mentoringdeliveredby
carefullyselectedandtrainedvolunteers–beingdeliveredinvariouspartsoftheRepublicofIrelandthroughForoige.
Reducedsmoking,alcoholanddrugconsumptionamongstyoungpeople■ BigBrothers/BigSisters(6-18yearolds)–seeabove
■ LifeSkillsTraining(9-15yearolds)–Universal–3-yearschool-basedprogramme(15sessionsinyear1;10inyear2;and5inyear3)–currentlybeingdeliveredinNottingham.Barnardo’shaveBigLotteryfundingtodeliverLSTintheUK,includingNorthernIreland
■ FunctionalFamilyTherapy(10-18yearolds)–Targeted-family-based–deliveredbyaspeciallytrainedqualifiedsocialworker-currentlybeingdeliveredbyArchwaysinDublinandbeingtrialedinBrighton.ActionforChildrenareplanningtodeliveritinNorthernIrelandwithBigLotteryfunding
■ Nurse-FamilyPartnerships–seeabove
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Reducedcrimeandanti-socialbehaviouramongstyoungpeople■ Nurse-FamilyPartnerships–seeabove
■ FunctionalFamilyTherapy(10-18yearolds)–seeabove
■ MultisystemicTherapy–Targetedonatriskyoungpeople(aged12-17)-familyandcommunity-based.ExternhavebeenpilotingMSTinNorthernIrelandandareplanningtoexpandtheprogrammewithfundingfromtheBigLottery
Increasedengagementoffatherswiththeirchild’slearningNo“proven”programmes.TheUSprogrammeFather’sReadingEveryDay(FRED)looksasifithaspotentialandengagesLibrariesinearlyintervention.AllagreedprogrammesshouldfollowtheFatherhoodInstituteguidelinesonengagingfathers.
Improvededucationalattainmentonleavingschool■ BigBrothers/BigSisters(6-18yearolds)–seeabove
Reducedchildhoodandteenageobesity■ Therehavebeenfewstudiesthathavedemonstratedeffectivenessin
preventingobesity.Effortstotackleobesityinschoolhavehadpoorresults.Thefocusofcurrentresearchisontheante-natal,post-natalandpre-schoolperiods.SureStartseemstohaveanimpactonchildren’sBMIbutnotonthelevelofobesity.PHAareinvolvedinarangeofprogrammestotryandimprovephysicalfitnessandreduceobesity
OtherProgrammesThereareotherprogrammeswhichaddresstheoutcomeshighlightedabove,buttheylacktherobustevidence-basetobeconfidentthatimplementingtheseotherprogrammesinLisburnwouldhaveasignificantimpactontheagreedoutcomes.
OtherpopularprogrammesarealreadybeingdeliveredinLisburn,includingtheNewParentingProgramme,ParentInfantProgramme(PIP)andMellowParents/Fathers/Bumps.TherearealsoanumberofyouthworkprogrammesinthetargetareasofLisburn.TheEarlyInterventionapproachdoesnotmeanthatthese“unproven”programmesshouldimmediatelybeabandoned,unlesstherearealternative“proven”programmesthatcanreplacethem,butthat,wheretheyarealreadymanualised,deliveredtoasignificantnumberofchildren/familiesandfocusedonspecificoutcomes,theyshouldberobustlyevaluatedusinganRCTmethodologyassoonaspossible.Othercurrentprogrammeswhicharenotyetatthisstageofdevelopment,suchasyouthwork,shouldbefurtherdeveloped,usingtherobustinternationalresearchevidence,tocreatemoreclearlydesired
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outcomes,andbemanualisedandevaluated.ThecurrentpartnershipwiththeUniversityofUlstershouldassistinthisprocess.
SureStartSureStart,whichisakeyGovernmentearlyinterventionindisadvantagedcommunitiesandwhichcurrentlyoperatesinOldWarrenandHillhall,hasnotyetbeendiscussedinanydetailinthisreport.
SureStartisagovernmentledinitiativeaimedatgivingeverychildthebestpossiblestartinlifeandwhichoffersabroadrangeofservicesfocusingonFamilyHealth,EarlyYearsCareandEducationandImprovedWellBeingProgrammestochildrenaged4andunder.TheSureStartProgrammeissupportedbyanumberofkeyprinciples:■ Toco-ordinate,streamlineandaddvaluetoexistingservicesforyoung
childrenandtheirfamiliesinlocalcommunities■ Toinvolveparents■ Toavoidstigma■ Toensurelastingsupport■ Tobesensitivetolocalfamiliesneeds■ Topromotetheparticipationofalllocalfamilies
Servicesprovidedbyprojectsmust:■ Addvaluetoexisting/plannedservices■ Bebaseduponevidenceofwhatinterventionsaresuccessful■ Imaginativelyrespondtolocalneed■ Beinformedbystrategicdirection
SureStartworkisfocusedon6highleveloutcomestoensurechildrenare:■ BeingHealthy■ EnjoyingLearningandAchieving■ LivinginSafetyandwithStability■ LivinginaSocietywhichRespectstheirRights■ ExperiencingEconomicandEnvironmentalWell-being■ ContributingPositivelytoCommunityandSociety
ThecoreservicesofSureStartare:■ OutreachandHomeVisitingServices-tomakecontactasearlyaspossiblein
thechild’slifeanddrawfamiliesintousingotherservices■ FamilySupportandParentingInformation-bothgroupandhomebased■ GoodQualityPlay,LearningandChildCareExperiences-forchildren,both
groupandhomebased■ PrimaryandCommunityHealthcareandAdvice
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■ SupportforChildrenwithSpecialNeeds-throughsignpostingtomorespecialisedserviceswherenecessary
Examplesofspecificservicesofferedthroughprojectsinclude:■ Homebasedantenatalcare■ BreastfeedingSupportGroups■ Advice,supportandinformationonhealthrelatedtopics■ EarlyLanguageDevelopmentProgrammes■ Playdevelopmentforallagesandstages■ Ageappropriatephysicaldevelopmentopportunities■ Highqualitycrèchesessions■ Promotionofthecreativearts■ Supportforsmoothtransitionsbetweenpreschoolandschool
SureStartservicesarecurrentlyavailableinatleastthetop20percentwardareasofdisadvantageinNorthernIreland,andthetop20percentSuperOutputareas,asdefinedbytheNorthernIrelandMultipleDeprivationMeasure2010.Therearenow34SureStartprogrammesacrossNorthernIrelandwhichcoverawidegeographicspreadandhaveagoodurbanandruralmix.Over30,000childrenagedunderfouryearsandtheirfamilieshaveaccesstotheservicesprovidedthroughtheprogramme.Outofthe32programmesoperatinghere,approximatelyone-thirdarebasedinruralsettings.
SureStartprogrammeshavebeendesignedspecificallytoreflectandrespondtolocalneeds.Forthatreason,eachSureStartprogrammeisuniqueintermsoftheservicesitprovidesandthemannerinwhichitprovidesthem.However,allSureStartprojectsnowprovideaDevelopmentalProgrammefortwotothreeyearoldswhichaimstoenhancesocialandemotionaldevelopment,buildoncommunicationandlanguageskillsandencourageimaginationthroughplay.Thiscanhelpsomechildrentobepreparedforstartingpre-schooleducation.TheProgrammeisnotintendedtobeauniversalserviceforallchildrenintheyearbeforestartingpre-schooleducationbutisaimedprimarilyatthosechildrenwhoarelikelytobenefitmostfromthissupport.
ThereisamajornationalevaluationoftheSureStartprogrammeinEngland,whichshouldproduceaclearerunderstandingoftheimpactoftheprogrammebytheendof2012.InterimevaluationshaveshownthatchildreninSurestartareasarelikelytohavebetterphysicalhealththantheequivalentnon-SureStartareas.Mothersalsoreportedprovidingamorecognitivelystimulatingandlesschaotichomelearningenvironmentfortheirchildren;experiencinggreaterlifesatisfaction;andengaginginlessharshdiscipline.Howeverthemothersalso
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reportedmoredepressivesymptomsandlessengagementwiththeirchild’sschool(althoughitwaslowoverallalready).
TheSureStartevaluator,onthebasisoftheinitialevidencehasrecommended,intheGrahamAllen2011EarlyInterventionreport(Allen2011),thatSureStart,deliveredtoahighstandard,shouldbeakeycomponentinanyearlyinterventioninitiative,althoughnotsufficientinitself.
ThereisalsoanimportantquestionastothenumberoffamiliesthatanyparticularSureStartschemewillbeabletosupportinlightofthefundingmadeavailable.Theevidence,highlightedabove,isthatthemajorityofchildreninthetargetareasofLisburnarelikelytosignificantlyunderachieveeducationally,withveryimportantimplicationsforotheraspectsoftheirlives.CurrentschemesinOldWarrenandHillhall(currentlypartoftheColinNeighbourhoodinitiative)canonlysupportaverysmallnumberoffamilies.IfSureStartistomakeasignificantimpactinthetargetareas,itneedstoreachamuchlargernumberoffamilieswithhighqualityservicesdeliveredbywelltrainedstaff.OnthecurrentDENIcriteria,TonaghshouldalsohaveaSureStartscheme.Fromthestatisticalevidence,oneducationalgrounds,thereisastrongcaseforalsohavingaSureStartschemeinHildenandLaganValley.
5.4CriteriatouseinselectingearlyinterventionprogrammestodeliverHavingsuggestedalong-listofevidence-basedprogrammeswhichwouldhaveanimpactonthedesiredoutcomes,itisimportanttobeclearaboutthecriteriathatwillbeusedtoselectasmallernumberofprogrammesfromthislist.Itisrecommendedthattheseshort-listingcriteriaareasfollows:
NumberofoutcomeseachoftheprogrammesislikelytohaveanimpactonEachoftheevidence-basedinterventionshighlightedabovehaveanimpactonadifferentnumberofthedesiredoutcomes.Allthingsbeingequal,priorityshouldthereforebegiventoprogrammesthathaveapositiveimpactonthelargestnumberofdesiredoutcomes.Thenumberofoutcomesthatwouldbeaffectedbythelong-listedprogrammesareasfollows:
ThereisevidencethataFamilyNursePartnershipprogrammecouldhaveapositiveimpactonatleastfiveofthedesiredoutcomes.
IncredibleYearsprogrammeforparents,childrenandteachersislikelytohaveanimpactonatleastfourofthedesiredoutcomes.
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Theory of change
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BigBrothers/BigSistersislikelytohaveanimpactonatleastthreeofthedesiredoutcomes,includingschoolattendanceandeducationalattainmentwhichareclearlycriticaloutcomesinLisburn.
FunctionalFamilyTherapyislikelytohaveanimpactonatleasttwoofthedesiredoutcomes
Thefollowingprogrammesarelikelytohaveanimpactonatleastoneoftheoutcomesabove:■ PATHS■ Parent-ChildInteractionTherapy■ SuccessforAllincludingcuriositycorner■ TripleP■ LifeSkillsTraining■ MultisystemicTherapy■ DoodleDen■ TimetoRead
AgegrouptobeaddressedTheevidenceisthattheearliertheageoftherecipientsofaprogrammethemoreeffectiveandcost-effectiveitislikelytobe.However,itisalsoimportantthatprogrammestoenhancethelifechancesofdisadvantagedchildrenandyoungpeoplecontinueaftertheearlyyearsprogrammesthroughprimaryschoolandthetransitiontosecondaryschool.Thetargetagegroupsofeachoftheprogrammesareasfollows:
Frombirth:■ FamilyNursePartnership-pregnancy–age2(targeted–home-based)■ IncredibleYears-age0-12(community-basedinc.schools)■ TripleP-age0-16
Fromage2/3:■ SuccessforAll,includingCuriosityCorner-age3-11(universalinprimary)■ Parent-ChildInteractionTherapy-age2-7(targetedhome-based)
Fromage4-6■ PATHS–age4/5-11(universalinprimaryschools)■ BigBrothers/BigSisters–age6-18(targeted–community-based)■ DoodleDen–age5/6(targetedinprimaryschools)
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Fromage8-12■ TimetoRead–aged8-10■ LifeSkillsTrainingage9-15(universalinprimaryandpost-primaryschools)■ StrengtheningFamiliesage10-14(targetedhome-based)■ FunctionalFamilyTherapy–age10-18(targetedhome-based)■ MultisystemicTherapy-age12-17(targetedhome-based)
TheappropriatelocationofprogrammesEachoftheprogrammesaredesignedtobedeliveredindifferenttypesoflocations.Theabilityofonetypeofvenuetotakeonmorethanonenewprogrammeatatimewouldsuggestthatprogrammesshouldcoverarangeofdifferentvenues.Thesepotentialtypesofvenuesarehighlightedbelow:
Universalinprimaryschools■ PATHS(4/5-11yearolds)■ SuccessforAll,includingcuriositycorner(3-11yearolds)■ LifeSkillsTraining(9-15yearolds)
Targetedinprimaryschool■ TimetoRead(6-8yearolds)■ DoodleDen(5/6yearolds)
Universalinpost-primarySchools■ LifeSkillsTraining(9-15yearolds)
Targeted–basedinacommunityvenue(includingschoolsandlibraries)■ IncredibleYears(0-12)■ BigBrothers/BigSisters(6-18yearolds)
Targeted–home-based■ FamilyNursePartnership(pregnancy–2yearolds)■ Parent-ChildInteractionTherapy(2-7yearolds)■ FunctionalFamilyTherapy(10-18yearolds)■ MultisystemicTherapy(12-17yearolds)
CapacitytodeliverThechoiceofthemostappropriateinterventionsandthetimingoftheirintroductionwillalsodependonthelocalcapacitytointroduceanddelivertheprogrammewithfidelity.AprogrammedevelopedintheUSA,forexample,thathasneverbeenusedintheUKorIrelandislikelytoneedtobeadaptedinawaythatisappropriateforthelocallanguageandcultureandtheadaptationwillneedtobeapprovedbytheprogrammelicense-holder(s)oftheprogramme.Onthepositive
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sidethereisarapidlyincreasingskillandexperienceindeliveringarangeofevidence-basedprogrammesintheUKandIreland,includingNorthernIreland.
ProgrammesalreadybeingdeliveredinNorthernIreland■ IncredibleYears■ FamilyNursePartnerships■ PATHS■ Multi-systemicTherapy
ProgrammesalreadyplannedforNorthernIreland■ LifeSkillsTraining
ProgrammesalreadybeingdeliveredintheUKorIreland(inadditiontothosedeliveredinNorthernIreland,whichareallalsobeingdeliveredinUKand/orIreland)■ BigBrothers/BigSisters■ SuccessforAll■ FunctionalFamilyTherapy■ TripleP
Otherprogrammes■ Parent-ChildInteractionTherapy■ MultisystemicTherapy
Short-listedevidence-basedprogrammesTheaboveselectioncriteriawouldsuggestthatthemosteffectiveandpracticallydeliverableinterventionstoimpactonthedesiredoutcomesabovewouldbeasfollows:
■ IncredibleYears(parentandchildprogrammes-throughtheprimaryschoolswiththepooresttestresultsatstages1&2andthroughSurestart)
■ FamilyNursePartnerships■ BigBrothers/BigSistersmentoringprogramme■ PATHS■ LifeSkillsTraining■ MultisystemicTherapy■ SuccessforAll■ DoodleDen■ TimetoRead
Note:FunctionalFamilyTherapyandMultisystemicTherapyareeffectivelyalternativestoeachother.OncostgroundsMultisystemicTherapyisbeingrecommendedhere.
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Itisimportanttosaythattheamountofrobustevaluationevidence,bothpositiveandnegative,onprogrammesforchildren,youngpeopleandfamiliesisincreasingrapidly.WithintwoyearstherewillbeovertwentyRCTevaluationsofsuchprogrammesintheUKandIreland,whichwillfurtherenhancetheabilityofEILtoidentifythemostappropriateinitiativestoachievetheagreedoutcomes.Theshortlisted“proven”programmesrecommendedinthisreportarebasedonthecurrentbestevidence.ResurgamandEarlyInterventionLisburnSteeringGroup/Consortium,inconsultationwiththemainstakeholders/funders,willneedtomakefinaldecisionsastotheprogrammestoprioritiseinphase1,aswellascontinuingtoexaminetheemergingnationalandinternationalefficacyevidence(theCYPSPparticularlyrecommends*trackingtheoutcomesofRCTevaluationsinNorthernIreland);buildinglocalcapacity,sothatthereisanongoingsustainedefforttochangeoutcomesforchildren,youngpeopleandfamilies.;promotinginnovationandtheinclusionoflocalcommunities,childrenandyoungpeopleinbuildingontheirassets,promotingtheirrightsandrespondingtotheirneeds.
5.5CostsoftheEarlyInterventionProgrammesTheevidenceonthecostsofdeliveringthelong-listedevidence-basedprogrammesisasfollows:
Programme Target group Total cost** to deliverIncredibleYears
Parentsand3-8yearolds
Parentprogramme:£4,833perschooleachyear;SchoolReadiness(enhancedparentingprogramme):£1,500perschool;DinaChildren’sProgramme:£6,253perschool
£12,586perschool/venue(inc.all3IYSprogrammes)
PATHS 4-6yearolds Costof£10,000peryearperschool(totalcosts)
£10,000perschool
FamilyNursePartnership
Pregnancy–age2
Costof£3,000perclientfamilyperyear,inc.nursetraining
£669,000for10%offamiliesintargetareas
BigBrothers/BigSisters
6-18yearolds Costperyoungpersonperyearc.£627
£140,000for10%ofallchildrenaged6+inthetargetareas
LifeSkillsTraining
9-15yearolds Costofc.£4.40perstudentplusthecostoftraining:£2,508
£7,000.00forallyoungpeopleaged9-15
MultisystemicTherapy
12-17yearolds c.£2,821peryoungperson £282,100for10%ofyoungpeopleage12-17
SuccessforAll,includingcuriositycorner
3-11yearolds £3,467forKeyStage1and£7,280forKeyStage2,perschool(allcosts)£3,526forthenursery/receptionprogramme
£10,747perschool(£14,273foraschoolwithanurseryorreception)
* CYPSP2012Recommendations“HowtomakeNorthernIrelandanEarlyInterventionRegion”**Willneedtobeadjustedeachyearforinflation
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DoodleDen 5/6yearolds £18,000sitecostsplus£4,200pergroupof15children
£35,000todeliverinfourprimaryschools(15pupilseach)
TimetoRead 6-8yearolds Free.Thecriticalresourcearethevolunteerstodelivertheprogramme
Free
TotalCosts(assumingschool-basedprogrammesaredeliveredinfourschools/venues):£1,312,777
5.6CostsoftheCo-ordinationInfrastructureInadditiontoprogrammerelatedcosts,EarlyInterventionLisburnwouldrequirefundingforitsinfrastructure,inordertodevelopandimplementprogrammes;ensureprogrammefidelity/quality;co-ordinaterelationshipswiththevariousstakeholders;managefinance;ensureeffectivecommunityengagement,etc..
Cost Headings Annual Cost (need to adjust for inflation)
EarlyInterventionCommunityCo-ordinator(salary&relatedcosts)-Resurgam £35,000
EarlyInterventionDeliveryManager(salary&relatedcosts)–DeliveryPartner £45,000
EarlyInterventionQuality&MonitoringOfficer(salary&relatedcosts)–DeliveryPartner
£35,000
AdministrationandservicingoftheEarlyInterventionConsortium-Resurgam £3,000
Programme-relatedFinance/Administration £15,000
Travel(local,nationalandinternational),phonecosts £8,000
Officeandenergycosts-Resurgam £7,500
Officeandenergycosts–Deliverypartner £7,500
Stationary,PRandmarketingcosts(incNewsletter) £6,000
Governancecosts-Resurgam £3,000
Evaluation(seebelow) £50,000
CommunityConsultations-Resurgam £2,000
OneProject-TwoCitieswithEarlyInterventionDerry-LondonderryandeffectivepartnershipworkingwithotherEarlyInterventionsites
£10,000
Thecostofparent-friendlyeventsandactivitiestohelpbuildtherelationshipswithparentsandattractthemtoparticipateinmorerigorousprogrammes
£3,000
TotalAnnualCosts £230,000
Thetotalannualcostofimplementingtherecommendedprogrammesandtherelatedinfrastructurecostswouldthereforebec.£1,540,000.However,itislikelytobeseveralyearsbeforetheinvestmentcanbeputinplacetodeliveralltherecommendedprogrammes,sothefundingrequiredinyear1islikelytobeconsiderablylower.
ThecostsofSureStarthavenotbeenincludedinthesecalculations,astheyaresubjecttoseparatenegotiationswiththeEasternChildcarePartnership.
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Therearealsopotentialissuesconcerningcommunitypremiseswhereprogrammesaregoingtobedeleivered,whicharehardtocalculateatthisstage.Insomeofthetargetareastherearegoodcommunitybuildings;otherareasarelikelytobeabletoaccessgreatlyimprovedcommunitypremisesinthenearfuture.Therearealsosomeareaswithverypoorfacilities,whichcurrentlyprovidelittlescopeforadditionalearlyinterventionservices.
5.7EvaluationThereisanimportantissueconcerningtheevaluation(s)ofanyagreedprogrammesimplemented.Iftheprogrammeshavealreadybeenrobustlyevaluatedatleasttwice(as“proven”Blueprintsprogrammesare,oriftheyarealreadysubjecttoamajorRCTtrialelsewhereintheUKorIreland,itmaynotbenecessarytocommissionanRCTevaluation.However,programmesthathavesomepromisingevidence,suchasMellowParents,theParentInfantProgramme(PIP)andtheNewParentingProgramme,buthavenotyetbeensubjecttoalarge-scaleRCTshouldbesubjecttoaRCTtrial.Inadditionitisstillimportanttocommissionanobjectiveformativeandsummativeassessmentofhowwelltheprogrammeshavebeenimplemented,whatprogressisbeingmadeinachievingtheagreedoutcomes,andidentifyanylessonsthatcanbelearnt.
Itwouldalsobeincrediblyvaluabletocommissionalong-termassessment,againstdatafromcomparableareas,astotheextentthattheagreedsetofEarlyInterventionLisburnprogrammesoverallhavebeenabletoimpactonthemeasurableoutcomeindicators.Ideallythisshouldbeoveratleast15years.
Therearealsovariousexistingprogrammesandservicesforchildren,youngpeopleandfamiliescurrentlybeingdeliveredinsomeofthetargetareas.Theevidencefromthisreportwouldsuggestthatcollectivelytheseprogrammesandservicesarenotenablingthechildrenandyoungpeoplefromthetargetareastoachievetheirpotential.However,perhapstheseoutcomeswouldbeevenworseiftheseprogrammesandservices,orsomeofthem,didnotexist.Theseprogrammesandservicesneedtobeeffectivelymappedandassessedagainsttheevidencefortheimpacttheyaremakingonthedesiredoutcomes,highlightedabove.Itwouldthenbepossibletomakeinformeddecisionsonwaysof:
■ clarifyingoutcomesofexistingprogrammesandservicesandevaluatingtheirimpactontheseoutcomes;
■ focusingexistingprogrammesandservicestoimprovethedesiredservices;■ expandingexistingprogrammesandservices;■ co-ordinatingthevariousprogrammesandservicesbetter;■ reducingorclosingexistingservices;and/or■ fillingthegapsidentified.
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Theory of change
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5.8PerformanceManagementInadditiontoexternalevaluationthereneedstobeaneffectiveperformancemanagementandqualityassurancesystemthatensuresthatallprogrammesaredeliveredwithfidelity(assetdownbytheownersofthelicense)andinaccordancewiththeobjectivesandcommitmentsagreedwithfunders.Somelicensedprogrammeshaveverytightfidelityandqualityassurancerequirementse.g.PATHS,othersarelesstightlyspecifiede.g.IncredibleYears.ThedangerinthelatteristhatprogrammmesmaybeimplementedinawaythatfailstoachievetheoutcomeswhichRCTevaluationshaveshowntheycanachieve.AnyprogrammesimplementedthroughEILneedtobedemonstrateaveryhighstandardoffidelity.
Therealsoneedstoaneffectiveprocessforgathering,measuring,analyzingandreportingonrelevantdatafromeachprogramme.
ThisissueisdiscussedmoreundertheOperatingModelbelow.
5.9PotentialSourcesofFunding:Fromthescanofpublicpolicydocuments,thefollowingareGovernmentDepartmentsandagencieswhichhaverelevantpublicpolicyobjectivesinrelationtotheagreedoutcomesandshouldthereforebepotentialsourcesoffundingfortheEarlyInterventionLisburnprogrammes:
■ OFMdFM–SocialInvestmentFund■ DHSSPS■ Health&SocialCareBoard■ PublicHealthAgency■ SouthEasternHealth&SocialCareTrust■ Children&YoungPersonsStrategicPartnership■ DepartmentofEducation■ SouthEasternEducation&LibraryBoard–schoolsbudget■ SouthEasternEducation&LibraryBoard–youthservicebudget■ Schools’ExtendedSchoolsbudget■ DepartmentofJustice■ YouthJusticeAgency■ ProbationBoard■ PSNI■ DepartmentofSocialDevelopment■ Departmentalresearchbudgetsreevaluations■ LisburnCityCouncil■ NIHousingExecutive■ BigLottery–e.g.SupportingFamilies■ Charitabletrusts/foundations
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5.10 TheoryofChangeLinkagesAtheoryofchangehighlightsthelogicoftheapproachtobeadoptedi.e.betweeninputs,activities,outputsandoutcomes.ThefollowinghighlightstheoveralllogicofthesuggestedEarlyInterventionLisburnapproach:
TheoverarchingobjectiveofEarlyInterventionLisburnis:ToimprovetheoutcomesforchildrenandyoungpeopleindisadvantagesareasofLisburn
Thisistobeachievedby:Puttinginplaceandeffectivelyimplementingprovenuniversalandtargetedprogrammeswhichhavebeenshowntoimproveoutcomesforchildrenandyoungpeopleoverasustainedperiod.
Thisistobeachievedby:BeingclearabouttheoutcomeswherechildrenandyoungpeopleindisadvantagedcommunitiesinLisburnfallsignificantlyshortoftheNorthernIrelandaverage.AND
IdentifyingthoseprovenuniversalandtargetedprogrammeswhichhavebeenshowntoimprovethespecificagreedoutcomesforchildrenandyoungpeopleindisadvantagedcommunitiesAND
Eitherrobustlyevaluating,and/orstopdelivering,existingprogrammesthatdonotdemonstrateclearlytheirpositiveimpactontheagreedoutcomesAND
Gainingeffectivecommunity,politicalandstatutorycommitmenttoandsupportfortheimplementationofacomprehensivesustainedearlyinterventionprogrammeandtoworkingeffectivelytogetherAND
Gainingsufficientlong-termfundingtosupportasustainedearlyinterventionprogrammeAND
Implementingagreeevidence-basedprogrammeswithfidelityAND
AttractingandretainingtheparticipationofthetargetparentsandchildrenintheprogrammesimplementedAND
Effectivelyevaluatingtheprogrammesagainstagreedoutcomes
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5.11 LogicModelThefollowinglogicmodelarticulatesinmoredetailthepotentialrelationshipbetweeninputs,activities,outputs,intermediateandfinaloutcomesandhowtheycanbemeasured.
Inputs Activities Outputs Intermediate outcomes
Final outcomes
==> ==> ==> ==>
AnnualFinancialsupportof£1.5Mfromstat.sources:• Co-ordinator
&programmestaff
• Programmecosts
• Governance&m’mentcosts
• Evaluation• Acommitment
fromagenciestoworktogethertoachievetheoutcomes
• Engagementoftargetlocalcommunities
• Supportfrompoliticalreps
• Contributionfromschoolstopromoteeffectivedelivery&liaison
• ContributionfromeachpartnertoparticipateintheConsort-ium&deliveragreedprogrammes
• Contributionfromparents&childrentoparticipate
• Qualityassurancere.programmefidelity
• Evaluationexpertise
UniversalinPrimarySchools
• PATHS(4-6yearolds)
• SuccessforAllinc.curiositycorner(age3-11)
• TimetoRead(8-10yrolds)
• LifeSkillsTraining(9-15yearolds)
UniversalinPost-PrimarySchools• LifeSkills
Training(9-15yearolds)
Targetedincommunityvenues• Incredible
Years(age0-12)
• BigBrothers/BigSisters(BB/BS)(6-18yearolds)
Targetedhome-based• FamilyNurse
P’ship(NFP)(pregnancy-2)
• MultisystemicTherapy(12-17yearolds
• PATHS(xsessionsforychildrenoverzmonths)
• SuccessforAll(xsessionsforychildrenoverzmonths)
• LifeSkillsTraining(xsessionsforychildrenoverzmonths)
• IncredibleYears(xsessionsforychildrenoverzmonths)in
• BB/BS(xsessionsforychildrenoverzmonths)
• FNP(xsessionsforychildrenoverzmonths)
• MultisystemicTherapy(xsessionsforychildrenoverzmonths)
• Reducednumberofteenagepregnancies
• Reducedlevelofsmokingduringpregnancy
• Improvedparentingskillsandconfidence
• Improvedparent-childattachmentfor0-2yearolds
• Improvedschoolattendance
• Improvedschoolreadinessamongst3&4yearolds
• Improvedthesocialandemotionalskillsandresilienceof4-11yearolds
• Improvedliteracy&numeracyinchildrenaged4-11
• Improvededucationalattainment
• Reducedbehavioural/conductproblems
• Reducedsmoking,alcohol&drugconsumptionamongstyoungpeople
• Reducedcrimeandanti-socialbehaviouramongstyoungpeople
• Improvedphysicalandmentalhealthofchildren
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How inputs will be measured
How activities will be measured
How outputs will be measured
How intermediate outcomes will be measured
How final outcomes will be measured
==> ==> ==> ==>
Financialbudgetandquarterlymanagementaccounts
Outputsinrelationtoparentandchildparticipation
ParticipationintheearlyYearsLisburnSteeringGroupandsub-groups
Outputs(seecolumntotheright)
Fidelitytotheprogrammemanual
Parentsatisfaction
Youngparticipantsatisfaction
Numberofprogrammesessionsdelivered
Numberofchildrenandyoungpeopleinvolvedintheprogrammes
Numberofparentsinvolvedintheprogrammes
%attendanceatprogrammes
%ofparticipantscompletingtheprogrammes
• %ofmotherssmokingduringpregnancy
• Increasedparentingconfidence(ParentsSenseofCompetenceScale)
• Increasedparentalengagementwiththeirchild’seducation
• Improvedchildbehaviour(TheEybergChildBehaviourInventoryforParentsandtheSutter-EybergBehaviourInventoryforteachers)
• Improvedchildsocial&emotionalskills(SDQforparentsandteachers)
• Literacy&numeracyatKeystages1&2
• Numberofteenagepregnancies
• Improvedparent-childattachmentfor0-2yearolds
• increased%ofchildrenwith85%schoolattendance
%deathsundertheageof75
Averageageatdeath
%youngpeoplegoingontohigherorfurthereducation
%ofyoungpeopleachieving5+GCSEsA*-C
%ofyoungpeopleachieving2+AlevelsA*-C
Numberofcrimesandanti-socialbehaviourincidents
Levelofsmoking,alcoholanddrugconsumptionamongstteenagers
CHAPTER FIVE
Theory of change
Page 95
CHAPTER SIX
Operating model
6.1IntroductionItisvitaltohaveaneffectiveandacceptedoperatingmodeltoplanandimplementacomprehensiveprogrammeofuniversalandtargetedearlyinterventionprogrammesinLisburn.Thestructuresneedtoengageallthekeyagenciesifitistoensureeffectiveco-ordinationandseamlessdeliveryofservices.ItisalsovitallyimportantthatthelocalcommunitieswhichEarlyInterventionLisburnwouldservefeelasenseofownershipoftheprogrammesthataredelivered,otherwise,iftheyareperceivedtobeparachutedinbyexternalagencies,theprogrammesareunlikelytogettheparticipationofthosewhomostneedtheservicesinordertobesuccessful.
6.2ResurgamTrustTheResurgamDevelopmentTrusthasbeenestablishedtocreateacommunity-ownedorganisationdesignedtopromotetheinterestsofthoseindisadvantagedcommunitiesinLisburn.ItwasformallyconstitutedasacompanylimitedbyguaranteeinJanuary2011.IthasbeenacceptedascharitablefortaxpurposesbytheInlandRevenue.ThemembershipofResurgamismadeupofc.1,000individualmembers(adultsandyoungpeople).TheBoardismadeupofrepresentativesfromlocalcommunityandyouthorganisations.
ItisResurgamthatinitiatedthecurrentexplorationofanearlyinterventionapproachtoaddressingmanyoftheproblemsfacedbydisadvantagedcommunitiesinLisburnandcurrentlyco-chairsandservicestheEarlyInterventionLisburnSteeringGroupmadeupofawiderangeofrelevantagencies.
Currently,atthetimeofwritingthisreport,however,Resurgamisaverynewplayeranddoesnotreceiveanycorefunding.ThisisanissuethatwouldneedtoberesolvedifitistohavethecapacitytoplayaleadingroleinthedevelopmentandmanagementofEarlyInterventionLisburn.DiscussionsarecurrentlytakingplacewithDSDinrelationtoResurgamasaflagshipsocialenterpriseinitiative.
ItisalsoimportantthatResurgamhastheorganisationalandfinancialpoliciesandprocedures,andassuredgovernancedevelopmentprocessesthatreflectitspotentialasthecentralco-ordinatingandservicingbodyofEarlyInterventionLisburn.
6.3ChildrenandYoungPeople’sOutcomesGroupAsecondkeyplayeristheinter-agencyinter-sectoralSouthEasternOutcomesGroupoftheChildrenandYoungPeople’sStrategicPartnership,whichisplayingavitalroleindrivingtheearlyinterventionagenda.AllthemainstatutoryandvoluntarybodiesconcernedwithmeetingtheneedsofchildrenandyoungpeoplewithintheSouth-Easternareaarerepresentedonthegroup.
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TheEarlyInterventionLisburnSteeringGroup,whichhasrepresentativesfromvariouscommunitygroupsandallthekeystatutoryagencies,shouldberefreshedastheEarlyInterventionLisburnConsortiumandberecognisedasaLocalitysub-groupoftheSouth-EasternYoungPeople’sStrategicPartnershipOutcomesGroupandshouldbecomethekeyco-ordinatinginter-agencybody,similartotherolefulfilledbyHealthImprovementorHealthCitiesPartnerships.
6.4OtherImportantPartnersThefollowingaresomeoftheotherkeyplayerswhichneedtobeengagedandcommittedtotheEarlyInterventionLisburnConsortiumifitistobeasuccess:
■ PublicHealthAgency■ SouthEasternHealth&SocialCareTrust■ SouthEasternChildcarePartnership■ DepartmentofEducation■ SouthEasternEducation&LibraryBoard/ESA■ StatutoryYouthService-SouthEasternEducation&LibraryBoard/ESA■ DepartmentofJustice/YouthJusticeAgency■ PSNI■ DepartmentofSocialDevelopment■ LisburnCityCouncil■ NIHousingExecutive■ Electedrepresentatives
6.5DeliveryPartner(s)Deliveringtheportfolioofearlyinterventionprogrammesrecommendedinthisreportwillrequireextensiveexperienceofdeliveringandqualityassuringprogrammesforchildrenandfamilies.ItisthereforevitalthatoneofmoreexperienceddeliverypartnerareappointedbyEarlyInterventionConsortiumLisburnConsortium.
Thereisanimportantquestionastohowmanydeliverypartnersthereshouldbe.Itispossibletomakeanargumentforseveraldifferentarrangements:
Option 1: Separatedeliverypartnersforeveryprogramme(potentiallylargenumberofdifferentdeliverypartners)■ Pros:abletobringinexperienceofdeliveringallthetargetprogrammes;bodies
currentlydeliveringthetargetprogrammeselsewherecanbeincludedinEIL■ Cons:complexstructure;variousdifferentorganisationalculturesand
systems;complex,diffuseaccountability;moredifficulttobuildeffectiverelationshipsandcross-programmeworking;timeandenergyrequiredtoeffectivelyco-ordinatethevariousbodies
CHAPTER SIX
Operating model
Page 97
Option2:Oneexperienceddeliverypartnerwhichtakesresponsibilityfortheimplementationofallprogrammes■ Pros:simplestructure;singleorganisationalcultureandsystems;clear
accountability;easiertobuildeffectiverelationshipsandcross-programmeworking
■ Cons:onebodyisunlikelytohavepreviousexperienceofdeliveringallthetargetprogrammes.
Option 3: Onedeliverypartner,whichcansub-contractdeliveryofprogrammes,ifnecessary■ Pros:Simplestructure;singleorganisationalcultureandsystem;clear
accountabilityandreportinglines;easytobuildeffectiverelationships;canengageotheragenciesindelivery(e.g.SEHSCTindeliveringFNP);sub-contractingcanbequalityassuredbythedeliverypartner;strongeffectiveco-ordinationbetweentheprogrammes
■ Cons:SuccessoftheEILinitiativedependsontheappointmentoftherightdeliverypartnerwhichcandelivercomplexprogrammeswithfidelityandworkwellwiththecommunity
Option3isrecommended.
6.6PotentialroleofResurgamCommunityengagementiscriticaltothesuccessofEarlyInterventionLisburn.Resurgam,asanrepresentativeumbrellacommunitybodyforthetargetareas,has,therefore,acrucialroleinthesuccessoftheinitiative.TheSouth-EasternYoungPeople’sStrategicPartnershipOutcomesGroup,onbehalfoftherelevantagencies,shouldcontractwithResurgumtofulfillthefollowingrolesfortheEarlyInterventionLisburnConsortium/LocalityGroup:
Consortium■ Organiseandco-ordinatemeetingsoftheEarlyInterventionLisburn
Consortium(notlessthan4/5timesayear)■ EnsureallConsortiummeetingsarewellplannedandeffectivelyserviced■ Provideaco-chairfortheConsortium■ EnsuretheEarlyInterventionLisburnConsortiumhastheappropriate
structureandofficers■ EnsuretheConsortiumoperatestothehighestgovernancestandardsand
regularlyreviewsitsperformance
DeliveryPartner■ Drawupthebrief(withexpertassistanceifrequired)fortheappointmentofa
deliverypartner,forapprovalbytheConsortium
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■ ServicetherecruitmentandselectionofadeliverypartnerbyapanelappointedbytheEILConsortium
■ Maintaineffectiveliaisonwiththedeliverypartner■ Facilitateandsupporttherelationshipbetweenthedeliverypartnerand
relevantcommunitygroups/organisations■ LiaisewiththeDeliveryPartnerinrelationtothedevelopmentoftheportfolio
ofnewevidence-basedearlyinterventionprogrammes,asagreedwiththeConsortium
RiskManagement■ Develop,andkeepup-to-date,ariskregister■ HighlighttotheConsortiumandDeliveryPartneranypotentialbarriersor
challengestoachievingtheagreedplans■ EnsureResurgamandEarlyInterventionInitiativeLisburnConsortium
complywiththehigheststandardsinrelationtogovernanceandpotentialconflictsofinterest
MarketingandPR■ ActivelypromoteandpublicisetheEarlyYearsLisburnInitiative,locallyinthe
targetcommunitiesandwidercommunitynetworks■ Activelysupportthemarketingofrelevantprogrammesinthetargetareas■ ProducearegularEarlyInterventionLisburnNewsletter,inpartnershipwith
theDeliveryPartner,anddisseminatewidelywithinthetargetcommunities
Employment■ EmployandmanageanEarlyInterventionCommunityEngagementOfficer■ Ensuregoodpracticeintherecruitment,selection,inductionandmanagement
ofstaffinallaspectsofEarlyInterventionLisburn■ Contributeasapanelmembertotheselectionofstaffforagreedprogrammes
ProgrammeDevelopment■ Negotiate,withtheConsortium,fundingfortheinitialagreedevidence-based
programmesandinfrastructurecosts■ Facilitate(withexpertassistanceifnecessary)thedevelopment,
implementationandmonitoringofoverallEarlyInterventionLisburnstrategicandannualoperationalplans
QualityAssurance&PerformanceManagement■ ConsiderQualityassurancereportsfromtheDeliveryPartnerinrelationto
ensuringtheeffectivedeliveryoftheoverallprogrammeandensuringthefidelityofevidence-basedprogrammes
CHAPTER SIX
Operating model
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■ EnsuretheDeliveryPartnerhasappropriatesystemsinplacetomonitorandevaluatetheperformanceofagreedprogrammes;andagainstspecificindicatorsfortheoverallprogrammeinrelationtoeachOutcome
Finance■ Ensurethehigheststandardsoffinancialplanning,accountingandreporting■ Ensureappropriatefinancialreportingmechanismstofunders/contractors
whichareprovidingfundingdirectlytoResurgamand/ortheEarlyInterventionLisburnConsortium
Collaboration■ Collaborateeffectivelywithothercommunityorganisationsengagedinearly
interventioninitiativesinNorthernIreland,GBandIreland■ Buildeffectiverelationshipsandworkpositivelytoresolveanydisputesor
difficulties
Consultation■ Activelypromotetheactiveparticipationofallthelocaltargetcommunitiesin
theagreedprogrammes■ Consultlocaltargetcommunitiesonperceptionsoftheprogrammesand
emergingneedsandissues■ EnsurethereisaneffectivecommunityvoiceontheEarlyInterventionLisburn
Consortium■ Ensureallrelevantlocalcommunitygroupsareeffectivelyrepresentedon
Resurgam
ResearchandEvaluation■ FacilitatetheappointmentandservicingofanExpertAdvisoryCommittee(of
earlyinterventionandevaluationexperts)toadvisetheConsortium■ Drawupabrief(withexpertassistance,ifrequired)fortheappointmentof
evaluators■ Sourceexperiencedevaluatorsthroughadministeringathoroughtender
recruitmentprocessandsitonthepanel(thepaneltobeappointedbyEILConsortium)
■ Ensuretheevaluationcontractiseffectivelymanaged■ Ensureeffectiveliaisonwithevaluators
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6.7RoleoftheDeliveryPartnerThefollowingissuggestedasappropriateresponsibilitiesoftheDeliveryPartner:
QualityAssurance&PerformanceManagement■ Ensuretheagreedprogrammesaredeliveredwithfidelity,througheffective
qualityassurance■ Ensuregoodpracticeinidentifyingandsourcinganysub-contracteddelivery
bodies■ Ensurethereareappropriatesystemsinplacetointernallymonitorand
evaluatetheperformanceofagreedprogrammes
ProgrammeDevelopment■ Contributetothenegotiationsforfundingofagreedevidence-based
programmesandinfrastructurecosts■ Developtenderbriefsforagreedprogrammestobedeliveredbysub-
contractors,forConsortiumapproval■ Contributetothedevelopment,implementationandmonitoringofoverall
EarlyInterventionLisburnstrategicandannualoperationalplans■ LiaisewiththeEarlyInterventionLisburnConsortiumandResurgamin
relationtothedevelopmentoftheportfolioofnewevidence-basedearlyinterventionprogrammes
RiskManagement■ Develop,andkeepup-to-date,ariskregisterinrelationtotheagreed
programmes■ HighlighttotheConsortiumandResurgam,assoonaspossible,anybarriers
orchallengestoachievingtheagreedplans■ Complywiththehigheststandardsinrelationtogovernanceandpotential
conflictsofinterest
MarketingandPR■ ActivelypromoteandpublicisetheEarlyYearsLisburnInitiative,locallyinthe
targetcommunities,NI-wideandintheUKandIreland■ Activelymarkettherelevantprogrammesinthetargetareas■ ProducearegularEarlyInterventionLisburnNewsletter,inpartnershipwith
Resurgam
Employment■ EmployandmanageanEarlyInterventionManager(notnecessarilythefinal
jobtitle)toleadandco-ordinatethevariousprogrammesandliaisewiththeConsortiumandResurgam
CHAPTER SIX
Operating model
Page 101
■ Ensuregoodpracticeintherecruitment,selection,inductionandmanagementofstaffinallaspectsofEarlyInterventionLisburn
■ Contributetotheselectionofstaffforanyagreedsub-contractedprogrammes■ Ensureallstaffaretrainedtotheappropriatestandard
Finance■ Ensurethehigheststandardsoffinancialplanning,accountingandreporting■ Ensureappropriatefinancialreportingmechanismstofunders/contractors
Collaboration■ EnsureeffectivecollaborationwithSureStart,relevantschools,andother
relevantprogrammes,organisationsandvenues■ Collaborateeffectivelywithotherearlyinterventiondeliverybodiesin
NorthernIrelandandbuildrelationshipswithotherearlyinterventioninitiativesinGBandIreland
■ Liaisecloselywithanysub-contracteddeliveryagenciesandworkpositivelytoresolveanydisputesordifficulties
Consultation■ Activelypromotetheactiveparticipationofthelocaltargetcommunities■ Consultlocaltargetcommunitiesonperceptionsoftheprogrammesand
emergingneedsandissues
ResearchandEvaluation■ KeepuptodatewithemergingevidenceintheUK,Irelandandinternationally
oftheefficacyofrelevantearlyinterventionprogrammes■ Ensurethereisanappropriateperformancemanagementinformationsystem
whichiseffectivelyimplemented■ Ensuretheevaluationcontractiseffectivelymanaged■ Ensureeffectiveliaisonwithevaluators
Reporting■ ProduceareportfortheEarlyInterventionLisburnConsortiumandResurgam
(notlessthan4timesayear)inaformatagreedwiththeConsortium■ Producefinancialandmonitoringreportsasagreedwiththerelevantfunders
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CHAPTER SEVEN
Implementation plan
7.1IntroductionThisshortsectionwilloutlinethenextstepsintermsofmovingtowardsimplementingtherecommendationsabove.Itisnotpossibletoimplementarangeofnewprogrammesatonce,soitisimportanttophasetheirintroduction.Whichprogrammeswouldbeimplementedbeforeotherprogrammeswouldbepartlydeterminedbyfunding,theavailabilityofaDeliveryPartnerwithrelevantexperience,andthereadinessoftheenvironmente.g.thecommunitiesandschoolstosupporttheimplementationofaprogramme.
7.2TimetableThefollowingoutlinesasuggestedimplementationplanbetweenJune2012andDecember2018:
June–September2012■ EarlyInterventionLisburnSteeringGrouptodiscussthereportandagree
whichrecommendations(ifany)itwishestoendorse
■ Agreetheprocessforprintinganddisseminatingthereport
■ MeetwiththeSouthEastOutcomesGroupoftheChildren&YoungPerson’sStrategicPartnershiptodiscussthereport
■ Agreeaprogrammeofface-to-facepresentationsofasummaryofthereporttoarangeofkeystakeholders,includingcommunityorganisationsandstatutoryagencies
■ Agreetheprocessfordevelopingacommonoutcomesframework(whichwillenableimpacttobemeasured)andasharedfocusonqualityachievedthroughjointreflectivepractice,trainingandpeerlearning,wherebydifferentorganisationscanlearnfromoneanother.
■ BringexistingorganisationstogethertoidentifyhowbesttotransformtheculturewithintheCityofLisburn,especiallywithinareasofdeprivation,toemphasiseaspirationandachievement(particularlyinrelationtoeducation)throughlocalmedia,doortodoorconsultations,celebratinglocalchampionsetc.
■ Agreeaprocessformappingexistingservices/programmesservingdisadvantagedcommunitiesinLisburnandtheevidenceforthecontributiontheymaketowardstheagreedoutcomes
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■ MeetwiththeprimaryschoolsintheExtendedSchoolsprogrammeinLisburntodiscusswiththemthekindsofsupportandassistancetheyrequiretohelpthemachievetheirobjectivesandthepotentialtohostappropriateprovenmodelsintheschools
■ DrawupabriefandprocessfortheappointmentofaDeliveryPartner.
■ AppointanappropriateDeliveryPartner
■ AgreeaService-LevelAgreementwiththeDeliveryPartner
■ Considerthepotentialforanyoftheprogrammestobedeliveredinpartnershipoverawidergeographicalarea(e.g.theOneProject:TwoCitiesinitiative;SEHSCTarea)
■ Identifythemostappropriatesource(s)ofinfrastructurefinance,andapply,forfundinginaccordancewithappropriateobjectivesandprocedures.
■ Identifythepotentialfundersofrecommendedprogrammesandarrangemeetingswitheachtodiscussthereportandpotentialfunding
■ NegotiateaninitialcontractbetweentheChildren&YoungPerson’sStrategicPartnershipandResurgamtotakeforwardtherecommendationsinthereport
■ DrawupandapprovejobdescriptionsandspecificationsforinfrastructurepostsinResurgamandtheDeliveryPartner
■ ArrangestudyvisitstoseetherecommendedprogrammesintheUKandIrelandinoperation
■ EnsureResurgamhasalltheorganisationalpoliciesandprocedures,financialpoliciesandprocedures,andexternallysupportedgovernancedevelopmentprocessesthatreflectitspotentialastheco-ordinatingandservicingbodyoftheEarlyInterventionLisburnConsortium
■ ConsiderthemostappropriatemembershipoftheEarlyInterventionConsortium
■ Appointtheco-chairsoftheearlyInterventionLisburnConsortium
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October–December2012■ RecruitandselectaResurgamEarlyInterventionCommunityCo-ordinator
(subjecttofundinghavingbeennegotiated)throughopenrecruitment(inaccordancewithagreedpoliciesandprocedures)
■ TheDeliveryPartnertorecruitandselectanappropriateEarlyInterventionLisburnDeliveryManager
■ Drawup(DeliveryPartner)servicedesignbriefsforeachoftheagreedphase1programmese.g.fromIncredibleYears,FamilyNursePartnerships,BigBrother/BigSisters,PATHS,SuccessforAllandLifeSkillsTraining
■ Putdetailedproposals/applicationstofunders/contractors,inrelationtophase1programmesandinfrastructure,asagreed
■ Meetwiththetargetschoolsconcerningtheirpotentialtohostappropriateprogrammese.g.Incredibleyearsfullparentandchildprogrammes,PATHSandSuccessforAll
■ DrawupanevaluationbrieffortheoverallEarlyInterventionLisburnProgrammeandseekfundingfortheevaluation
January–March2013■ InductandtraintheResurgamEarlyInterventionCommunityCo-ordinator
andDeliveryPartnerEarlyInterventionDeliveryManager
■ RecruitandselectaDeliveryPartnerEarlyInterventionQuality&MonitoringOfficer(subjecttofundinghavingbeennegotiated)throughopenrecruitment(inaccordancewithagreedpoliciesandprocedures)
■ Goouttotenderonthephase1agreedprogrammese.g.fromIncredibleYears,FamilyNursePartnershipsandBigBrothers/BigSisters,PATHS,SuccessforAll,LifeSkillsTraining,whenappropriatefundinghasbeenapproved
■ MeetwithBITCaboutthepotentialtodeliverTimetoReadintheadditionaltargetprimaryschools
■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase1asagreed
■ Agreewhichprogrammestoincludeinphase2e.g.fromthepriorityprogrammesnotimplementedinphase1
CHAPTER SEVEN
Implementation plan
Page 105
■ Goouttotenderforanappropriateevaluationteam
■ Drawupandagreeastrategicplanfor2013-2018andanoperationalplanfor2013/14.
April2013–August2013■ DeliveryPartnertocarryoutthestartup(planning,trainingandrecruitment)
phaseofthefirstearlyinterventionprogrammes
■ Marketthephase1programmeseffectivelytothetargetlocalaudiences
■ Drawupservicedesignbriefsandtenderspecificationsforeachoftheagreedphase2programmes
■ Evaluatorstoagreemeasuresandinstrumentsandcarryoutbaselinemeasurement
■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase2asagreed
■ EarlyInterventionLisburnConsortiumandResurgamtodiscussannualearlyinterventionreportfromtheDeliveryPartner
September–December2013■ Startdeliveringagreedphase1earlyinterventionprogrammes
■ Evaluatorstoproducebaselinereport
■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase2programmes,asagreed
■ Goouttotenderonthephase2agreedprogrammes,whenappropriatefundinghasbeenapproved
January-June2014■ DeliveryPartnertocarryoutstartupphase(planning,negotiatinglicenses,
training,baselineevaluationandrecruitment)ofphase2earlyinterventionprogrammes
■ Agreewhichprogrammesshouldbepartofphase3
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■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase3programmes,asagreed
■ EarlyInterventionConsortiumandResurgamtodiscussannualearlyinterventionreportfromtheDeliveryPartner
July–December2014■ Startdeliveringagreedphase2earlyinterventionprogrammes(community,
homeandschoolbased)
■ Drawupservicedesignbriefsandtenderspecificationsforeachoftheagreedphase3programmes
■ Goouttotenderonthephase3agreedprogrammes
■ ReviewthegovernanceoftheEarlyInterventionLisburninitiativeandagreeactionstofurtherimproveit
■ Putmoredetailedproposals/applicationtofunders/contractors,inrelationtophase3programmes,asagreed
■ Consider1styearformativeevaluationreport(s)andadjustmentsrequiredinthedeliveryoftheprogrammes
January–June2015■ Startup(planning,negotiatinglicenses,training,baselineevaluationand
recruitment)phaseofphase3earlyinterventionprogrammes
■ Agreewhichprogrammesshouldbepartofphase4(considerableadditionalevidenceonwhatworksintermsofearlyinterventionshouldbeavailableatthispoint,incarangeofRCTsinIrelandandGB)
■ Putdetailedproposals/applicationtofunders/contractors,inrelationtophase4programmes,asagreed
■ EarlyInterventionsteeringgrouptodiscussannualearlyinterventionreportfromResurgam
CHAPTER SEVEN
Implementation plan
Page 107
July–December2015■ Startdeliveringagreedphase3earlyinterventionprogrammes
■ Considertheformative2yearevaluationreport(2yearsofphase1and2yearsofphase2)
■ Drawupservicedesignbriefsforeachoftheagreedphase4programmes(wherefundingisagreedandthereisaviabledeliveryagency),whichhavenotbeendevelopedintheprevious3phasesoftheprogramme.
January–June2016■ Startup(planning,negotiatinglicenses,training,baselineevaluationand
recruitment)phaseofphase4earlyinterventionprogrammes
■ EarlyInterventionsteeringgrouptodiscussannualearlyinterventionreportfromResurgam
July–December2016■ Startdeliveringagreedphase4earlyinterventionprogrammes
■ Considerthe3yearevaluationreport(3yearsofphase1;2yearsofphase2;and1yearofphase3)
■ ReviewthegovernanceoftheEarlyInterventionLisburninitiativeandagreeactionstofurtherimprovethem
January–June2018■ EarlyInterventionConsortiumandResurgamtodiscussannualearly
interventionreportfromtheDeliveryPartner
July–December2017■ Considerthe4yearevaluationreport(4yearsofphase1;3yearsofphase2;2
yearsofphase3;and1yearofphase4)
January–June2018■ EarlyInterventionConsortiumandResurgamtodiscussannualearly
interventionreportfromtheDeliveryPartner
July–December2018■ Considerthe5yearevaluationreport(5yearsofphase1;4yearsofphase2;3
yearsofphase3;and2yearsofphase4)
Page 108
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Bibliography-OtherHandbookofProgrammes(October2011)ColinEarlyInterventionCommunity
OutcomesfortheColinAreaOctober2011ColinEarlyInterventionCommunity
ReportforEasternChildcarePartnershiptoascertainneedsandpossiblestructureofaLisburnCentralSureStart(March2012)ResurgamCommunityDevelopmentTrust
ResurgamTrustStrategicPlan2010-2015(2010)ResurgamDevelopmentTrust
Bibliography – Public Policy/Strategy
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AComparisonoftheNewParentProjectwithotherhomevisitingprogrammes(February2009)NCBNI
EarlyYearsAllianceEarlyYearsManifesto(undated)EarlyYearsStrategicAlliance
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APPENDIX ONE
Terms of Reference for the developmentof a detailed model of delivery for Early Intervention Lisburn
BackgroundResurgumDevelopmentTrusthasdevelopedtheconceptofanEarlyInterventionLocalitywithinLisburninordertomeetarangeofdisproportionatelypooroutcomesforchildrenandfamiliesintheLisburnarea.Todevelopthisconceptfurther,ResurgumandthePublicHealthAgencyhavecommissionedBarnadostodeliverspecificdeliverableswhichwillhelptakethisinitaiveforward.Barnadosarealsocontributingfundingtothisprojectinaspiritofcollaborationandhaveallocatedanexperiencedconsultanttooperationallyleadthisworkontheirbehalf.
TimescaleAlldeliverablesshouldbecompletedby31stMay,2012
DeliverablesThemaindeliverablefromthispieceofworkwillbeasinglereporttitled‘TheDevelopmentofanEarlyInterventionLocalitywithinLisburn’.Withinthisreport,severaldistinctelementswillbecovered,asdetailedbelow:
1. TheCaseforChange:thissectionwillarticulatewhyanearlyinterventioninitiativeisrequiredinLisburn.ItwoulddetailoutcomesforchildrenlivingwithinthemostdeprivedestateswithinLisburn,especiallyOldWarren,HillhallandTonagh(althoughitwillalsocoverotherestates)andhowthesecomparewithotherareasinNorthernIreland.ThissectionwillalsodetailthespecificneedswithinLisburn,thecurrentservicesinplace,thegapsandthepotentialoverlapsbetweencurrentservices.
2. SharedOutcomesandPrinciples:ThiskeysectionwillarticulatethesharedOUTCOMESandPRINCIPLESthatallstakeholdersinEarlyInterventionLisburnhavesignedupto.Obviously,togettothispoint,engagementwithcommunity,statutory(includingschools)andvoluntarypartnerswillneedtotakeplace.Thisengagementshouldincludeallkeystakeholdersandshouldbefullyinclusivefromanearlystage.TheengagementprocesswillneedtobedesignedandimplementedtoensuretheviewsofallkeystakeholdersareincludedandthatagreementisreachedbetweenallpartnersastowhichsharedoutcomesandprinciplesshouldunderpinthedevelopmentofEarlyInterventionLisburn.
3. Whatworks–aglobalreviewofevidence:UsingtheOutcomesagreedinsection2,thissectionwilldetailthetypesofprogrammesandpracticeswhichhavebeenproventodelivertheexpectedOutcomese.g.improvedadolescentmentalhealth,reducedteenagedrinking,kidsmorereadyforschoolinP.1,improvedschoolattendanceorbetteracademicachievementetcetc.
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4. DesignofanintegratedmodelofdeliveryforEarlyInterventionLisburn(EIL):ThiselementwilltakeallthelearningfromtheprevioussectionsandwilldesignasuiteofinterventionswhichcollectivelywillenableEILtoachievetheOutcomesidentifiedinsection2.Thus,eachinterventionwillbeclearlylinkedtospecificOutcomes.Inaddition,clearperformanceindicatorswillbeidentifiedtoensurethatprogresstowardsspecificoutcomescanbemeasurede.g.GCSEresultsforanoutcomeofbetteracademicachievement.Thissectionwillalsoprovideanestimatefortheoverallprojectedcostoftheprogramme.ThiscostshouldincludetherecruitmentbyResurgumofanoverallEILProgrammeManagertooverseetheimplementationoftheEILinitiative.Thissectionwillnotdetailpotentialprovidersbutmayprovideexamplesofwherespecificprogrammeshavebeenproventomakeameasurabledifferenceinotherareas.
5. RoleofResurgumasprogrammeowners:ThissectionwillprovidebackgroundinformationaboutResurgumandwilllayouttherationaleforResurgumtakingresponsibility,asaleadingcommunityorganisationinLisburn,forthedeliveryoftheEarlyInterventionLisburninitiative.SpecificelementsoftheroleofResurgummayinclude:
a. Responsibilityforfinancialmanagementb. Responsibilityforidentifyingandsourcing,viatendering,thebest
providersforeachinterventionc. Monitoringtheperformanceagainstspecificindicatorsfortheoverall
programmeinrelationtoeachOutcomed. Reportingprogresstofunderse. Qualityassuranceofthedeliveryoftheoverallprogramme
6. ImplementationPlan:Thisshortsectionwilloutlinethenextstepsintermsofmovingtowardsimplementationsuchasdesigningadetailedspecificationforeachintervention,leadingtotenderdocumentationandtherecruitmentbyResurgumofanoverallEILProgrammeManager.
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APPENDIX TWO
Membership of the Early Intervention Lisburn Steering Group:
AdieBird(Chair)DenisPaisleyJasonWhiteAnneHardyMabelScullionCarolineMcGrathIanSutherlandJonathonCraigMartinDevlinNeilMcGivernMonicaMcCannPaulPorterUnaGeelanPaulGivanFrancisFerris
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APPENDIX THREE
Descriptions of Recommended Early Intervention Programmes
MultisystemicTherapy
BigBrothersBigSisters
FunctionalFamilyTherapy
LifeSkillsTraining
FamilyNursePartnerships
PATHS(PromotingAlternativeThinkingStrategies)
IncredibleYears
TripleP–PositiveParenting
Parent-ChildHome
ReadingRecovery
Parent-ChildInteractionTherapy
FathersReadingEveryDay(FRED)
TimetoRead
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MULTISYSTEMICTHERAPY(MST)
ProgramSummaryMultisystemicTherapy(MST)isanintensivefamily-andcommunity-basedtreatmentthataddressesthemultipledeterminantsofseriousantisocialbehaviorinjuvenileoffenders.Themultisystemicapproachviewsindividualsasbeingnestedwithinacomplexnetworkofinterconnectedsystemsthatencompassindividual,family,andextrafamilial(peer,school,neighborhood)factors.Interventionmaybenecessaryinanyoneoracombinationofthesesystems.
ProgramTargetsMSTtargetschronic,violent,orsubstanceabusingmaleorfemalejuvenileoffenders,ages12to17,athighriskofout-of-homeplacement,andtheoffenders’families.
ProgramContentMSTaddressesthemultiplefactorsknowntoberelatedtodelinquencyacrossthekeysettings,orsystems,withinwhichyouthareembedded.MSTstrivestopromotebehaviorchangeintheyouth’snaturalenvironment,usingthestrengthsofeachsystem(e.g.,family,peers,school,neighborhood,indigenoussupportnetwork)tofacilitatechange.
ThemajorgoalofMSTistoempowerparentswiththeskillsandresourcesneededtoindependentlyaddressthedifficultiesthatariseinraisingteenagersandtoempoweryouthtocopewithfamily,peer,school,andneighborhoodproblems.Withinacontextofsupportandskillbuilding,thetherapistplacesdevelopmentallyappropriatedemandsontheadolescentandfamilyforresponsiblebehavior.Interventionstrategiesareintegratedintoasocialecologicalcontextandincludestrategicfamilytherapy,structuralfamilytherapy,behavioralparenttraining,andcognitivebehaviortherapies.
MSTisprovidedusingahome-basedmodelofservicesdelivery.Thismodelhelpstoovercomebarrierstoserviceaccess,increasesfamilyretentionintreatment,allowsfortheprovisionofintensiveservices(i.e.,therapistshavelowcaseloads),andenhancesthemaintenanceoftreatmentgains.TheusualdurationofMSTtreatmentisapproximately60hoursofcontactoverfourmonths,butfrequencyanddurationofsessionsaredeterminedbyfamilyneed.
ProgramOutcomesEvaluationsofMSThavedemonstratedforseriousjuvenileoffenders:
■ reductionsof25-70%inlong-termratesofrearrest,
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■ reductionsof47-64%inout-of-homeplacements,■ extensiveimprovementsinfamilyfunctioning,and■ decreasedmentalhealthproblemsforseriousjuvenileoffenders.
ProgramCostsMSThasachievedfavorableoutcomesatcostsavingincomparisonwithusualmentalhealthandjuvenilejusticeservices,suchasincarcerationandresidentialtreatment.Atacostof$4,500peryouth,arecentpolicyreportconcludedthatMSTwasthemostcost-effectiveofawiderangeofinterventionprogramsaimedatseriousjuvenileoffenders.
ProgramBackgroundMultisystemicTherapy(MST)wasdevelopedinthelate1970s.Itaddressesseverallimitationsofexistingmentalhealthservicesforseriousjuvenileoffenderswhichincludeminimaleffectiveness,lowaccountabilityofserviceprovidersforoutcomes,andhighcost.
Treatmentefforts,ingeneral,havefailedtoaddressthecomplexityofyouthneeds,beingindividually-oriented,narrowlyfocused,anddeliveredinsettingsthatbearlittlerelationtotheproblemsbeingaddressed(e.g.,residentialtreatmentcenters,outpatientclinics).Givenoverwhelmingempiricalevidencethatseriousantisocialbehaviorisdeterminedbytheinterplayofindividual,family,peer,school,andneighborhoodfactors,itisnotsurprisingthattreatmentsofseriousantisocialbehaviorhavebeenlargelyineffective.Restrictiveout-of-homeplacements,suchasresidentialtreatment,psychiatrichospitalization,andincarceration,failtoaddresstheknowndeterminantsofseriousantisocialbehaviorandfailtoalterthenaturalecologytowhichtheyouthwilleventuallyreturn.Furthermore,mentalhealthandjuvenilejusticeauthoritieshavehadvirtuallynoaccountabilityforoutcome,asituationthatdoesnotenhanceperformance.Theineffectivenessofout-of-homeplacement,coupledwithextremelyhighcosts,haveledmanyyouthadvocatestosearchforviablealternatives.MSTisonetreatmentmodelthathasawell-documentedcapacitytoaddresstheaforementioneddifficultiesinprovidingeffectiveservicesforjuvenileoffenders.
TheoreticalRationale/ConceptualFrameworkConsistentwithsocial-ecologicalmodelsofbehaviorandfindingsfromcausalmodelingstudiesofdelinquencyanddruguse,MSTpositsthatyouthantisocialbehaviorismultideterminedandlinkedwithcharacteristicsoftheindividualyouthandhisorherfamily,peergroup,school,andcommunitycontexts.Assuch,MSTinterventionsaimtoattenuateriskfactorsbybuildingyouthandfamilystrengths(protectivefactors)onahighlyindividualizedandcomprehensivebasis.Theprovisionofhome-basedservicescircumventsbarrierstoserviceaccessthat
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oftencharacterizefamiliesofseriousjuvenileoffenders.Anemphasisonparentalempowermenttomodifythenaturalsocialnetworkoftheirchildrenfacilitatesthemaintenanceandgeneralizationoftreatmentgains.
BriefDescriptionofInterventionMSTisapragmaticandgoal-orientedtreatmentthatspecificallytargetsthosefactorsineachyouth’ssocialnetworkthatarecontributingtohisorherantisocialbehavior.Thus,MSTinterventionstypicallyaimto:■ improvecaregiverdisciplinepractices;■ enhancefamilyaffectiverelations;■ decreaseyouthassociationwithdeviantpeers;■ increaseyouthassociationwithprosocialpeers;■ improveyouthschoolorvocationalperformance;■ engageyouthinprosocialrecreationaloutlets;and■ developanindigenoussupportnetworkofextendedfamily,neighbors,and
friendstohelpcaregiversachieveandmaintainsuchchanges.
Specifictreatmenttechniquesusedtofacilitatethesegainsareintegratedfromthosetherapiesthathavethemostempiricalsupport,includingcognitivebehavioral,behavioral,andthepragmaticfamilytherapies.
MSTservicesaredeliveredinthenaturalenvironment(e.g.,home,school,andcommunity).Thetreatmentplanisdesignedincollaborationwithfamilymembersandis,therefore,familydrivenratherthantherapistdriven.TheultimategoalofMSTistoempowerfamiliestobuildanenvironment,throughthemobilizationofindigenouschild,family,andcommunityresources,thatpromoteshealth.Thetypicaldurationofhome-basedMSTservicesisapproximatelyfourmonths,withmultipletherapist-familycontactsoccurringeachweek,determinedbyfamilyneed.
AlthoughMSTisafamily-basedtreatmentmodelthathassimilaritieswithotherfamilytherapyapproaches,severalsubstantivedifferencesareevident:
1. MSTplacesconsiderableattentiononfactorsintheadolescentandfamily’ssocialnetworksthatarelinkedwithantisocialbehavior.Hence,forexample,MSTprioritiesincluderemovingoffendersfromdeviantpeergroups,enhancingschoolorvocationalperformance,anddevelopinganindigenoussupportnetworkforthefamilytomaintaintherapeuticgains.MSTprogramshaveanextremelystrongcommitmenttoremovingbarrierstoserviceaccess(e.g.,thehome-basedmodelofservicedelivery).
2. MSTservicesaremoreintensivethantraditionalfamilytherapies(e.g.,severalhoursoftreatmentperweekvs.50minutes).
3. Mostimportantly,MSThaswell-documentedlong-termoutcomeswith
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adolescentspresentingseriousantisocialbehaviorandtheadolescents’families.
ThestrongestandmostconsistentsupportfortheeffectivenessofMSTcomesfromcontrolledstudiesthatfocusedonviolentandchronicjuvenileoffenders.Importantly,resultsfromthesestudiesshowedthatMSToutcomesweresimilarforyouthacrosstheadolescentagerange(i.e.,12-17years),formalesandfemales,andforAfricanAmericanaswellasWhiteyouthandfamilies.
EvidenceofProgramEffectivenessThefirstcontrolledstudyofMSTwithjuvenileoffenderswaspublishedin1986,andthreerandomizedclinicaltrialswithviolentandchronicjuvenileoffendershavebeenconductedsincethen.Inthesetrials,MSThasdemonstratedlong-termreductionsincriminalactivity,drug-relatedarrests,violentoffenses,andincarceration.Thissuccesshasledtoseveralrandomizedtrialsandquasi-experimentalstudiesaimedatextendingtheeffectivenessofMSTtootherpopulationsofyouthpresentingseriousclinicalproblemsandtheirfamilies.
Theinformationforthisfactsheetwasexcerptedfrom:
Henggeler,S.W.,Mihalic,S.F.,Rone,L.,Thomas,C.,&Timmons-Mitchell,J.(1998).BlueprintsforViolencePrevention,BookSix:MultisystemicTherapy.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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BIGBROTHERSBIGSISTERSOFAMERICA(BBBSA)
ProgramSummaryBigBrothersBigSistersofAmerica(BBBSA)hasbeenprovidingadultsupportandfriendshiptoyouthfornearlyacentury.Areportin1991demonstratesthatthroughBBBSA’snetworkofnearly500agenciesacrossthecountry,morethan70,000youthandadultsweresupervisedinone-to-onerelationships.
ProgramTargetsBBBSAtypicallytargetsyouth(aged6to18)fromsingleparenthomes.
ProgramContentServicedeliveryisbyvolunteerswhointeractregularlywithayouthinaone-to-onerelationship.Agenciesuseacasemanagementapproach,followingthroughoneachcasefrominitialinquirythroughclosure.Thecasemanagerscreensapplicants,makesandsupervisesthematches,andclosesthematcheswheneligibilityrequirementsarenolongermetoreitherpartydecidestheycannolongerparticipatefullyintherelationship.
BBBSAdistinguishesitselffromothermentoringprogramsviarigorouspublishedstandardsandrequiredprocedures:
■ Orientationisrequiredforallvolunteers.■ VolunteerScreeningincludesawrittenapplication,abackgroundcheck,an
extensiveinterview,andahomeassessment;itisdesignedtoscreenoutthosewhomayinflictpsychologicalorphysicalharm,lackthecapacitytoformacaringbondwiththechild,orareunlikelytohonortheirtimecommitments.
■ YouthAssessmentinvolvesawrittenapplication,interviewswiththechildandtheparent,andahomeassessment;itisdesignedtohelpthecaseworkerlearnaboutthechildinordertomakethebestpossiblematch,andalsotosecureparentalpermission.
■ Matchesarecarefullyconsideredandbasedupontheneedsoftheyouth,abilitiesofvolunteers,preferencesoftheparent,andthecapacityofprogramstaff.
■ Supervisionisaccomplishedviaaninitialcontactwiththeparent,youth,andvolunteerwithintwoweeksofthematch;monthlytelephonecontactwiththevolunteer,parentand/oryouthduringthefirstyear;andquarterlycontactwithallpartiesduringthedurationofthematch.
ProgramOutcomesAnevaluationoftheBBBSAprogramhasbeenconductedtoassesschildrenwhoparticipatedinBBBSAcomparedtotheirnon-participatingpeers.Afteraneighteenmonthperiod,BBBSAyouth:
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■ were46%lesslikelythancontrolyouthtoinitiatedruguseduringthestudyperiod.
■ were27%lesslikelytoinitiatealcoholusethancontrolyouth.■ werealmostone-thirdlesslikelythancontrolyouthtohitsomeone.■ werebetterthancontrolyouthinacademicbehavior,attitudes,andperformance.■ weremorelikelytohavehigherqualityrelationshipswiththeirparentsor
guardiansthancontrolyouth.■ weremorelikelytohavehigherqualityrelationshipswiththeirpeersattheend
ofthestudyperiodthandidcontrolyouth.
ProgramCostsThenationalaveragecostofmakingandsupportingamatchrelationshipis$1,000(£627)peryear.
ProgramBackgroundBigSistersactivitywasinitiatedin1902,whenagroupofwomeninNewYorkCitybeganbefriendinggirlswhocamebeforetheNewYorkChildren’sCourt.KnownthenastheLadiesofCharity,thegrouplaterbecameCatholicBigSistersofNewYork.AstoryintheNewYorkTimesin1902reportedthatajudgeoftheNewYorkChildren’sCourtsecuredpromisesfromagroupofinfluentialmenthateachonewouldbefriendoneboywhohadbeenbeforehiscourt.Hisactivitycouldhaveinfluencedamemberofhiscourt,ClerkErnestK.Coulter,whoiscreditedwithfoundingtheorganizedBigBrothersMovementin1904.ACincinnatibusinessman,IrvinF.Westheimer,andamemberofacloselyknit,charity-mindedJewishcommunity,urgedhisfriendsandbusinessassociatestobefriendtroubledanddisadvantagedyouths,whicheventuallyledtotheorganizationofaBigBrothersagencyinCincinnatiin1910.
BeforeWorldWarI,theBigBrothersandBigSistersMovementwascharacterizedbymanyformsoforganization,underavarietyofsponsors,utilizinganumberofapproaches.Butalloftheeffortswereunitedbyasinglespirit—adesiretohelpchildren,generallyfromone-parenthomes,whosemoral,mental,andphysicaldevelopmentwasendangeredbytheirenvironmentsandbackgrounds.By1922,“standards”(i.e.,basicrequirements)werecreatedandadopted.Theseearlystandardsaddressedtheone-to-onerelationshipasavolunteer’sindividualandpersonaleffortinbehalfofchildren,andassertedtheneedforanagencytomanageitsaffairsinaprofessionalmanner.Bytheearly1930s,thestandardshadbecomemorestringentinsettingforthminimumrequirementsforoperationatthelocallevel.
Inthemid-1930s,theGreatDepressionaffectedtheBigBrothersandBigSistersFederation,andby1937thenationalofficecloseditsdoors,whilelocalagencies
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continuedtooperate.FollowingWorldWarII,anewfederationwasestablishedonlyforBigBrothersagencies.Outofaconvictionthatwomencouldhelpmeettheneedsofgirls,BigSistersInternationalwascreatedbytheBigSistersagenciesthenoperatingin1970.In1977,BigSistersInternationalandBigBrothersofAmericamergedtobecomeBigBrothersBigSistersofAmerica(BBBSA).
EffortsfocusedonthedevelopmentandpilotingofasetofStandardsandRequiredProceduresforOne-To-OneService(BigBrothersBigSistersofAmerica,1986;asamended,1996),whichwereadoptedin1986.Thisconsistsofcorporatemanagementandprogrammanagementstandards,witheachstandardhavingasetofrequiredproceduresthatweredeemednecessarytofulfilleachstandard.CompliancewiththesestandardsandrequiredproceduresbecamethehallmarkofaneffectiveBigBrothersBigSisters(BBBS)agencyandthebasisforbuildingaconsistentone-to-oneserviceofover500BBBSagenciesacrossall50states.AdescriptionofmanualspublishedbyBBBSAcanbefoundinAppendixB.
Duringmorethan85yearsofnationalorganizationaldevelopmentandlocalizedservicedelivery,theword“mentoring”wasnotapartofthemovement’snomenclature.Infact,itwasnotuntilthelate1980s,whenfundersandresearchersdeterminedthatmentoringmaybeapromisingapproachforchildrenat-risk,thatthewordmentoringfounditswayintotheBBBSA’srhetoricfordescribingtheirservice.TherewasastronginclinationonthepartoflocalBBBSagencies,however,tonotconfuseBBBSA’ssystematicandstructuredvolunteerapproachwiththemorelooselyfashionedmentoringprogramsthatwerebeingdeveloped.Mentoringhasvariousdefinitions,dependingontheemphasisthataparticularcommunityyouthprogramhasasitsgoal.“Mentoring”isoftenusedinterchangeablywith“tutoring,”andsometimes,withthegoalofapprenticeship.Mentoringtendstobeanadd-ontoprogramsthathaveveryspecificgoalsandobjectives,withmentoringbeingseenasonlyoneofmanyingredients.Historically,mentoringhashadahelping-to-learnaspecttoit;forexample,anolderpersonguidingayoungerperson,usuallyaroundsomeprescribedactivityoraspectoflife.BigBrothersBigSisterswork,however,focusesonfriendshipastheprimaryaspectoftherelationship,whichshouldleadtoafeelingoftrustovertime,andwhichthenmayleadtosomeaspectsoflearning,regardlessofthesubjectorbehavior.Buttherelationship—thetrust,themutuallysharedexperiencesofeverydaylife—istheessenceoftheservice.Whilethewordmentoringisnowused,forthemostpart,interchangeablywithBigBrothersBigSisters,BBBSA’semphasiscontinuestobeonthequalityoftherelationshipbetweenthevolunteerandthechild,andnotonasetofprescribedactivities.
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TheoreticalRationale/ConceptualFrameworkAlthoughBBBSAwasnotdevelopedwithacademictheoriesofdelinquencyinmind,theproject’srationalemostcloselyresemblessocialcontroltheory.Accordingtothisperspective,attachmentstoprosocialothers,commitmenttosociallyappropriategoals,andinvolvementinconventionalactivitiesrestrainyouthfromengagingindelinquentactivitiesorotherproblembehaviors,becausemoresociallybondedyouthhavemoretolosebymisbehavior.
TherationalethathasguidedBBBSAservicefornearlyacenturyhasbeenthattheconsistentpresenceofanon-familialcaringadultcanmakeadifferenceinthesocial/emotionaldevelopmentofachildoryoungperson,particularlyonegrowingupinasingleparentfamilyorinanadversesituation.OvertheyearsthedevelopmentoftheBBBSservicehasbeenbasedontheoverridingbeliefthataconsistentandfrequentvolunteercontactisapowerfulinfluence.Thisbeliefhasbeenbased,predominantly,onanecdotalreportsfromparents,teachers,casemanagers,andchildrenthemselves.
ThemostrelevantresearchtodatehascomefromtheresiliencystudiescarriedoutbyresearcherssuchasEmmyWerner,andothers,undertherubricof“caringadults.”Werner,ina30yearlongitudinalstudyontheislandofKauai,hasfoundthatthenumberofcaringadultsoutsidethefamilywithwhomthechildlikedtoassociatewasasignificantprotectivefactorforbothhighriskboysandgirlswhomadeasuccessfultransitionintoadulthood.Basedonsuchresearch,BBBSAcontinuesitsgeneralizedapproachandconcentratesonenhancingtheinfrastructuretosupportthedevelopmentandmaintenanceoftherelationshipbetweenthevolunteerandchild.
BriefDescriptionofInterventionBBBSisacommunitymentoringprogramwhichmatchesanadultvolunteer,knownasaBigBrotherorBigSister,toachild,knownasaLittleBrotherorLittleSister,withtheexpectationthatacaringandsupportiverelationshipwilldevelop.Hence,thematchbetweenvolunteerandchildisthemostimportantcomponentoftheintervention.Equallyimportant,however,isthesupportofthatmatchbytheongoingsupervisionandmonitoringofthematchrelationshipbyaprofessionalstaffmember.Theprofessionalstaffmemberselects,matches,monitors,andclosestherelationshipwiththevolunteerandchild,andcommunicateswiththevolunteer,parent/guardian,andthechildthroughoutthematchedrelationship.
Inpractice,thevolunteerinterventioninthetraditionalone-to-onerelationshipwithachildisthreetofivehoursperweek,onaweeklybasis,overthecourseofayearorlonger.Thegeneralizedactivityofthatrelationshipisrelatedtothegoalsthatweresetinitiallywhenthematchwasestablished.Thesegoalsareidentified
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fromtheextensivecasemanagerinterviewheldwiththeparent/guardianandwiththechild.Theforemostgoalusuallysetistodeveloparelationship—onethatismutuallysatisfying,wherebothpartiescometogetherfreelyonaregularbasis.Morespecificgoalsmightrelatetoschoolattendance,academicperformance,relationshipswithotherchildrenandsiblings,generalhygiene,learningnewskillsordevelopingahobby.Thegoalsestablishedforaspecificmatcharedevelopedintoanindividualizedcaseplan,whichisupdatedbythecasemanagerasprogressismadeandcircumstanceschangeovertime.
Generallyspeaking,BBBSagencystaffdonottellavolunteerspecificallywhatactivitiestoengageinwiththechildduringtheirtimetogether,buttheyguidethevolunteerandmakesuggestionsofpossibleactivitiesandapproaches,basedonthechild’sandvolunteer’sinterestsandneeds.Consistencyintherelationshipovertimeisahigherprioritythanthetypesofactivitiesinwhichtheyparticipate.Oncethematchhasbeeninitiallyagreedupon,inthepresenceofthechild,volunteer,andthechild’sparent/guardian,itisthentheresponsibilityoftheprofessionalstaffmember,knownasthecasemanager,tomaintainon-goingcontactwithallpartiesinthematchrelationship.
TheStandardsandRequiredProceduresforOne-To-OneServiceoutlinesthescheduleofcontactsthecasemanageristohavewiththevolunteer,aswellaswiththeparentand/orchild.Thereistobemorefrequentcontactduringtheearlystagesofthematchwithaninitialcontactwithintwoweeksofmakingthematch,thenmonthlycontactthroughouttherestoftheyear,andthencontacteverythreemonthsafterthefirstyearandthroughoutthedurationofthematch.Thecasemanagercallsthevolunteerandtheparentafterthefirstandsecondweekoftherelationshiptodeterminehowtherelationshipisdeveloping,andmaycontinueonaweeklybasisthroughthefirstsixweeks,dependingonthesituation.However,iteventuallydevelopsintoamonthlycontactwiththevolunteerandtheparent.
Atleastquarterly,thecasemanagerisintouchwiththechildtolearnoftheyouth’sexperiences.Thesesupervisorycontactsinformthecasemanagerhowtherelationshipisdevelopingandprovideanopportunitytogiveadviceandguidancearoundanyissuesthevolunteermighthave,aswellastoencourageandsupportvariousactivities.Formostagencies,theon-goingcasemanagersupervisionwiththevolunteertakesplaceoverthephone.Thecasemanageristoassessthematchgoalsonanannualbasisandmakeappropriateadjustmentstothecaseplan.
EvidenceofProgramEffectivenessIncontrasttopriorresearchonmentoringprogramswhichhasfailedtodemonstratetheeffectivenessofthoseprograms,researchconductedbyPublic/PrivateVentures(P/PV)ontheBBBSmodelprovidesclearevidencethatacaring
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relationshipbetweenanadultvolunteerandayoungpersoncanprovideawiderangeoftangiblebenefits.
P/PVconductedacomparativestudyofnearly1,000ten-tosixteen-yearoldsfromeightBBBSagenciesduringtheyears1992-1993.Halfoftheseyoungpeoplewererandomlyassignedtoatreatmentgroup,forwhichBBBSmatchesweremade;theotherhalfwererandomlyassignedtoacontrolgroupandwerenotmatched(thecontrolgroupmemberswereputonawaitinglistfor18months).TheP/PVstudycomparedthesetwogroupsafteran18monthperiodoftime.
Attheconclusionofthe18-monthstudyperiod,itwasfoundthatLittleBrothersandLittleSisters(youthparticipantsintheprogram)werelesslikelytohavestartedusingdrugsoralcohol,werelesslikelytohavehitsomeone,feltmorecompetentaboutdoingschoolwork,attendedschoolmore,gotbettergrades,andhadbetterrelationshipswiththeirparentsandpeersthanthosewhodidnotparticipateintheprogram.
Theinformationforthisfactsheetwasexcerptedfrom:
McGill,D.E.,Mihalic,S.F.,&Grotpeter,J.K.(1998).BlueprintsforViolencePrevention,BookTwo:BigBrothersBigSistersofAmerica.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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FUNCTIONALFAMILYTHERAPY(FFT)ProgramSummaryFunctionalFamilyTherapy(FFT)isanoutcome-drivenprevention/interventionprogramforyouthwhohavedemonstratedtheentirerangeofmaladaptive,actingoutbehaviorsandrelatedsyndromes.
ProgramTargetsYouth,aged11-18,atriskforand/orpresentingwithdelinquency,violence,substanceuse,ConductDisorder,OppositionalDefiantDisorder,orDisruptiveBehaviorDisorder.Oftentheseyouthpresentwithadditionalcomorbidchallengessuchasdepression.
ProgramContentFFTrequiresasfewas8-15sessionsofdirectservicetimeforcommonlyreferredyouthandtheirfamilies,andgenerallynomorethan26totalsessionsofdirectserviceforthemostsevereproblemsituations.
DeliverymodesFlexibledeliveryofservicebyoneand(rarely)twopersonteamstoclientsin-home,clinic,school,juvenilecourt,communitybasedprograms,andattimeofre-entryfrominstitutionalplacement.
ImplementationWiderangeofinterventionists,includingtrainedprobationofficers,mentalhealthtechnicians,degreedmentalhealthprofessionals(e.g.,M.S.W.,Ph.D.,M.D.,R.N.,M.F.T.,L.C.P.).
FFTeffectivenessderivesfromemphasizingfactorswhichenhanceprotectivefactorsandreducerisk,includingtheriskoftreatmenttermination.Inordertoaccomplishthesechangesinthemosteffectivemanner,FFTisaphasicprogramwithstepswhichbuilduponeachother.Thesephasesconsistof:
■ Engagement,designedtoemphasizewithinyouthandfamilyfactorsthatprotectyouthandfamiliesfromearlyprogramdropout;
■ Motivation,designedtochangemaladaptiveemotionalreactionsandbeliefs,andincreasealliance,trust,hope,andmotivationforlastingchange;
■ Assessment,designedtoclarifyindividual,familysystem,andlargersystemrelationships,especiallytheinterpersonalfunctionsofbehaviorandhowtheyrelatedtochangetechniques;
■ BehaviorChange,whichconsistsofcommunicationtraining,specifictasksandtechnicalaids,basicparentingskills,problemsolvingandconflictmanagementskills,contractingandresponse-costtechniques;and
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■ Generalization,duringwhichfamilycasemanagementisguidedbyindividualizedfamilyfunctionalneeds,theirinterfacewithcommunitybasedenvironmentalconstraintsandresources,andthealliancewiththeFFTtherapist/FamilyCaseManager.
ProgramOutcomesClinicaltrialshavedemonstratedthatFFTiscapableof:
■ EffectivelytreatingadolescentswithConductDisorder,OppositionalDefiantDisorder,DisruptiveBehaviorDisorder,alcoholandotherdrugabusedisorders,andwhoaredelinquentand/orviolent;
■ Interruptingthematriculationoftheseadolescentsintomorerestrictive,highercostservices;
■ Reducingtheaccessandpenetrationofothersocialservicesbytheseadolescents;
■ Generatingpositiveoutcomeswiththeentirespectrumofinterventionpersonnel;
■ Preventingfurtherincidenceofthepresentingproblem;■ Preventingyoungerchildreninthefamilyfrompenetratingthesystemofcare;■ Preventingadolescentsfrompenetratingtheadultcriminalsystem;and■ Effectivelytransferringtreatmenteffectsacrosstreatmentsystems.
ProgramCostsThe90-daycostsrangebetween$1,600and$5,000foranaverageof12homevisitsperfamily.Currentcostsvaryandarehighlydependentoncostoflabor.
ProgramBackgroundManytherapiesarenamedtoreflectatheoreticalperspective(e.g.,behavioral,objectrelations)oraprimaryfocus(e.g.,multiplesystems,cognitive).FunctionalFamilyTherapy(FFT)isnamedtoreflectasetofcoretheoreticalprincipleswhichrepresentstheprimaryfocus(family),andanoverridingallegiancetopositiveoutcomeinamodelthatunderstandsbothpositiveandnegativebehaviorasrepresentationsoffamilyrelationalsystems(functional).Thus,FunctionalFamilyTherapyhasadoptedanintegrativestancethatstressesfunctionalityofthefamily,thetherapy,andtheclinicalmodel.
ThedevelopersandreplicatorsofFunctionalFamilyTherapyhaverecognizedthatsolutionsrequireanintegrationofhighqualityscience,testedtheoreticalprinciples,andextensiveclinicalexperienceinpursuitofspecificfunctionalgoalsof:
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1. Effectivelychangingthemaladaptivebehaviorsofyouthandfamilies,especiallythosewhoattheoutsetmaynotbemotivatedormaynotbelievetheycanchange
2. Reducingthepersonal,societal,andeconomicdevastationthatresultsfromthecontinuationorexacerbationofthevariousdisruptivebehaviordisordersofyouth
3. Doingsowithlesscost,intermsoftimeandmoney,thansomanyofthemoreexpensive(butnotnecessarilyeffective)treatmentscurrentlyavailable.
Unlikeothertherapies,FFTwasnotdevelopedoncollegestudents,neuroticindividuals,orinpatientadults.Instead,FFTgrewoutofaneedtoserveapopulationofat-riskadolescentsandfamiliesthatwereunderserved,hadfewresources,weredifficulttotreat,andwereoftenperceivedbyhelpingprofessionstobetreatmentresistant.Inmanycasesthesefamiliesenteredthe“system”angry,resistant,andunmotivatedtochange.Essentiallythe“helpingprofessions”didnotknowhowtotreatthispopulation.FFTdevelopedoutoftheawarenessthattobesuccessfulintreatmentofthispopulationweneededtobeculturallycompetent,andunderstandwhythisgroupwassotreatmentresistant.Thus,FFTattemptedtodevelopwaystoengagethesefamiliesinordertohelpthemachieveobtainablechangeandbecomemoreadaptableandproductive.Overthelast30years,FFThaslearnedthatitisimportanttodomorethansimplystoppingbadbehaviors.Weknowthatitisimportanttomotivatefamiliestochangeinapositivewaybyuncoveringanddevelopingtheuniquestrengthsofthefamilyinwaysthatenhancethefamilies’self-respectwhileprovidingspecificwaystoimprove.
Sinceitsinceptionin1969,FFThasaccomplisheditsprimarygoalsbyintegratingthemostpromisingtheoreticalperspectives,theempiricaldataavailable,andhoursandhoursofdirectclinicalexperiencewiththetroubledyouthwewantedtohelp.FFTisdesignedtoincreaseefficiency,decreasecosts,andenhanceourabilitytoprovideservicetomoreyouthby:
1. Targetingriskandprotectivefactorsthatwecan,infact,changeandthenprogrammaticallychangingthem;
2. Engagingandmotivatingthefamiliesandyouthsotheyparticipatemoreinthechangeprocess;
3. Enteringeachsessionandphaseofinterventionwithaclearplanandbyusingproventechniquesforimplementation;
4. Constantlymonitoringprocessandoutcomesowedon’tfoolourselvesormakeexcusesforfailure;and
5. Believinginthefamiliesweseeandthenbelievinginourselves.
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AtthetimeoftheinceptionofFunctionalFamilyTherapy,themajortheoreticalperspectivesandservicesavailablefortreatingtroubledyouthinafamilycontextwererudimentary,thoughpromising.Earlyon,FFTrepresentedanintegrationofsystemsperspectivesandbehavioraltechniques.ThesystemicbackgroundofFFTemphasizeddynamicandreciprocalprocesseswhichneededtobeidentifiedinreferredfamilies.Thisledtoearlyobservationalresearchontheinteractionsofdelinquentandnon-delinquentfamiliesusingasystemicframework.ThebehavioralbackgroundofFFTprovidednotonlyspecific,manualizeableinterventionssuchascontracting,butitalsofeaturedanurgentawarenessoftheneedforrigoroustreatmentdevelopment-ascientificimperativetosystematicallyexaminetheeffectsofinterventionanddevelopstrategiesforidentifyingpositivechangeprocesses.Theseoriginsledtoacontinuingseriesofstudiesinvolvingcontrolledoutcomeevaluationsandadditionalreplications.Duringthemid-1970’s,FFTalsobeganaddressingissuesoftherapistcharacteristicsandin-sessionprocessesfromanintegratedclinical/researchperspective,bothreflectingandcontributingtothetrainingoftherapistsforsubsequentinterventions.Inthelate1990’sFFTfurtherarticulatedtheclinicalchangemodeladdingacomprehensivesystemofclient,process,andoutcomeassessmentimplementedthroughacomputer-basedclienttrackingandmonitoringsystem(FFT-CSS).
ThroughoutitsdevelopmentFFThasinsistedonstepbystepdescriptionsoftheclinicalchangeprocessaswellasrigorousevaluationofboththeprocessandoutcomesofthiswork.FFThasalsoinsistedonintegratinghighqualityscience(inregardtoevaluationandresearch)withsoundclinicaljudgementandexperienceandcomprehensivetheoreticalprinciples.Thus,overthelast30yearsFFThasbeenadynamicandevolvingclinicalsystemthatretainsitscoreprincipleswhileaddingclinicalfeaturesthatfurtherenhancesuccessfuloutcomes.Initsmostrecentiteration,FFThasdevelopedafunctionalfamilyassessmentsystemtoaidFFTtherapistsintargetingandimplementingtherapeuticchangegoalsinawaythatleadstoaccountabilitythroughprocessandoutcomeevaluation.Thus,FFThasmaturedintoaclinicalinterventionmodelwithsystematictraining,supervision,andprocessandoutcomeassessmentcomponentsalldirectedatenhancingthedeliveryofFFTinlocalcommunities(seeFigure1).
BriefDescriptionofInterventionFunctionalFamilyTherapy(FFT)isawelldocumentedfamilypreventionandinterventionprogramwhichhasbeenappliedsuccessfullytoawiderangeofproblemyouthandtheirfamiliesinvariouscontexts.Whilecommonlyemployedasaninterventionprogram,FFThasdemonstrateditseffectivenessasamethodforthepreventionofmanyoftheproblemsofat-riskadolescentsandtheirfamilies.FunctionalFamilyTherapy(FFT)isanempiricallygroundedinterventionprogram
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thattargetsyouthbetweentheagesof11and18,althoughyoungersiblingsofreferredadolescentsarealsotreated.FFTisashort-terminterventionwith,onaverage,8to12one-hoursessionsformildcasesandupto26to30hoursofdirectserviceformoredifficultsituations.Inmostprogramssessionsarespreadoverathree-monthperiodoftime.Targetpopulationsrangefromat-riskpreadolescentstoyouthwithveryseriousproblemssuchasconductdisorder.Thedatafromnumerousoutcomestudiessuggeststhatwhenappliedasintended,FFTcanreducerecidivismbetween25%and60%.AdditionalstudiessuggestthatFFTisacost-effectiveinterventionthatcan,whenappropriatelyimplemented,reducetreatmentcostswellbelowthatoftraditionalservicesandotherfamily-basedinterventions.
Practice SitesWashington StateImplementation
CSPV Blueprint Project (8 sites)Nevada
UtahPennsylvania
VirginiaArizonaIndianaKansasFlorida
KentuckyDelwareClinical Practice Training
Supervision
Science
Clinical ServicesSystem
Clinical monitoring/tracking
Family/AdolescentAssessment
ProtocolClient Assessment
Process AssessmentOutcome Assessment
Externship
Clinical Training Supervision
FFT Clinical Model
FFT-PRNPractice Research
Network
Adherence StudiesThe Family Project/
UNLV
Clinical Trials
Effectiveness StudiesThe Family Project/
UNLV
Process StudiesCTRADA Study 2
Univ. Utah
Figure1:MatureClinicalModel
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Asitdeveloped,FFThasbeenreadilyadoptedinmanycontextsduetoitsclearidentificationofspecificphases,eachofwhichincludesdescriptionsofgoals,requisitetherapistcharacteristics,andtechniques.Thephasesofintervention,andtheircomponentactivities,havedevelopedinthecontextofmanyclinicalhourswithmanyfamiliesofvariouscharacteristics,coupledwithintensivesupervisionandclinicalcasediscussion.Asaresult,eachphaseinvolvesclinicallyrichandsuccessfulinterventionsthatareorganizedinacoherentmannerandallowclinicianstomaintainfocusinthecontextofconsiderablefamilyandindividualdisruption.Thephasesconsistof:
1. Phase 1: Engagement and Motivation.Duringtheseinitialphases,FFTappliesreattribution(e.g.,reframing)andrelatedtechniquestoimpactmaladaptiveperceptions,beliefs,andemotions.Thisproducesincreasinghopeandexpectationofchange,decreasingresistance,increasingallianceandtrust,reducingtheoppressivenegativitywithinfamilyandbetweenfamilyandcommunity,andincreasingrespectforindividualdifferencesandvalues.
2. Phase 2: Behavior Change.Thisphaseappliesindividualizedanddevelopmentallyappropriatetechniquessuchascommunicationtraining,specifictasksandtechnicalaids,basicparentingskills,andcontractingandresponse-costtechniques.
3. Phase 3: Generalization.Inthisphase,FamilyCaseManagementisguidedbyindividualizedfamilyfunctionalneeds,theirinteractionwithenvironmentalconstraintsandresources,andthealliancewiththetherapist.
Eachofthesephasesinvolvesbothassessmentandinterventioncomponents.Familyassessmentfocusesoncharacteristicsoftheindividualfamilymembers,familyrelationaldynamics,andthemultisystemiccontextinwhichthefamilyoperates.Thefamilyrelationalsystemisdescribedinregardtointerpersonalfunctionsandtheirimpactonpromotingandmaintainingproblembehavior.Interventionisdirectedataccomplishingthegoalsoftherelevanttreatmentphase.Forexample,intheengagementandmotivationphase,assessmentisfocusedondeterminingthedegreetowhichthefamilyoritsmembersarenegativeandblaming.Thecorrespondinginterventionwouldtargetthereductionofnegativityandblaming.Inbehaviorchange,assessmentwouldfocusontargetingtheskillsnecessaryformoreadaptivefamilyfunctioning.Interventionwouldbeaimedathelpingthefamilydevelopthoseskillsinawaythatmatchedtheirrelationalpatterns.Ingeneralization,theassessmentfocusesonthedegreetowhichthefamilycanapplythenewbehaviorinbroadercontexts.Interventionswouldfocusonhelpinggeneralizethefamilybehaviorchangeintosuchcontexts.
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Asaclinicalmodel,FFThasbeenconductedinvariedclinicalsettingsandasahome-basedmodel.ThefidelityoftheFFTmodelisachievedbyaspecifictrainingmodelandasophisticatedclientassessment,tracking,andmonitoringsystemthatprovidesforspecificclinicalassessmentandoutcomeaccountability(FFT-CSS).TheFFTPracticeResearchNetwork(FFT-PRN)allowsclinicalsitestoparticipateinthedevelopmentanddisseminationofFFTmodelinformation.
EvidenceofProgramEffectivenessTodate,thirteenstudiesinreferencedjournals(plusoneinpreparation)demonstratedramaticandsignificantpositivetreatmenteffects,includingfollow-upperiodsofuptofiveyears.Ratesofoffendingandfostercareorinstitutionalplacementhavebeenreducedatleast25percentandasmuchas60percentincomparisontotherandomlyassignedormatchedalternativetreatments,orbaserates.Onestudyalsodemonstratedapositivethreeyearfollow-upeffectonsiblings.Additionalformalprogramreports(e.g.,countyandfederalfundedprojects)fromcompletedandongoingreplicationsreflectsimilarpositiveoutcomes,andfivecurrentlyfundedtrials(NationalInstituteofDrugAbuse,NationalInstituteofAlcoholAbuseandAlcoholism,GovernmentofSweden)promiseadditionaldataregardinggeneralizationofeffectsforFFTacrossmorecontextsandpopulations.StudieshavealsoidentifiedspecificFFTbasedinterventionsanddirectchangesinfamilyfunctioningwhichrelatetotheoutcomefindings.
OnemajorfactorinthesuccessfulevolutionofFFThasbeenthecontinuous(29year)involvementofitsprogenitorsandmanyofitsco-contributorsinvariousuniversitysettings.Thiscontexthasnotonlymaintainedastandardofscientificscrutiny,buthasalsocontributedtotheconceptualintegrityofthemajorconstructsandtechniques.TheprimeexampleofthisimpactistheextensiveworkonreframinginFFT,informedbyotherwell-developedtheoreticalperspectivessuchasinformationprocessingtheory,socialcognition,andthepsychologyofemotion.Laboratorybasedresearchhasidentifiedspecificcomponentsofthiscriticaltechnique,whichinturnhasledtoappliedresearchoncognitivesetandattributionalprocessesinreferredadolescentfamilies.Further,investigationshaveidentifiedin-sessiontherapistcharacteristicsandfamilyinteractionprocessesrelevanttothephasesofFFTwhicharepredictiveofpositivechange.Mostnotableprocesschangesappeartobeinfamilycommunicationpatterns,andespeciallynegative/blamingcommunicationsand“withholding”typesofsilence.Withrespecttotherapistcharacteristics,processandoutcomedatademonstratethatFFTtherapistsmustbefirstrelationallysensitiveandfocused,thencapableofclearstructuringandteaching,inordertoproducesignificantlyfewerdropoutsduringtreatmentandlowerrecidivism.
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Morerecently,FFThasbeenwidelyadoptedbecauseithasevolvedanincreasinglymulticulturalperspective,andhasaddedeffectivehome-basedintervention.Inthehome-basedClarkCounty,Nevada,YouthandFamilyServicesprogram,forexample,referredadolescentsareroughly30percentAfricanAmerican,20percentHispanic/Latino(mostlyMexicanAmerican),andjustunder50percentEuropeanAmericanwithafewAmericanIndianandAsianAmericanyouth.PreliminarydataonthefirstyearofFFTinvolvementindicatenodifferenceinreoffendingrateamongthedifferentethnic/racialgroups,supportingthegeneralizabilityofFFTeffectsacrosscultural/racialgroups.TheFayetteville,NorthCarolina,programhasinvolvedprimarilyWhiteandAfricanAmericanfamiliesandtherapists,includingasignificantnumberofmixedracerelationshipsandoffspring.ThetwoclinicaltrialsbeingconductedinNewMexicoinvolveHispanic/LatinoandWhiteyouth,andthehome-basedprograminurbanWillowRun,Michigan,involvesalargeproportionofAfricanAmericanandmixedfamilies.(Seereplicationinformationinlatersectionsformoredetails.)Asthemodelhasbeenincreasinglyadoptedinmulticulturalcontexts,focusisbeingplacedonissuesofcultureandethnicity,withmuchofthisrecentworkundertakeninthecontextofthemulti-siteNationalInstituteofDrugAbuse(NIDA)fundedCenterforResearchonAdolescentDrugAbuse(CRADA,HowardLiddle,P.I.).
Takentogether,28yearsofdataandclinicalexperiencewithFFTinvolvinghundredsoftherapistsandthousandsoffamilieshaveprovidedstrongempiricalsupportforthisfamily-basedinterventionwithadolescents.Inaddition,theresearchhasdemonstratedthatinterventionmustincludeamajorfocusonchangingemotionalandattributional,especiallyblaming,componentsoffamilyinteraction,thenprovideaprogramofspecificbehaviorchangetechniquesthatareculturallyappropriate,familyappropriate,andconsistentwiththecapabilitiesofeachfamilymember.
Theinformationforthisfactsheetwasexcerptedfrom:
Alexander,J.,Barton,C.,Gordon,D.,Grotpeter,J.,Hansson,K.,Harrison,R.,Mears,S.,Mihalic,S.,Parsons,B.,Pugh,C.,Schulman,S.,Waldron,H.,&Sexton,T.(1998).BlueprintsforViolencePrevention,BookThree:FunctionalFamilyTherapy.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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LIFESKILLSTRAINING(LST)
ProgramSummaryTheresultsofoveradozenstudiesconsistentlyshowthattheLifeSkillsTraining(LST)programdramaticallyreducestobacco,alcohol,andmarijuanause.Thesestudiesfurthershowthattheprogramworkswithadiverserangeofadolescents,producesresultsthatarelong-lasting,andiseffectivewhentaughtbyteachers,peerleaders,orhealthprofessionals.
ProgramTargetsLSTisaprimaryinterventionthattargetsallmiddle/juniorhighschoolstudents(initialinterventioningrades6or7,dependingontheschoolstructure,withboostersessionsinthetwosubsequentyears).
ProgramContentLSTisathree-yearinterventiondesignedtopreventorreducegatewaydruguse(i.e.,tobacco,alcohol,andmarijuana),primarilyimplementedinschoolclassroomsbyschoolteachers.Theprogramisdeliveredin15sessionsinyearone,10sessionsinyeartwo,and5sessionsinyearthree.Sessions,whichlastanaverageof45minutes,canbedeliveredonceaweekorasanintensivemini-course.Theprogramconsistsofthreemajorcomponentswhichteachstudents(1)generalself-managementskills,(2)socialskills,and(3)informationandskillsspecificallyrelatedtodruguse.Skillsaretaughtusingtrainingtechniquessuchasinstruction,demonstration,feedback,reinforcement,andpractice.
ProgramOutcomesUsingoutcomesaveragedacrossmorethanadozenstudiesconductedwithLST,ithasbeenfoundto:
■ Cuttobacco,alcohol,andmarijuanause50%-75%.
Long-termfollow-upresultsobservedsixyearsfollowingtheinterventionshowthatLST:
■ Cutspolydruguseupto66%;■ Reducespack-a-daysmokingby25%;and■ Decreasesuseofinhalants,narcotics,andhallucinogens.
ProgramCostsLSTcanbeimplementedatacostofapproximately$7perstudentperyear(curriculummaterialsaveragedoverthethree-yearperiod).Thisdoesnotincludethecostoftrainingwhichisaminimumof$2,000perdayforoneortwodays.
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ProgramBackgroundTheLifeSkillsTraining(LST)programwasdevelopedtoaddressthemonumentalproblemofsubstanceabuseinthiscountry.Theadversehealth,social,andlegalconsequencesofthisproblemhavebeenwelldocumented.Cigarettesmokingisarisk-factorforheartdisease,variouscancers,andchronicobstructivelungdiseaseandaccountsforover430,000deathsperyear.Alcoholisnotonlyrelatedtochronicdiseasessuchascirrhosisoftheliver,butisalsoamajorfactorinautofatalitiesandhomicides.Beyondthis,adolescentdrugusepredictsanumberofotherundesirableoutcomessuchasreducingtraditionaleducationalaccomplishmentsandjobstability,increasingthelikelihoodofmarryingandhavingchildrenatyoungerages,andincreasingthelikelihoodofengagingincriminalbehavior.
Despiteconsiderablepublicattentionandtheexpenditureofwelloverabilliondollarsinthepastfewyearsalone,littleifanyprogresshasbeenmadetowardreducingdrugabuse.Atpresent,druguseamongAmericanyouthisaproblemofenormousproportionsanditisgettingworse.Since1991,accordingtonationalsurveys,drugusehasincreasedbymorethan30percentleadingsomeexpertstobelievethatweareonthevergeofanewdrugepidemic.Figure1illustratesthistrendinannualprevalence(proportionofusers)ofillicitdrugusefortwelfthgradestudentssince1975.Accordingtothemostrecentnationalsurveydata,thefollowingproportionsofhighschoolstudentshaveusedalcohol,cigarettes,andillicitdrugsatleastonce(Johnston,O’Malley&Bachman,1995):
Alcohol Cigarettes Illicit Drugs8thGraders 56% 46% 26%
10thGraders 71% 57% 37%
12thGraders 80% 62% 46%
Resultsfromthesamesurveyindicatedthatduringthepast30days,thefollowingproportionsofhighschoolstudentsusedthefollowingsubstancesoneormoretimes:
Alcohol Cigarettes Illicit Drugs8thGraders 26% 19% 11%
10thGraders 39% 25% 19%
12thGraders 50% 31% 22%
Forsomeoftheseteens,usemaybediscontinuedafterabriefperiodofexperimentation.However,formany,initiationofcigarettesmoking,drinking,ordrug-takingmayleadtopatternsofusewhichresultinbothpsychologicalandphysicaldependence.Ingeneral,programsdesignedtohelpindividualsquit
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smoking,drinking,orusingdrugshaveonlybeenmoderatelyeffective.Quitesimply,onceanytypeofsubstanceusehabitisacquireditisextremelydifficulttobreak.Scientificevidencenowsuggeststhatthedevelopmentofeffectivepreventionprogramsmayofferthegreatestpotentialforimpactingthisimportanthealthproblem.
Unfortunately,reviewsofthepreventionresearchliteratureandmeta-analyticstudiesshowthatmanywidelyuseddrugabusepreventionapproachesareineffective.Themostcommonapproachestosubstanceabusepreventionoverthepasttwodecadeshaveinvolvedeitherthepresentationoffactualinformationconcerningthedangersofsubstanceuseorwhathasbeenreferredtoas“affective”education.
Approachesrelyingontheprovisionoffactualinformationarebasedlargelyontheassumptionthatincreasedknowledgeaboutpsychoactivesubstancesandtheiradverseconsequenceswouldbeaneffectivedeterrent.Affectiveeducationapproachesaredesignedtoenrichthepersonalandsocialdevelopmentofstudentsthroughclassdiscussionandexperimentalclassroomactivities.Bothoftheseapproacheshaveproventobelargelyineffectivebecausetheydonotaddressthefactorspromotingtheinitiationandearlystagesofsubstanceuse/abuse.
TheLSTprogramisadrugabusepreventionprogramthatisbasedonanunderstandingofthecausesofsmoking,alcohol,anddruguse/abuse.TheLSTinterventionhasbeendesignedsothatittargetsthepsychosocialfactorsassociatedwiththeonsetofdruginvolvement.Withthisinmind,theprogramimpactsondrug-relatedexpectancies(knowledge,attitudes,andnorms),drug-relatedresistanceskills,andgeneralcompetence(personalself-managementskillsandsocialskills).Increasingprevention-relateddrugknowledgeandresistanceskillscanprovideadolescentswiththeinformationandskillsneededtodevelopanti-drugattitudesandnorms,aswellastoresistpeerandmediapressuretousedrugs.Teachingeffectiveself-managementskillsandsocialskills(improvingpersonalandsocialcompetence)offersthepotentialofproducinganimpactonasetofpsychologicalfactorsassociatedwithdecreaseddrugabuserisk(byreducingintrapersonalmotivationstousedrugsandbyreducingvulnerabilitytopro-drugsocialinfluences).
TheoreticalRationale/ConceptualFrameworkManytheorieshavebeenadvancedtoexplaindrugabuse.Themostprominentamongthesefocusonsociallearning,problembehaviors,self-derogation,persuasivecommunications,peerclusters,andsensation-seeking.However,theetiologyofdrugabuseinvolvesadynamicprocesswhichunfoldsovermanyyears.
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Acommonlimitationofmosttheoreticalmodelsisthattheyareessentiallysnap-shotsoftheetiologyofdrugabuseanddonotadequatelycapturethecomplexityoftheproblem.
Wenowknowthattheinitiationofdruguseistheresultofthecomplexcombinationofmanydiversefactors.Thereisnosinglepathwayorsinglevariablewhichservesasanecessaryandsufficientconditionforthedevelopmentofeitherdruguseordrugabuse.Withthisinmind,theLSTapproachtodrugabusepreventionisbasedonaperson-environmentinteractionistmodelofdrugabuse.Likeothertypesofhumanbehavior,drugabuseisconceptualizedasbeingtheresultofadynamicinteractionofanindividualandhis/herenvironment.Socialinfluencestousedrugs(alongwiththeavailabilityofdrugs)interactwithindividualvulnerability.Someindividualsmaybeinfluencedtousedrugsbythemedia(TVshowsandmoviesglamorizingdruguseorsuggestingthatdruguseisnormalorsociallyacceptableaswellasadvertisingeffortstopromotethesaleofalcoholandtobaccoproducts),byfamilymemberswhousedrugsorconveypro-drugattitudes,and/orbyfriendsandacquaintanceswhousedrugsorholdattitudesandbeliefssupportiveofdruguse.Othersmaybepropelledtowarddruguseoradrug-usingpeergroupbecauseofintrapersonalfactorssuchaslowself-esteem,highanxietyorotherdysphoricfeelings,ortheneedforexcitement.
Sincetherearemultiplepathwaysleadinginitiallytodruguseandlatertodrugabuse,amoreusefulwayofconceptualizingdrugabuseisfromarisk-factorperspectivesimilartothatusedintheepidemiologyofchronicdiseasessuchascancerandheartdisease.Fromthisperspective,thepresenceofspecificriskfactorsislessimportantthantheiraccumulation.Asmoreriskfactorsaccumulatesodoesthelikelihoodthatanindividualwillbecomeadruguserandeventuallyadrugabuser.Thus,thepresenceofmultipleriskfactorsisassociatedwithbothinitialdruguseandtheseverityofdruginvolvement.
Ithasalsobeenwellestablishedthattheprevalenceofdrugusegenerallyincreaseswithageandprogressesinawell-definedsequence.Drugusetypicallybeginswiththeuseofalcoholandtobaccofirst,progressinglatertotheuseofmarijuana,and,forsome,totheuseofstimulants,opiates,hallucinogens,andotherillicitsubstances.Notsurprisingly,thisprogressioncorrespondsexactlytotheprevalenceandavailabilityofthesesubstanceswithalcoholbeingthemostprevalentformofdruguseandthemostwidelyavailable,followedbytobacco(cigarettes)andmarijuana.Becausealcohol,tobacco,andmarijuanaareamongthefirstsubstancesused,theyhavebeenreferredtoas“gateway”substances.Theuseofthese“gateway”substancessignificantlyincreasestheriskofusingillicitdrugsotherthanmarijuana.
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Takingthisintoaccount,theLSTpreventionprogramtargetsthose“gateway”substances(tobacco,alcohol,andmarijuana)thatoccuratthebeginningofthedevelopmentalprogression.Thus,LSToffersthepotentialforinterruptingthenormaldevelopmentalprogressionfromuseofthesesubstancestootherformsofdruguse/abuse.Asecondreasonfortargetingthistypeofdruguseisthattheuseofthesesubstancesaccountsforthelargestportionofdrug-relatedannualmortalityandmorbidity.
BriefDescriptionofIntervention
OverviewTheLSTpreventionprogramisathree-yearinterventiondesignedtobeconductedinschoolclassrooms.Basedonthetheoreticalframeworkdiscussedearlier,theLSTprogramwasdevelopedtoimpactondrug-relatedknowledge,attitudesandnorms;teachskillsforresistingsocialinfluencestousedrugs;andpromotethedevelopmentofgeneralpersonalself-managementskillsandsocialskills.Consistentwiththis,theLSTpreventionprogramcanbestbeconceptualizedasconsistingofthreemajorcomponents.Thefirstcomponentisdesignedtoteachstudentsasetofgeneralself-managementskills.Thesecondcomponentfocusesonteachinggeneralsocialskills.Thethirdcomponentincludesinformationandskillsthatarespecificallyrelatedtotheproblemofdrugabuse.Thefirsttwocomponentsaredesignedtoenhanceoverallpersonalcompetenceanddecreaseboththemotivationstousedrugsandvulnerabilitytodrugusesocialinfluences.Theproblem-specificcomponentisdesignedtoprovidestudentswithmaterialrelatingdirectlytodrugabuse(drugresistanceskills,anti-drugattitudes,andanti-drugnorms).AcompletedescriptionofeachLSTcomponentmaybefoundinthesectionlabeled“ProgramasDesignedandImplemented.”
ProgramStructureTheLSTprogramconsistsoffifteenclassperiods(roughly45minuteseach)andisintendedformiddleorjuniorhighschoolstudents,dependinguponthestructureoftheschool.Aboosterinterventionhasalsobeendevelopedwhichconsistsoftenclassperiodsinthesecondyearandfiveclassperiodsinthethirdyear.Thismeansforschooldistrictswithamiddleschoolstructure,theLSTprogramcanbeimplementedwithstudentsinthesixthgrade,followedbyboostersessionsintheseventhandeighthgrades.IftheLSTprogramisimplementedinajuniorhighschoolsetting,studentsreceivetheprogramintheseventhgrade,andtheboostersessionsintheeighthandninthgrade,respectively.TherationaleforimplementingtheLSTprogramatthispointconcernsavarietyoffactorsconcerningthedevelopmentalprogressionofdruguse,normalcognitiveandpsychosocialchangesoccurringatthistime,theincreasingprominenceofthepeergroup,andissuesrelatedtothetransitionfromprimarytosecondaryschool.
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Drugexpertshaveestablishedthatearlyadolescenceisatimeofincreasedriskforexperimentingwithoneormorepsychoactivesubstances.Childrenfirsttypicallyexperimentwithalcoholduringthesixthandseventhgrades.Thegreatestproportionalchangeincigarettesmokingoccursbetweentheseventhandeighthgrades.Correspondingly,thegreatestchangeinmarijuanausetakesplacebetweentheeighthandninthgrades.Adolescenceisalsoatimeofincreasedrelianceonthepeergroup,separationfromparentsastheydevelopasenseofindependenceandautonomy,andchangesinthewayindividualsthink.Forexample,duringthistime,individualsbegintoshiftfromaconcretestyleofthinkingthatincludesaclearsenseofrightandwrongorabsoluterulesofbehaviortoonethatismorerelativeandhypothetical.Thisenablestheadolescenttoacceptdeviationfromestablishedrulesandtorecognizethefrequentlyirrationalandinconsistentnatureofadultbehavior.Inaddition,ithasbeennotedthatthetransitionfromprimarytosecondaryschoolcanbeasourceofstressthatincreasesriskfromproblembehaviorssuchastobacco,alcohol,andillicitdruguse.Finally,thestrongestevidenceconcerningtheeffectivenessofdrugabusepreventionprogramsisbasedonevaluationresearchwithprogramsimplementedwithindividualsduringthisperiod.
Whiletheprogramiseffectivewithjusttheoneyearofprimaryintervention,researchalsohasshownthatpreventioneffectsaregreatlyenhancedwhenboostersessionsareincluded.Forexample,twostudieshaveshownthatoneyearoftheprimaryinterventionofLSTproducedreductionsof56-67percentinsmokingwithoutanyadditionalboostersessions;butforthosestudentsreceivingboostersessions,thesereductionswereashighas87percent.Inaddition,theboostersessionsenhancethedurabilityofpreventioneffects,sothattheydonotdecayasmuchovertime.LSThasbeenshowntobeeffectiveusingavarietyofserviceprovidersincludingoutsidehealthprofessionals,regularclassroomteachers,andpeerleaders.Peercounselorsareoftenslightlyolder(highschool)andalmostalwaysworkinconjunctionwithatrainedadultprovider.
EvidenceofProgramEffectiveness
OverviewConsiderablepreventionresearchhasbeenconductedoverthepasttwentyyears.Despitethebesteffortsofeducators,healthprofessionals,anddrugabusepreventionspecialists,alargenumberofevaluationstudieshavefailedtodemonstratethatthepreventionapproachbeingutilizedwasabletoproduceameasurableimpactondrugusebehavior.Somestudieshavedemonstratedreductionsinattitudestowarddrugsanddruguse.Othershavedemonstratedincreasesinknowledgeaboutdrugsortheconsequencesofusingdrugs.But,effortstodemonstratethatpreventionprogramscouldimpactonactualdrugusehavebeendisappointing.
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ResearchwiththeLifeSkillsTrainingProgramMorethanoneandahalfdecadesofresearchwiththeLSTprogramhaveconsistentlyshownthatparticipationintheprogramcancutdruguseinhalf.Thesereductions(relativetocontrols)inboththeprevalence(i.e.,proportionofpersonsinapopulationwhohavereportedsomeinvolvementinaparticularoffense)andincidence(i.e.,thenumberofoffenseswhichoccurinagivenpopulationduringaspecifiedtimeinterval)ofdrugusehaveprimarilybeenwithrespecttotobacco,alcohol,andmarijuanause.Thesestudieshavedemonstratedthatthispreventionapproachcanproducereductionsindrugusethatarelong-lastingandclinicallymeaningful.Forexample,long-termfollow-updataindicatethatreductionsindruguseproducedwithseventhgraderscanlastuptotheendofhighschool.EvaluationresearchhasdemonstratedthatthispreventionapproachiseffectivewithabroadrangeofstudentsincludingWhite,middle-classyouthandpoorinner-cityminority(AfricanAmericanandHispanic/Latino)youth.Ithasnotonlydemonstratedreductionsintheuseoftobacco,alcohol,ormarijuanauseofupto80percent,butevaluationstudiesshowthatitalsocanreducemoreseriousformsofdruginvolvementsuchastheweeklyuseofmultipledrugsorreductionsintheprevalenceofpack-a-daysmoking,heavydrinking,orepisodesofdrunkenness.
ResultsfromfourpublishedstudiestestingtheLSTprogramshowthatdruguseamongtheLSTstudentswasatleasthalfthatofthecontrolgroup.
TheinformationforthisfactsheetwasexcerptedfromBotvin,G.J.,Mihalic,S.F.,&Grotpeter,J.K.(1998).BlueprintsforViolencePrevention,BookFive:LifeSkillsTraining.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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FAMILYNURSEPARTNERSHIPS(NURSE-FAMILYPARTNERSHIPSINTHEUSA)
ProgramSummaryFamilyNursePartnershipsorNurse-FamilyPartnershipsintheUSA(FormerlyPrenatalandInfancyHomeVisitationbyNurses),guidedbyastrongtheoreticalorientation,consistsofintensiveandcomprehensivehomevisitationbynursesduringawoman’spregnancyandthefirsttwoyearsafterbirthofthewoman’sfirstchild.Whiletheprimarymodeofservicedeliveryishomevisitation,theprogramdependsuponavarietyofotherhealthandhumanservicesinordertoachieveitspositiveeffects.Theprogramisdesignedtoservelow-income,at-riskpregnantwomenbearingtheirfirstchild.
ProgramContentNursehomevisitorsworkwithfamiliesintheirhomesduringpregnancyandthefirsttwoyearsofthechild’slife.Theprogramisdesignedtohelpwomenimprovetheirprenatalhealthandtheoutcomesofpregnancy;improvethecareprovidedtoinfantsandtoddlersinanefforttoimprovethechildren’shealthanddevelopment;andimprovewomen’sownpersonaldevelopment,givingparticularattentiontotheplanningoffuturepregnancies,women’seducationalachievement,andparents’participationintheworkforce.Typically,anursevisitorisassignedtoafamilyandworkswiththatfamilythroughthedurationoftheprogram.
ProgramOutcomesThisprogramhasbeentestedwithbothWhiteandAfricanAmericanfamiliesinruralandurbansettings.Nurse-visitedwomenandchildrenfaredbetterthanthoseassignedtocontrolgroupsineachoftheoutcomedomainsestablishedasgoalsfortheprogram.Ina15-yearfollow-upstudyofprimarilyWhitefamiliesinElmira,NewYork,findingsshowedthatlow-incomeandunmarriedwomenandtheirchildrenprovidedanursehomevisitorhad,incontrasttothoseinacomparisongroup:
■ 79%fewerverifiedreportsofchildabuseorneglect;■ 31%fewersubsequentbirths;■ anaverageofovertwoyears’greaterintervalbetweenthebirthoftheirfirst
andsecondchild;■ 30monthslessreceiptofAidtoFamilieswithDependentChildren;■ 44%fewermaternalbehavioralproblemsduetoalcoholanddrugabuse;■ 69%fewermaternalarrests;■ 60%fewerinstancesofrunningawayonthepartofthe15-year-oldchildren;■ 56%fewerarrestsonthepartofthe15-year-oldchildren;and■ 56%fewerdaysofalcoholconsumptiononthepartofthe15-year-oldchildren.
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ProgramCostsThecostoftheprogramwasrecoveredbythefirstchild’sfourthbirthday.Substantialsavingstogovernmentandsocietywerecalculatedoverthechildren’slifetimes.In1997,thetwo-and-a-half-yearprogramwasestimatedtocost$3,200peryearperfamilyduringthestart-upphase(thefirstthreeyearsofprogramoperation)and$2,800perfamilyperyearoncethenursesarecompletelytrainedandworkingatfullcapacity.Actualcostoftheprogramwillvarydependingprimarilyuponthesalariesoflocalcommunity-healthnurses.Communitieshaveusedavarietyoflocal,state,andfederalfundingsourcestosupporttheprogram,includingMedicaid,welfare-reform,maternalandchildhealth,andchildabusepreventiondollars.
ProgramBackgroundManyofthemostpervasive,intractable,andcostlyproblemsfacedbyyoungchildrenandparentsinoursocietytodayareaconsequenceofadversematernalhealth-relatedbehaviors(suchascigarettesmoking,drinking,anddruguse)duringpregnancy,dysfunctionalinfantcaregiving,andstressfulenvironmentalconditionsthatinterferewithparentalandfamilyfunctioning.Theseproblemsincludeinfantmortality,pretermdeliveryandlowbirthweight,childabuseandneglect,childhoodinjuries,youthviolence,closelyspacedpregnancy,andthwartedeconomicself-sufficiencyonthepartofparents.Standardindicesofchildhealthandwell-beingindicatethatmanychildreninoursocietyaresuffering.
■ NineinfantsoutofeverythousandintheUnitedStatesdiebeforetheirfirstbirthday.Asaresultofhighratesoflowbirthweight(lessthan2500gramsor5pounds8ounces),ourinfantmortalityrateisworsethan19othernations,inspiteofdramaticreductionsininfantmortalityinthelasttwodecadesduetoimprovementsinnewbornintensivecare.Lowbirthweightbabieswhosurviveare50percentmorelikelytousespecialeducationservicesoncetheyenterschoolthanarenormalbirthweightcontrols.
■ Over2.5millionchildrenwerereportedasbeingabusedorneglectedin1990,andoneinthreeofthevictimsofphysicalabusewereinfantslessthanoneyearofage.Between1,200and1,500childrendieeachyearasaresultofparentorcaregivermaltreatment.Notonlyismaltreatmentmorallyunacceptable,butthesocialconsequencesaresodevastatingthattheU.S.AdvisoryPanelonChildAbuseandNeglecthascalledchildmaltreatmentanationalemergency.
■ Childhoodinjuriesaretheleadingcauseofdeathamongchildrenagedonetofourteen.
■ Highratesofviolenceamongadolescents,bothasvictimsandperpetrators,threatenthesafetyandwell-beingofourneighborhoods.Amongyoungpeopleaged15-24,homicideisaleadingcauseofdeath,andforAfricanAmericansitisthenumberonecause.
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■ In1992,52percentofthemothersonAFDChadtheirfirstbirthasteens,costingthegovernmentapproximately$12.8billion.Rapidsuccessivepregnancyincreasesthelikelihoodofcontinuedwelfaredependenceandahostofassociatedproblems.
Evidenceindicatesthatasignificantportionoftheseproblemscanbetracedtoparentalbehavior—inparticular,towomen’shealth-relatedbehaviorsduringpregnancy,tothequalityofcarethatparentsprovidetotheirchildren,andtowomen’slifechoiceswithrespecttofamilyplanning,educationalachievement,andworkforceparticipation.WhiletheseproblemscutacrossallsegmentsofU.S.society,theyaremorecommonamongwomenwhobeginchildbearingaspoor,unmarriedadolescents.Low-income,single,adolescentmotherscanhavegoodpregnancyoutcomesandchildrenwhodowell,buttheircapacitytocareforthemselvesandfortheirchildrenisoftencompromisedbyhistoriesofmaltreatmentintheirownchildhood,psychologicalimmaturityordepression,stressfullivingconditions,andinadequatesocialsupport.Theseconditionscontributetothegreaterlikelihoodthatsociallydisadvantagedparentswillabusecigarettesandotherdrugsduringpregnancyandwillfailtoprovideadequatecarefortheirchildren,oftenwithdevastatingresults.
Womenwhosmokecigarettesanduseothersubstancesduringpregnancy,forexample,areatconsiderableriskforbearinglowbirthweightnewborns,andtheirchildrenareatheightenedriskforneurodevelopmentalimpairment.Evensubtledamagetothefetalbraincanunderminechildren’sintellectualfunctioningandcapacityforemotionalandbehavioralregulation.Parents’capacitiestoreadandrespondtotheirinfants’communicativesignalsformthebasisforchildren’ssenseofsecurityandtrustintheworldandtheirbeliefintheircapacitytoinfluencethatworld.Breachesofthattrusthavelong-termconsequences,especiallywhencaregivingdysfunctioniscombinedwithneurodevelopmentalimpairmentonthepartofthechild.
AlongitudinalstudyofalargeDanishsampleofchildrenandtheirfamiliesfoundthatchildrenwhoexperiencedthecombinationofbirthcomplicationsandparentalrejectioninthefirstyearoflifewereatsubstantiallyincreasedriskforviolentcriminalityatage18incomparisontochildrenwhoexperiencedonlybirthcomplicationsorparentalrejectionalone.Whileonly4.5percentofthesampleexperiencedbothbirthcomplicationsandparentalrejection,thatgroupaccountedfor18percentofallviolentcrimesamongthose18yearsofage.Parentalrejectionorbirthtraumabyitselfdidnotincreasetheriskforviolence.Whenriskfactorsaccumulate,theriskforadverseoutcomesincreases,ofteninsynergisticallyviciousways.
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Theproblemslistedhavebeenresistivetogovernmentinterventionoverthepastthirtyyears.However,scientificevidenceisaccumulatingthatitispossibletoimprovetheoutcomesofpregnancy,toimproveparents’abilitiestocarefortheirchildren,andtoreducewelfaredependencewithprogramsofprenatalandearlychildhoodhomevisitation,butitisnoteasy.Ouroptimismstandsincontrasttoearlierresearchonhomevisitation.Theearlierresearchwasdifficulttointerpretbecausetheprogramsstudiedwereoftennotdesignedtoaddresstheneedsofparentsinsensibleandpowerfulways,andtheresearchitselffrequentlylackedscientificrigor.
Theprogramofprenatalandinfancyhomevisitationbynursesdescribedhereisdistinguishedfromotherprogramsbyitsfirmfoundationinepidemiologyandtheory.Theprogramisbaseduponananalysisofproximalrisksfortheparticularoutcomesthatitisdesignedtoaffect(usuallyparentalbehaviorsorconditionsinthehomethatincreasethelikelihoodofadverseoutcomesonthepartofthemotherorchild).Italsoisfoundeduponthreeinterrelatedtheoreticalfoundations—self-efficacy,attachment,andhumanecologytheories.Eachofthesetheoriesaddressesdifferentaspectsofthedevelopmentalsystemthatcontributestoadversematernalandchildoutcomesinvulnerablefamilies.
TheoreticalRationale/ConceptualFrameworkTheprogramhasbeengroundedintheoriesofhumanecology(Bronfenbrenner,1979,1992),self-efficacy(Bandura,1977,1982),andhumanattachment(Bowlby,1969).Theearliestformulationsoftheprogramgavegreatestemphasistohumanecology,butastheprogramhasevolved,ithasbeengroundedmoreexplicitlyintheoriesofself-efficacyandhumanattachment.
TheoriginalformulationofthisprogramwasbasedinlargepartonBronfenbrenner’stheoryofhumanecology.Humanecologytheoryemphasizestheimportanceofsocialcontextsasinfluencesonhumandevelopment.Parents’careoftheirinfants,fromthisperspective,isinfluencedbycharacteristicsoftheirfamilies,socialnetworks,neighborhoods,communities,andcultures,andinterrelationsamongthesestructures.Bronfenbrenner’soriginaltheoreticalframeworkhasbeenelaboratedmorerecently(withgreaterattentiontoindividualinfluences)inhisperson-process-contextmodelofresearchonhumandevelopment.
Thepersonelementsofthemodelarereflectedintheprogramcomponentsthathavetodowithbehavioralandpsychologicalcharacteristicsoftheparentandchild.Intheformulationofthetheoreticalfoundationsoftheprogram,parents,andespeciallymothers,areconsideredbothdevelopingpersonsandtheprimaryfocusofthepreventiveintervention.Particularattentionisfocusedonparents’progressivemasteryoftheirrolesasparentsandasadultsresponsiblefortheirownhealthand
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economicself-sufficiency.Thisprogramemphasizesparentdevelopmentbecauseparents’behaviorconstitutesthemostpowerfulandpotentiallyalterableinfluenceonthedevelopingchild,particularlygivenparents’controlovertheirchildren’sprenatalenvironment,theirface-to-faceinteractionwiththeirchildrenpostnatally,andtheirinfluenceonthefamily’shomeenvironment.
Theconceptofprocessencompassesparents’interactionwiththeirenvironmentaswellastheintrapsychicchangesthatcharacterizetheirmasteryoftheirrolesasparentsandproviders.Threeaspectsofprocessemphasizedhererelatetoindividuals’functioning:(1)programprocesses(e.g.,thewaysinwhichthevisitorsworkwithparentstostrengthenparents’competencies);(2)processesthattakeplacewithinparents(i.e.,theinfluenceoftheirpsychologicalresources—developmentalhistories,mentalhealth,andcopingstyles—onbehavioraladaptation);and(3)parents’interactionwiththeirchildren,otherfamilymembers,friends,andhealthandhumanserviceproviders.Forthesakeofsimplicity,thediscussionoftheseprocesseshasbeenintegratedbelowintotheperson(parent)partofthemodel.
Thefocusonparentselaboratedhereisnotintendedtominimizetherolethatcontextualfactorssuchaseconomicconditions,culturalpatterns,racism,andsexismplayinshapingtheopportunitiesthatparentsareafforded.Mostofthosefeaturesoftheenvironment,however,areoutsideoftheinfluenceofpreventiveinterventionsprovidedthroughhealthandhumanservicesystems.Certaincontexts,nevertheless,areaffectedbyparents’adaptivecompetencies.Itisthesefeaturesoftheenvironmentthatthecurrentprogramattemptstoaffect,primarilybyenhancingparents’socialskills.Theaspectsofcontextthatwearemostconcernedabouthavetodowithinformalandformalsourcesofsupportforthefamily,characteristicsofcommunitiesthatcansupportorunderminethefunctioningoftheprogramandfamilies,theimpactofgoingtoschoolorworkingonfamilylife,aswellasculturalconditionsthatneedtobetakenintoconsiderationinthedesignandconductoftheprogram.
Oneofthecentralhypothesesofecologicaltheoryisthatthecapacityoftheparent-childrelationshiptofunctioneffectivelyasacontextfordevelopmentdependsontheexistenceandnatureofotherrelationshipsthattheparentmayhave.Theparent-childrelationshipisenhancedasacontextfordevelopmenttotheextentthateachoftheseotherrelationshipsinvolvesmutualpositivefeelingsandthattheotherpartiesaresupportiveofthedevelopmentalactivitiescarriedonintheparent-childrelationship.Conversely,thedevelopmentalpotentialoftheparent-childrelationshipisimpairedtotheextentthateachoftheotherrelationshipsinwhichtheparentisinvolvedconsistsofmutualantagonismorinterferencewiththedevelopmentalactivitiescarriedonintheparent-childrelationship.
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LimitationsofHumanEcologyTheory.Comparedtootherdevelopmentaltheories,Bronfenbrenner’sframeworkprovidesamoreextendedandelaboratedconceptionoftheenvironment.Theoriginalformulationofthetheory,however,tendedtotreattheimmediatesettingsinwhichchildrenandfamiliesfindthemselvesasshapedbyculturalandstructuralcharacteristicsofthesociety.Littleconsiderationwasgiventotherolethatadults(inparticularparents)playinselectingandshapingthesettingsinwhichtheyfindthemselves.Whilemanyinvestigatorstodayreasonthatthepersonalcharacteristicsthatinfluenceindividuals’selectionandshapingoftheircontextshavegeneticorigins,wehavechosentodeterminetheextenttowhichandthemeansbywhichhealthychoicesandadaptivebehaviorscanbepromoted.
Consequently,self-efficacyandattachmenttheorieswereintegratedintothemodeltoprovideabroaderconceptionoftheparentsettingrelationship.Theintegrationofthesetheoriesallowsforaconceptualizationofdevelopmentthatencompassestrulyreciprocalrelationshipsinwhichsettings,children,andotheradultsinfluenceparentalbehavior,andinwhichparentssimultaneouslyselectandshapetheirsettingsandinterpersonalrelationships.
Self-EfficacyTheorySelf-efficacytheoryprovidesausefulframeworkforpromotingwomen’shealth-relatedbehaviorduringpregnancy,careoftheirchildren,andpersonaldevelopment.AccordingtoBandura,differencesinmotivation,behavior,andpersistenceineffortstochangeawiderangeofsocialbehaviorsareafunctionofindividuals’beliefsabouttheconnectionbetweentheireffortsandtheirdesiredresults.Accordingtothisview,cognitiveprocessesplayacentralroleintheacquisitionandretentionofnewbehaviorpatterns.Inselfefficacytheory,Banduradistinguishesoutcomeexpectationsfromefficacyexpectations.Outcomeexpectationsareindividuals’estimatesthatagivenbehaviorwillleadtoagivenoutcome.Efficacyexpectationsareindividuals’beliefsthattheycansuccessfullycarryoutthebehaviorrequiredtoproducetheoutcome.Itisefficacyexpectationsthataffectboththeinitiationandpersistenceofcopingbehavior.Individuals’perceptionsofself-efficacycaninfluencetheirchoiceofactivitiesandsettings,andcandeterminehowmuchefforttheywillputforthinthefaceofobstacles.
LimitationsofSelf-EfficacyTheory.Whileself-efficacytheoryprovidespowerfulinsightsintohumanmotivationandbehavior,itislimitedinseveralrespects.Thefirstlimitationisthatitisprimarilyacognitive-behavioraltheory.Itattendstotheemotionallifeofthemotherandotherfamilymembersonlythroughtheimpactofbehavioronwomen’sbeliefsorexpectations,whichinturnaffectemotions.Manypeoplehaveexperiencedmultipleadversitiesintheformofoverlyharshparenting,rejection,orneglectthatoftencontributetoasenseofworthlessness,depression,
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andcynicismaboutrelationships.Self-efficacygivesinadequateattentiontomethodsofhelpingparentscopewiththesefeaturesoftheirpersonalhistoryortheimpactofthoseearlyexperiencesontheircareoftheirchildren.Wehaveaugmentedthetheoreticalunderpinningsoftheprogramregardingthesesocialandemotionalissueswithattachmenttheory(discussedbelow).
Thesecondlimitationisthatself-efficacyattendstoenvironmentalinfluencesinacursoryway.Peoplecangiveupbecausetheydonotbelievethattheycandowhatisrequired,buttheyalsocangiveupbecausetheyexpectthattheireffortswillmeetwithpunitiveness,resistance,orunresponsiveness.WhileBanduraacknowledgesthatadversityandintractableenvironmentalconditionsareimportantfactorsinthedevelopmentofindividuals’senseoffutility,thestructureofthoseenvironmentalforcesisnotthesubjectofBandura’stheory.Inotherwords,individuals’feelingsofhelplessnessandfutilityarenotsimplyintra-psychicphenomena,butareconnectedtoenvironmentalcontextsthatprovidelimitedopportunitiesandthatfailtonurtureindividuals’growthandwell-being.Thestructureofthoseenvironmentalinfluencesistheprimarysubjectofhumanecologytheory,discussedabove.
AttachmentTheoryHistorically,thisprogramowesmuchtoBowlby’stheoryofattachment.Attachmenttheorypositsthathumanbeings(andotherprimates)haveevolvedarepertoireofbehaviorsthatpromoteinteractionbetweencaregiversandtheirinfants(suchascrying,clinging,smiling,signaling),andthatthesebehaviorstendtokeepspecificcaregiversinproximitytodefenselessyoungsters,thuspromotingtheirsurvival,especiallyinemergencies.Humans(aswellasmanyotherspecies)arebiologicallypredisposedtoseekproximitytospecificcaregiversundertimesofstress,illness,orfatigueinordertopromotesurvival.Thisorganisationofbehaviordirectedtowardthecaregiverisattachment.
Inrecentyears,agrowingbodyofevidenceindicatesthatcaregivers’levelsofresponsivitytotheirchildrencanbetracedtocaregivers’ownchildrearinghistoriesandattachment-relatedexperiences.Caregivers’attachment-relatedexperiencesarethoughttobeencodedin“internalworkingmodels”ofselfandothersthatcreatestylesofemotionalcommunicationandrelationshipsthateitherbuffertheindividualintimesofstressorthatleadtomaladaptivepatternsofaffectregulationandcreatefeelingsofworthlessness.Differencesininternalworkingmodels,accordingtoattachmenttheorists,haveenormousimplicationsformothers’capacitiesfordevelopingsensitiveandresponsiverelationships,especiallywiththeirownchildren.
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LimitationsofAttachmentTheoryAttachmenttheoryprovidesarichsetofinsightsintotheoriginsofdysfunctionalcare-givingandpossiblepreventiveinterventionsfocusedonparent-visitorandparent-childrelationships.Itgivesscantattentiontotherolethatindividualdifferencesininfantsmayplayasindependentinfluencesonparentalbehavior,anditprovidesinadequateattentiontoissuesofparentalmotivationforchangeincare-giving.Moreover,itminimizestheimportanceofthecurrentsocialandmaterialenvironmentinwhichthefamilyisfunctioningasinfluencesonparents’capacitiestocarefortheirchildren.Formoresystematictreatmentsoftheseissues,weturnedtoself-efficacyandhumanecologytheories(discussedabove).
SummaryoftheRoleofTheoryandEpidemiologyinProgramDesignTheprogramanditsspecificinterventionstrategieshavebeenbuiltupon:
■ theoriesabouthumandevelopmentandchange,and■ asolidunderstandingoftheriskfactorsforparticularnegativeoutcomesand
howtoreducethoserisksbypromotingadaptivebehavior.
BriefDescriptionofInterventionTheprogramofhomevisitationbeginsduringpregnancyandcontinuesthroughthechild’ssecondbirthday.Eachfamilyisassignedanursewhovisitsfamiliesaboutonceeveryotherweekduringpregnancyandthefirsttwoyearsofthechild’slife.Totheextentpossible,programsshouldkeepthesamenurseassignedtoafamilyfortheentiretimetheyparticipateintheprogram.Programprocessstudieshaveshownthatprogrameffectivenesstendstodeclinewhenfamiliesareservedbymorethanonenurseoverthecourseoftheirparticipation.
Thenursesuseprogramprotocolsthataredesignedtoaccomplishthreeoverridinggoals:(1)theimprovementofpregnancyoutcomes;(2)theimprovementofthechild’shealthanddevelopment;and(3)theimprovementofthemothers’ownpersonaldevelopment.Inthehomevisits,thenursespromotethreeaspectsofmaternalfunctioning:(a)health-relatedbehaviorsduringpregnancyandtheearlyyearsofthechild’slife;(b)thecareparentsprovidetotheirchildren;and(c)parents’familyplanning,educationalachievement,andparticipationintheworkforce.Intheserviceofthesethreegoals,thenurseslinkfamilieswithneededhealthandhumanservicesandinvolveotherfamilymembersandfriendsinthepregnancy,birth,andearlycareofthechild.
Thenursesusedetailedassessments,record-keepingforms,andprotocolstoguidetheirworkwithfamiliesbutadaptthecontentoftheirhomevisitstotheindividualneedsofeachfamily.Theyprovideacomprehensiveeducationalprogramdesignedtopromoteparents’andotherfamilymembers’effectivephysicalandemotional
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careoftheirchildren.Thenursesalsohelpwomenclarifytheirgoalsanddevelopproblem-solvingskillstoenablethemtocopewiththechallengesofcompletingtheireducation,findingwork,andplanningfuturepregnancies.Developingacloseworkingrelationshipwiththemotherandherfamily,thenurseshelpmothersidentifysmallachievableobjectivesthatcanbeaccomplishedbetweenvisitsthat,ifmet,willbuildmothers’confidenceandmotivationtomanagethedemandsofcare-givingandbecomeeconomicallyself-sufficient.
Theprogramfocusesonspecificparentalbehaviorsandmodifiableenvironmentalconditionsthatareassociatedwithadverseoutcomesineachofthedomainsidentifiedasprogramgoals.Theprotocolsandrecordkeepingsystemaredesignedtoreinforcehomevisitors’focusonprogramgoalsandtheoreticalfoundationsoftheprogram.
Thenursesarescheduledtovisitfamiliesonceaweekforthefirstmonthafterregistrationandtheneveryotherweekthroughdelivery.Afterdeliverythenursesarescheduledtovisitonceaweekforthefirstsixweeksofthebaby’slifeandtheneveryotherweekuntilthe21stmonthpostpartum.From21to24monthspostpartum,thenursesvisitonceamonth.Inthesevisits,whichtypicallylastfrom60-90minutes,thenursesworktoachievethegoalsandobjectivesoutlinedabove,employingclinicalinterventionsthataregroundedintheoriesofhumanecology,attachment,andself-efficacy.Itshouldbenoted,however,thatsomemothersareincrisesthatinterferewiththeirconsistentlykeepingscheduledappointments.Althoughthenursesmakeeveryefforttofollowthespecifiedscheduleofvisits,theyareallowedtovisitmorefrequentlywhenfamiliesexhibitcrisesthatwouldwarrantmoreintensivesupport.Inaddition,althoughtherearespecifieddomainsofprogramcontentthataredevelopmentallyorganizedandexpectedtobecoveredduringparticularperiods,familiesexhibitconsiderablevariationintheirexpressedneeds.Thisleadstosubstantialindividualvariationintheamountoftimethatmaybespentonparticularprogramcontentareas.Allofthisleadstovariationintheamountandcontentoftheprogramexperiencedbyanyonefamily.Theprogramneverthelessadherestoacoresetofprogramgoals,content,andmethods.
EvidenceofProgramEffectivenessForlow-incomewomenandtheirchildren,theprogramhasbeensuccessfulin:
■ improvingwomen’sprenatalhealth-relatedbehaviors(especiallyreducingcigarettesmokingandimprovingdiet);
■ reducingpregnancycomplications,suchashypertensivedisordersandkidneyinfections;
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■ reducingharmtochildren,asreflectedinfewercasesofchildabuseandneglectandinjuriestochildrenrevealedintheirmedicalrecords;
■ improvingwomen’sownpersonaldevelopment,indicatedbyreductionsintheratesofsubsequentpregnancy,anincreaseinspacingbetweenfirstandsecondbornchildren,areductioninwelfaredependence,andreductionsinbehavioralproblemsduetosubstanceabuseandincriminalbehavioronthepartofmotherswhowereunmarriedandfromlow-incomehouseholdsatregistrationduringpregnancy;and
■ reducingcriminalandantisocialbehavioronthepartofthe15-yearoldchildrenasindicatedbyfewerarrests,convictions/violationsofprobation,anddaysofconsumingalcohol.
Thecostoftheprogram,fromthestandpointofgovernmentspending,isrecoveredbythetimethechildrenreachfouryearsofage,andthecostsavingstogovernmentandsocietyexceedthecostoftheprogrambyafactorofatleast4:1overthechild’slifetime.
IntheUKFamilyNursePartnershipstendstobedeliveredtoyoungparentse.g.uptoage20oruptoage24.
Theinformationforthisfactsheetwasexcerptedfrom:
Olds,D.,Hill,P.,Mihalic,S.,&O’Brien,R.(1998).BlueprintsforViolencePrevention,BookSeven:PrenatalandInfancyHomeVisitationbyNurses.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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PROMOTINGALTERNATIVETHINKINGSTRATEGIES(PATHS)
ProgramSummaryThePATHS(PromotingAlternativeTHinkingStrategies)Curriculumisacomprehensiveprogramforpromotingemotionalandsocialcompetenciesandreducingaggressionandbehaviorproblemsinelementaryschool-agedchildrenwhilesimultaneouslyenhancingtheeducationalprocessintheclassroom.Thisinnovativecurriculumisdesignedtobeusedbyeducatorsandcounselorsinamulti-year,universalpreventionmodel.Althoughprimarilyfocusedontheschoolandclassroomsettings,informationandactivitiesarealsoincludedforusewithparents.
ProgramTargetsThePATHSCurriculumwasdevelopedforuseintheclassroomsettingwithallelementaryschoolaged-children.PATHShasbeenfield-testedandresearchedwithchildreninregulareducationclassroomsettings,aswellaswithavarietyofspecialneedsstudents(deaf,hearing-impaired,learningdisabled,emotionallydisturbed,mildlymentallydelayed,andgifted).IdeallyitshouldbeinitiatedattheentrancetoschoolingandcontinuethroughGrade5.
ProgramContentThePATHSCurriculum,taughtthreetimesperweekforaminimumof20-30minutesperday,providesteacherswithsystematic,developmentally-basedlessons,materials,andinstructionsforteachingtheirstudentsemotionalliteracy,self-control,socialcompetence,positivepeerrelations,andinterpersonalproblem-solvingskills.Akeyobjectiveofpromotingthesedevelopmentalskillsistopreventorreducebehavioralandemotionalproblems.PATHSlessonsincludeinstructioninidentifyingandlabelingfeelings,expressingfeelings,assessingtheintensityoffeelings,managingfeelings,understandingthedifferencebetweenfeelingsandbehaviors,delayinggratification,controllingimpulses,reducingstress,self-talk,readingandinterpretingsocialcues,understandingtheperspectivesofothers,usingstepsforproblem-solvinganddecision-making,havingapositiveattitudetowardlife,self-awareness,nonverbalcommunicationskills,andverbalcommunicationskills.Teachersreceivetraininginatwo-tothree-dayworkshopandinbi-weeklymeetingswiththecurriculumconsultant.
ProgramOutcomesThePATHSCurriculumhasbeenshowntoimproveprotectivefactorsandreducebehavioralriskfactors.Evaluationshavedemonstratedsignificantimprovementsforprogramyouth(regulareducation,specialneeds,anddeaf)comparedtocontrolyouthinthefollowingareas:
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■ Improvedself-control,■ Improvedunderstandingandrecognitionofemotions,■ Increasedabilitytotoleratefrustration,■ Useofmoreeffectiveconflict-resolutionstrategies,■ Improvedthinkingandplanningskills,■ Decreasedanxiety/depressivesymptoms(teacherreportofspecialneeds
students),■ Decreasedconductproblems(teacherreportofspecialneedsstudents),■ Decreasedsymptomsofsadnessanddepression(childreport–specialneeds),
and■ Decreasedreportofconductproblems,includingaggression(childreport).
ProgramCostsProgramcostsoverathree-yearperiodwouldrangefrom$15/student/yearto$45/student/year.Thehighercostwouldincludehiringanon-sitecoordinator,thelowercostwouldincluderedeployingcurrentstaff.
ProgramBackgroundThePATHS(PromotingAlternativeTHinkingStrategies)Curriculumwasdevelopedtofilltheneedforacomprehensive,developmentally-basedcurriculumintendedtopromotesocialandemotionalcompetenceandpreventorreducebehaviorandemotionalproblems.Fromitsinception,thegoalofPATHSwasfocusedonpreventionthroughthedevelopmentofessentialdevelopmentalskillsinemotionalliteracy,positivepeerrelations,andproblem-solving.TheCurriculum(Kusché&Greenberg,1994)isdesignedtobetaughtbyelementaryschoolteachersfromgradeKthroughgrade5.
Twodecadesofpriorresearchhadindicatedanincreasingemphasisontheneedforuniversal,school-basedcurriculaforthepurposesofbothpromotingemotionalcompetenceanddecreasingriskfactorsrelatedtolatermaladjustment.However,althoughpreviousresearchhassuggestedthatsuchapproachesmightbeespeciallyeffectiveduringtheelementaryschoolyears,mostevaluationshadbeenrestrictedinscopeand/orhadinvolvedprogramswithconsiderablelimitations(e.g.,narrowdevelopmentalfocus,shortduration,andunreliableandinvalidoutcomemeasures).Extensivefocusonteachingemotionalcompetency,understanding,andawarenesswasnotablylacking,andcomprehensiveevaluationsandinclusiveprogramswererare.Theseshortcomingsweresurprising,giventhewiderangeofcurriculautilizedinelementaryeducationthatwereintendedtopromotesocialcompetenceandpreventdisorder.Nevertheless,researchstronglysuggestedthatacomprehensivepreventionprogramintheclassroomsettinghadthepotentialtoprovidemuchneededassistanceforbothnormally-adjustedandbehaviorallyat-riskstudents.
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Inaddition,webelievedthattherapidandcomplexculturalchangesofthepastfewdecades,aswellasthosepredictedfortheforeseeablefuture,madeemotionalandsocialcompetencycrucialrequirementsforadaptiveandsuccessfulfunctioningofchildrenandfortheircontinuingadaptationasadolescentsandadults.Althoughsocialandemotionalcompetencehadneverbeenconsideredanecessarycomponentofeducationinthepast,wefeltthatithadbecomeascriticalforthebasicknowledgerepertoireofallchildrenasreading,writing,andarithmetic.Teachersacknowledgedthattheyhadlittlebackgroundorestablishedstrategiestodealwithemotionalandsocialcompetency,sowefeltthatitwasnecessarytoprovidedetailedlessons,aswellasmaterialsandinstruction.
Aswithmanyofthemorerecentschool-basedpreventiveinterventions,PATHSwasdesignedtobetaughtbyregularclassroomteachers(initiallywithsupportfromprojectstaff)asanintegratedcomponentoftheregularyear-longcurriculum.However,itisimportanttoensurethatchildrengeneralize(i.e.,applytheskillstonewcontexts)theuseofPATHSskillstotheremainderofthedayandtoothercontexts.Thus,generalizationactivitiesandstrategieswereincorporatedtobeusedin(andoutsideof)theclassroomthroughouteachschoolday,andmaterialswereincludedforusewithparents.
Morerecentliteraturereviewshaveindicatedthatsuccessfulprogramshavethefollowingcharacteristics:(a)utilizingaprogramoflongerduration,(b)synthesizinganumberofsuccessfulapproaches,(c)incorporatingadevelopmentalmodel,(d)providinggreaterfocusontheroleofemotionsandemotionaldevelopment,(e)providingincreasedemphasisongeneralizationtechniques,(f)providingongoingtrainingandsupportforimplementation,and(g)utilizingmultiplemeasuresandfollow-upsforassessingprogrameffectiveness.
Allsevenoftheseunder-emphasizedbutcriticalfactorshavebeenincorporatedintothePATHScurriculum.Furthermore,asPATHShasbeenutilizedwithdifferentcohortsandpopulationsoverthepast15years,multiplefield-testswithextensivefeedbackfromteachershasledtoexpansionandimprovementinPATHSovertime.
TheoreticalRationale/ConceptualFrameworkThePATHSprevention-interventionprogramisbasedonfiveconceptualmodels.Thefirst,theABCD(Affective-Behavioral-Cognitive-Dynamic)ModelofDevelopmentfocusesonthepromotionofoptimaldevelopmentalgrowthforeachindividual.Thesecondmodelincorporatesaneco-behavioralsystemsorientationandemphasizesthemannerinwhichtheteacherusesthecurriculummodelandgeneralizestheskillstobuildahealthyclassroomatmosphere(i.e.,onethatsupportsthechildren’suseandinternalizationofthematerialtheyhavebeentaught).Thethirdmodelinvolvesthedomainsofneurobiologyandbrain
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structuralization/organization,whilethefourthparadigminvolvespsychodynamiceducation(derivedfromDevelopmentalPsychodynamicTheory).Finally,thefifthmodelincludespsychologicalissuesrelatedtoemotionalawareness,orasitismorepopularlylabeled,emotionalintelligence.
TheABCDModelTheABCDmodelincorporatesaspectsofdiversetheoriesofhumandevelopmentincludingpsychodynamicdevelopmentaltheory,developmentalsocialcognition,cognitivedevelopmentaltheory,cognitivesocial-learningtheory,andattachmenttheory.TheABCDmodelplacesprimaryimportanceonthedevelopmentalintegrationofaffect(i.e.,emotion,feeling,mood)andemotionlanguage,behavior,andcognitiveunderstandingtopromotesocialandemotionalcompetence.Abasicpremiseisthatachild’scoping,asreflectedinhisorherbehaviorandinternalregulation,isafunctionofemotionalawareness,affective-cognitivecontrol,andsocial-cognitiveunderstanding.ImplicitintheABCDmodelistheideathatduringthematurationalprocess,emotionaldevelopmentprecedesmostformsofcognition.Thatis,youngchildrenexperienceemotionsandreactonanemotionallevellongbeforetheycanverbalizetheirexperiences.Inearlylife,affectivedevelopmentisanimportantprecursorofotherwaysofthinkingandlaterneedstobeintegratedwithcognitiveandlinguisticabilities,whichareslowertodevelop.Table1presentsasummaryofstagesintheABCDModel(SeeGreenberg&Kusché,1993forelaboration).
Duringthefirstthreeyearsoflife,theentirerepertoireofemotionalsignalsdevelops,andthesesignals/displaysaresubsequentlyusedthroughouttherestofanindividual’slifetime.Thus,bythetimechildrenarebeginningtoutilizelanguagefluentlytoexpressinternalstatesofbeing(e.g.,feelingsad,happy,jealous),mostoftheiremotionalresponseshavealreadybecomehabitual.
Bytheendofthepreschoolyears,mostchildrenhavebecomeskilledinbothshowingandinterpretingemotionaldisplays,althoughthereareconsiderableindividualdifferencesinchildren’semotionalprofiles.Thechildalsobeginstodemonstrateaffectiveperspective-takingskills(i.e.,theabilitytodifferentiatetheemotions,needs,anddesiresofdifferentpeopleinaparticularcontext).Thepreschoolergraduallyfindsnewwaystocopewithunpleasantemotionsanddiscoversthatinternallyexperiencedaffectscanbedirectlysharedwithothersthroughverbalmeans.Furthermore,thechildbeginstoregulateinternalaffectivestatesthroughverbalself-regulation,acriticaldevelopmentalachievement.Anexampleofthisabilityiswhenapreschoolerisabletotellsomeoneheisangryinsteadofshowingaggressiontowardsapeerorobject.
Betweentheagesof5and7,childrenundergoamajordevelopmental
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transformationthatgenerallyincludesincreasesincognitiveprocessingskills,aswellaschangesinbrainsizeandfunction.Thistransitionandtheaccompanyingalterationsallowchildrentoundertakemajorchangesinresponsibilities,independence,andsocialroles.
Duringtheelementaryschoolyears,furtherdevelopmentalintegrationsoccurbetweenaffect,behavior,andcognition/language.Thisintegrationisofcrucialimportanceinachievingsociallycompetentactionandhealthypeerrelations.Forexample,intheearlyelementaryyearswhenachildhasbeenrebuffedwhenattemptingtoenteragamewithpeers,shemightwalkaway,calmdown,assesshowbothsheandtheotherkidsfeel,andthinkofanotherstrategytoenterthegame,orthinkofsomethingelsetodoorsomeoneelsewithwhomshecanplay.
Althoughresearchhasdemonstratedthelinkagebetweendeficitsinemotionaldevelopmentandpsychopathology,surprisinglylittleattentionhasbeenpaidtothecrucialroleofemotionaldevelopmentinmodelsofpreventiveintervention.Takingthisfactorintoaccount,thePATHSCurriculummodelsynthesizesthedomainsofself-control,emotionalawarenessandunderstanding,andsocialproblem-solvingtoincreasesocialandemotionalcompetence.
Table 1 ABCDModel(Affective-Behavioral-Cognitive-Developmental)
StagesofDevelopmentalIntegration
1.Infancy(Birthto18months)
Emotion=CommunicationArousalandDesire=Behavior
2.Toddlerhood(18monthsto36months)
LanguageSupplementsEmotion=CommunicationVeryInitialDevelopmentofEmotionalLabelingArousalandDesire=Behavior
3.PreschoolYears(3to6years)
LanguageDevelopsPowerfulRoleinCommunicationChildcanRecognize/LabelBasicEmotionsArousalandDesire>SymbolicMediation>BehaviorDevelopmentofRole-takingAbilitiesBeginningofReflectiveSocialPlanningProblem-Solving(GenerationofAlternativePlansforBehavior)
4.SchoolYears(6to12-13years)
ThinkinginLanguagehasbecomeHabitualIncreasingAbilitytoReflectonandPlanSequencesofActionDevelopingAbilitytoConsiderMultipleConsequencesofActionIncreasingAbilitytoTakeMultiplePerspectivesonaSituation
5.Adolescence UtilizeLanguageintheServiceofHypotheticalThoughtAbilitytoSimultaneouslyConsiderMultiplePerspectives
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TheEco-BehavioralSystemsModelThesecondconceptualmodelincorporatesaneco-behavioralsystemsorientationandexamineslearningprimarilyatthelevelofsystemschange.School-basedprogramsthatfocusindependentlyonthechildorenvironmentarenotaseffectiveasthosethatsimultaneouslyeducatethechildandinstillpositivechangesintheenvironment.Trainingprogramsmayappropriatelybeconsideredperson-centeredwhenskillsaretaughtintheabsenceofcreatingenvironmentalsupportsforcontinuedskillapplicationindailyinteractions.Incontrast,ecologicallyorientedprogramsemphasizenotonlytheteachingofskills,butalsothecreationofmeaningfulreal-lifeopportunitiestouseskillsandtheestablishmentofstructurestoprovidereinforcementforeffectiveskillapplication.Thus,althoughacentralgoalofPATHSistopromotethedevelopmentalskillsofeachchildbyprovidinglearningthatintegratesaffect,cognition,andbehavior,acriticalingredientforsuccessisthedevelopmentofahealthyclassroomandschoolenvironment.
Fromthisperspective,thesuccessofskillstrainingprogramsmaydependlargelyontheirattentiontoencouragingandsupportingsocializationpatternsandsupportsintheinterventionsetting.Forexample,ecologicallyorientedproblem-solvingprogramstrytointroduceacommonsocialinformationprocessingframeworkthatchildrenandteacherscanusetocommunicatemoreeffectivelyaboutproblemsituations.Inotherwords,theytrytochangenotonlythechild’sbehavior,butalsotheteacher’sbehavior,therelationshipbetweentheteacherandchild,andclassroomandschool-levelresourcesandprocedurestosupportadaptiveproblem-solvingefforts,assumingthattheinteractionsaredysfunctionalorineffective.
Thegeneralizationprocedures,extensiveteachertraining,andfocusonsomelevelofparentparticipationusedinPATHShavethegoalofcombiningclassroominstructionwitheffortstocreateenvironmentalsupportandreinforcementfrompeers,familymembers,schoolpersonnelhealthprofessionals,andotherconcernedcommunitymembers.Further,trainingemphasizesthemannerinwhichtheteacherusesthecurriculummodelandgeneralizestheskillstobuildahealthyclassroomatmosphere(i.e.,onethatsupportsthechildren’suseandinternalizationofthematerialtheyhavebeentaught).
NeurobiologyandBrainStructuralization/OrganizationWhendesigningPATHS,wepaidspecialattentiontodevelopmentalmodelsofbrainorganization.Twoofthemostrelevantconceptsweincorporatedinvolve“vertical”controland“horizontal”communication(Kusché,1984).
“Vertical”controlreferstohigher-orderprocessingandregulationofemotionandactionsbythefrontallobesoverthelimbicsystemandsensory-motorareas.Whenadultsfirstexperienceemotionalinformation,itisrapidlyperceivedandprocessed
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inthelimbicsysteminthemiddlepartofthebrain.Thisinitialinformationisthentransmittedtothefrontallobesintheneocortexforfurtherprocessingandinterpretation,and,subsequently,thefrontallobescantransmitmessagesbacktothelimbicsystemtomodifyemotionsignalsandtothesensory-motorcortextoinfluencepotentialactions.
Forexample,ifyousawacarcomingtowardsyouandyoustartledandjumpedtothesideoftheroad,allofthisrapidprocessingwouldhaveoccurredprimarilyinthelimbicsystemwithoutanytrueconsciousawarenessonyourpart.Afterwards,however,youwouldtakeinandprocessfurtherinformationatacorticallevel(e.g.,thethought,“Thatcaralmosthitme!”;thecolorofthecar;thelicenseplatenumber,etc.).Inadditiontotheinitialfear,youwouldprobablystarttofeelangry,aswellasrelieved,andyoumightdecidetoreporttheincidenttothepolice.
Rapidprimaryprocessingissometimescrucialforsurvival,asinthiscase,butsecondaryprocessinginthefrontalcortexisimportantbecauseitallowsustointegratedatainvolvingemotionswithknowledge-basedinformation,which,inturn,assistswithmakingappropriateplansforfurtheraction.
Earlyindevelopment(i.e.,bythetimeoftoddlerhood),therearefewinterconnectionsbetweenthelimbicsystemandthefrontallobes;thus,duringthe“terrible-twos,”childrenfrequentlyhit,bite,orkick“automatically”whentheyfeelangry.Aschildrenmature,however,increasingneuronalinterconnectionsevolvebetweenthefrontallobesandthelimbicsystem.Thisisespeciallyimportantwithregardtothedevelopmentofselfcontrol,becausethefrontalcortexbecomesincreasinglyabletoregulateimpulsesfromthelimbicareasandmodifypotentialactions.Betweentheagesof5and7,amajorshiftoccursinwhichnetworksinthefrontalareasachievesignificantdominancewithregardtoexertingemotionalself-regulationandbehavioralself-control.
However,thesedevelopmentalmilestonesdonotautomaticallyunfold,butratherareheavilyinfluencedbyenvironmentalinputthroughoutearlychildhood.Moreover,ifthesenetworksdonotdevelopinanoptimalmanner,childrenwillnothavetheneuronalstructurenecessarytocontroltheiractionsinresponsetostrongemotionalsignals.
Thus,inordertopromotethedevelopmentofexecutiveorverticalcontrolwithPATHS,weteachchildrentopracticeconsciousstrategiesforself-control,includingself-talk(i.e.,verbalmediationandtheControlSignalsPoster).Foryoungerchildrenandthosewitheitherdelayedlanguageordifficultiesinbehavioralandemotionalcontrol,weutilizethe“TurtleTechnique,”whichincludesamotor-inhibitingresponseinadditiontoself-talk.
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“Horizontal”communicationreferstoaphenomenonthatresultsfromtheasymmetryofinformationprocessinginthetwohalvesoftheneocortex(theoutermostandevolutionarilynewerpartofthebrain).
Thelefthemisphereisresponsibleforprocessingreceptiveandexpressivelanguageaswellasexpressingpositiveaffect.TherighthemisphereisspecializedforprocessingbothcomfortableanduncomfortablereceptiveaffectanduncomfortableexpressiveaffectinthemajorityofEnglish-speakingadults,theonlyculturalgrouponwhichresearchisavailable(Bryden&Ley,1983).
Nonlinguisticinformation(suchasemotionalsignals)isoftenprocessedwithoutawareness(preconsciousprocessing)unlessweverbally“think”aboutit.Toverballylabelouremotionalexperiences,andthusbecomeconsciouslyawareofthem,thisinformationmustbetransmittedtothelefthemisphere.However,theleftandrighthemispherescancommunicatewithoneanotheronlyviathecorpuscallosum,a“bridge”thathorizontallyconnectsthetwosidesofthebrain.Therefore,inordertobetrulyawareofouremotionalexperiences,wemustutilizeboththerightandlefthemispheres.Thelanguageareasontheleftsideofthebraincanalsomodifyandinfluenceaffectiveprocessingintheright(Davidson,1998;Sutton&Davidson,1997).
Aninterestingsituationoccursif,forsomereason,emotioninformationdoesnotreachthelefthemisphere(e.g.,anadequateneuralnetworkhasneverdevelopedorinterconnectionsareblockedfromintercommunication).Whenthisoccurs,anindividualwillexperienceemotion,butwillnotbeawareofhavingdoneso.Thus,otherpeoplecanbeawareofhowthepersonfeels(i.e.,byobservingfacialcues),buttheindividualwillnotbeawareofhavingexperiencedthefeelings.Afrequentillustrationofthisphenomenonoccurswhenateacherobservesachildwhoisclearlyfeelingangry,butthatchildtrulyhasnoconsciousawarenessofsuchanemotion(“Iamnotangry;Ifeelfine”).
Developmentofthecorpuscallosumisrelativelyslow,sothatitisonlywithmaturationthatoptimumhemisphericcommunicationispossible.Aswithverticalneuralnetworks,thewayinwhichinterhemisphericcommunicationoccursdependsheavilyonenvironmentalinputduringdevelopment.
Basedonthistheoryof“horizontal”communicationandcontrol,wehypothesizedthatverbalidentificationandlabeling,especiallyofuncomfortablefeelings,wouldpowerfullyassistwithmanagingthesefeelings,controllingbehavior,andimprovinghemisphericintegration.Thus,westresstheuseofFeelingFacecardsthatincludeboththefacialdrawingofeachaffect(recognitionofwhichismediatedbytherighthemisphere)anditsprintedlabel(whichismediatedbytheleft).In
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addition,wealsoutilizeacolor-codeddifferentiationofcomfortable(yellow)versusuncomfortable(blue)feelings.Inaddition,encouragingchildrentotalkaboutemotionalexperiences(bothatthetimetheyareoccurringandinrecollection)furtherstrengthensneuralintegration.
Insummary,ourknowledgeoftheneurobiologicaldevelopmentofthebrainwasheavilyinfluentialinthedevelopmentofPATHS.Researchstronglysuggeststhatlearningexperiencesinthecontextofmeaningfulrelationshipsduringchildhoodinfluencethedevelopmentofneuralnetworksbetweendifferentareasofthebrain,whichinturnaffectself-controlandemotionalawareness.Thus,weincorporatedstrategiesinPATHStooptimizethenatureandqualityofteacher-childandpeer-peerinteractionsthatarelikelytoimpactbraindevelopmentaswellaslearning(Greenberg&Snell,1997).Optimumdevelopmentofboth“vertical”and“horizontal”communicationandcontrolduringchildhoodshouldpromotebetteradaptationinbothcurrentandlaterlife.
PsychodynamicEducationTheapplicationofpsychoanalytictheorytotheeducationofchildrenhasonlyrecentlyreceivedsignificantattention.Psychodynamiceducationisintendedtoenhancedevelopmentalgrowth,promotementalhealth,andpreventemotionaldistress,butitisnottreatment.Inthisregard,teachersarenottherapistsandarenotexpectedtoactassuch.However,teachersarepowerfulrolemodels(individualswithwhomchildrencanidentifyinapositivemanner),andtheinformationtheyimpartisoftengiventhestatusofabsolutetruth(i.e.,omniscience),especiallyduringtheelementaryschool-ageyears.Whenteachersexpressaninterestinchildren’sfeelingsandemotionalexperiencesorshowrespectforchildren’sopinions,theirstudentsareimpactedinaprofoundmanner.Astheteacher-studentrelationshipsgrowincreasinglymorepositiveandenriched,learningisenhanced.
Psychodynamiceducationisderivedfromadevelopmentaltheoryandaimstocoordinatesocial,emotional,andcognitivegrowth.Teachersareencouragedtoutilizeactualclassroomexperiencesandusechildren’screative,imaginalprocesses.Studentscanthendevelopahealthysenseofself-esteemfromobservingthepositivereactionsofotherstowardsthem,notbecausetheyhavebeenencouragedtoparrotsimplisticaffirmations.Further,teachersplayacrucialrolebyprovidingclarificationsandexplanationsofemotionsandsituations.Animportantwayinwhichpsychodynamiceducationdiffersfromothermodelsisitsemphasisoninternalization,theprocessofhealthydevelopmentofconscience,or“takingownership”andself-responsibilityforone’sactions.
Bypromotingthedevelopmentofinternalself-controlandself-motivationalongwithhealthystandardsforbehavior,childrendevelopanoptimalsenseofautonomy
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anddecision-makingwhilealsoconsideringtheneedsandfeelingsofothers.Forexample,studentscontemplateanddiscusstheconsequencesofhavinggoodvs.badmannersandevaluatewhygoodmannersareimportant(e.g.,thewayweactaffectshowotherpeoplefeel),ratherthansimplybeingtaughtalistofgoodmannersthattheyaresupposedtouse.Inthisway,thechildrencometo“own”theconceptsasbelongingtothemselves(i.e.,theyinternalizethem);asaresult,theyvoluntarilychoosetousegoodmannersbecausetheybelieveitistherightthingtodo.
Insummary,someofthelong-rangegoalsofpsychodynamiceducationareforeachchildtodevelopakindbutfairsenseofprosocialbehavioralcontrol,positivesenseofself,respectforselfandothers,healthyinternalmotivation,curiosityandloveforlearning,andsoonthatoperateindependentlyoftheexternalenvironment.Thesefactorsenhancedevelopmentalgrowth,improveschoolfunctioning,andoptimizementalhealth,whilepreventingantisocialtendencies,violentbehavior,andsubstanceabuse.
PsychologicalIssuesRelatedtotheCrucialRoleofEmotionalAwarenessResearchsuggeststhataschildrendevelopmorecomplexandaccurateplansandstrategiesregardingemotions,theseplanshaveamajorinfluenceontheirsocialbehavior.Forexample,theabilitytothinkthroughproblemsituationsandtoanticipatetheiroccurrenceiscriticalforsociallycompetentbehavior.However,these“cold”cognitiveprocessesareunlikelytobeeffectivelyutilizedinrealworldconditions(e.g.,whenbeingteased)unlessthechildcanbothaccuratelyprocesstheemotionalcontentofthesituationandeffectivelyregulatehisorheremotionalarousalsothatheandshecanthinkthroughtheproblem.
Similarly,ifchildrenmisidentifytheirownfeelingsorthoseofothers,theyarelikelytogeneratemaladaptivesolutionstoaproblem,regardlessoftheirintellectualcapacities.Inadditiontothesetypesofchallenges,thechild’smotivationtodiscussthesefeelingsandproblem-solveininterpersonalcontextswillalsobegreatlyimpactedbythemodelingandreinforcementofadultsandpeers.
Emotionalawarenessandunderstandingareimplicitinmanymodelsthathavebeendevelopedtopromotesocialcompetence,buthaverarelybeenacentralfocus,eventhoughnumerousstudieshaveassessedsocialproblem-solvingabilityasbothamediatorandoutcomeofintervention.Recently,emotionalcompetencehasbeensubsumedunderanew,morepopularterm,emotionalintelligence(Goleman,1995;Mayer&Salovey,1997),definedastheabilitytorecognizeemotionalresponsesinoneself,otherpeople,andsituations,andusethisknowledgeineffectiveways(e.g.,inmanagingone’sownemotionalresponses,motivatingoneself,andhandlingrelationshipseffectively).“Self-awareness—recognizingafeelingasithappens—isthekeystoneofemotional
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intelligence….[T]heabilitytomonitorfeelingsfrommomenttomomentis[also]crucialtopsychologicalinsightandself-understanding.Aninabilitytonoticeourtruefeelingsleavesusattheirmercy.Peoplewithgreatercertaintyabouttheirfeelingsarebetterpilotsoftheirlives”(Goleman,1995,p.43).Thus,ithasbeenproposedthatemotionalintelligencemaybemoreimportantthancognitiveintelligenceinachievingsuccessandhappinessinlife.
Assuch,acentralfocusofPATHSisencouragingchildrentodiscussfeelings,experiences,opinions,andneedsthatarepersonallymeaningful,andmakingthemfeellistenedto,supported,andrespectedbybothteachersandpeers.Asaresult,theinternalizationoffeelingvalued,caredfor,appreciated,andpartofasocialgroupisfacilitated,which,inturn,motivateschildrentovalue,carefor,andappreciatethemselves,theirenvironment,theirsocialgroups,otherpeople,andtheirworld.
Thisfocuscannotbeemphasizedenough.Althoughallchildrenneedtofeellistenedtoorrespectedbyothers,especiallyadults,manychildrendonothaveanadultrolemodelwhowillsupporttheminthismanner;hence,theydonotlearntorespectthemselvesorothers.Theseaspectsofsocializationmustbetaughttochildren,andtobecometrulysocialized,childrenmustinternalizeandembracethemastheirown,hopefullypriortoreachingadolescence.Itisimportanttorecognize,however,thatthiscannotbeforceduponchildren,butratherisbestachievedthroughnurturanceandrespect.
BriefDescriptionofInterventionThePATHSCurriculumconsistsofanInstructionalManual,sixvolumesoflessons,pictures,photographs,posters,FeelingFaces,andadditionalmaterials.PATHSisdividedintothreemajorunits:(1)theReadinessandSelf-ControlUnit,12lessonsthatfocusonreadinessskillsanddevelopmentofbasicself-control;(2)theFeelingsandRelationshipsUnit,56lessonsthatfocusonteachingemotionalandinterpersonalunderstanding(i.e.,EmotionalIntelligence);and(3)theInterpersonalCognitiveProblem-SolvingUnit,33lessonsthatcoverelevenstepsforformalinterpersonalproblem-solving.TwofurtherareasoffocusinPATHSinvolvebuildingpositiveself-esteemandimprovingpeercommunications/relations.Ratherthanhavingseparateunitsonthesetopics,relevantlessonsareinterspersedthroughouttheotherthreeunits.ThereisalsoaSupplementaryUnitcontaining30lessonswhichreviewandextendPATHSconceptsthatarecoveredinthemajorthreeunits.ThePATHSunitscoverfiveconceptualdomains:
1. self-control,2. emotionalunderstanding,3. positiveselfesteem,
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4. relationships,and5. interpersonalproblemsolvingskills.
Eachofthesedomainshasavarietyofsub-goals,dependingontheparticulardevelopmentallevelandneedsofthechildrenreceivinginstruction.
PATHSisanexpansiveandflexibleprogramthatallowsimplementationofthe131lessonsovera5yearperiod,butitshouldbenotedthatanyparticularlessonisnotnecessarilyequivalenttoonesession;indeed,dependingontheneedsofanyspecificclassroom,onePATHSlessoncanrunfromonetofiveormorePATHSsessions.Picturesandphotographsareincludedforallofthelessons,withsmallergraphicsprovidedinthemarginsofthescriptstomakethecurriculummoreuser-friendly.MostofthematerialsthatareneededareincludedinThePATHSCurriculumkit,butsupplementarymaterialscancertainlybeaddedasdesired.
AseparatevolumeisalsoincludedwithPATHStoserveasanInstructionalManualforteachers.Toencouragegeneralizationtothehomeenvironment,parentlettersandinformationareprovidedperiodicallyinthecurricularlessonsandcanbesenthomebytheteachersasdesired.“Homeactivityassignments”(separateversionsforyoungerandolderstudents)arealsoincludedforchildrentodoathome(e.g.,Askyourmomordadorotheradultaboutatimewhentheyfeltproud)tofurtherinvolveparents(pleaseseeAppendicesEandF).
EvidenceofProgramEffectivenessThreecontrolledstudieswithrandomizedcontrolvs.experimentalgroups(usingoneyearofPATHSimplementationwithpre,post,andfollow-updata)havebeenconductedbythepresentauthors.Thesehaveincludedthreedifferentpopulationsincludingdeaf/hearingimpaired,regulareducation,andspecialeducation-classifiedchildren.
TherobustRCTevaluationofthePATHSprogrammeinCraigavon/Lurganshouldreportin2012.
IncreasingProtectiveFactorsInallthreeclinicaltrials,comparedtomatchedcontrolchildren,theuseofthePATHSCurriculumhassignificantlyincreasedthechildren’sabilityto:■ Recognizeandunderstandemotions■ Understandsocialproblems■ Developeffectivealternativesolutions■ Decreasethepercentageofaggressive/violentsolutions
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Inallthreegroupsofchildren,teachersreportsignificantimprovementsinchildren’sprosocialbehaviorinthefollowingdomains:
■ Self-control■ Emotionalunderstanding■ Abilitytotoleratefrustration■ Useofeffectiveconflict-resolutionstrategies
CognitivetestingindicatesthatPATHSleadstoimprovementsinthefollowingskills:
■ Abilitytoplanaheadtosolvecomplextaskswithnormalandspecialneedschildren(WISC-RBlockDesignandAnalogiesoftheTestofCognitiveAbilities;nottestedintheDeaf/Hearing-Impairedgroup)
■ Cognitiveflexibilityandlowimpulsivitywithnon-verbaltasks(CodingfromtheWISC-R)
■ Improvedreadingachievementforyoungdeafchildren
ReducingMaladaptiveOutcomesTeachersreportthefollowingreductionsinbehavioraldifficultiesatone-yearpostintervention:
■ Decreasedinternalizingsymptoms(sadness,anxiety,andwithdrawal)inspecialneedsclassrooms
■ Decreasedexternalizingsymptoms(aggressiveanddisruptivebehavior)inspecialeducationclassrooms
Students(inregularandspecialneedsclasses)self-reportthefollowingreductionsinbehavioraldifficultiesatone-yearpostintervention:
■ Decreasedsymptomsofsadnessanddepression(ChildDepressionInventory)■ Decreasedreportofconductproblems
InitialFindingfromtheNationalFastTrackDemonstrationProgramTheFT/PATHSCurriculum(arevisedversionofPATHSwhichmaintainsthecriticalcomponentsoftheoriginalcurriculum)isthecentraluniversalpreventioncomponentoftheFastTrackProgram.FastTrackisacomprehensiveprogramwhosegoalsincludethepreventionofaggressionanddelinquencyandthepromotionofsocialandacademiccompetence.TheFastTrackPrograminvolvesalongitudinaldesignandisconductedinfourAmericanlocations(Seattle,Nashville,Durham,andruralPennsylvania).Findingsattheendoffirstgrade(afteroneyearofimplementation)indicatethatinschoolsinwhichPATHSis
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operating,thereisimprovedsocialadaptation(ascomparedtomatchedcontrolschools)asindexedbymorepositivereportsofthefollowingdimensions:
■ Lowerpeeraggressionscoresbasedonpeerratings(Sociometrics)■ Lowerteacherratingsofdisruptivebehavior(Teacherreport)■ Improvedclassroomatmosphere(assessedbyIndependentObservers)
Theinformationforthisfactsheetwasexcerptedfrom:
Greenberg,M.T.,Kusché,C.&Mihalic,S.F.(1998).BlueprintsforViolencePrevention,BookTen:PromotingAlternativeThinkingStrategies(PATHS).Boulder,CO:CenterfortheStudyandPreventionofViolence.
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INCREDIBLEYEARSSERIES(IYS)
ProgramSummaryTheIncredibleYearsSeriesisasetofthreecomprehensive,multi-faceted,anddevelopmentally-basedcurriculumsforparents,teachersandchildrendesignedtopromoteemotionalandsocialcompetenceandtoprevent,reduce,andtreatbehaviorandemotionproblemsinyoungchildren.
ProgramTargetsChildren,agestwototen,atriskforand/orpresentingwithconductproblems(definedashighratesofaggression,defiance,oppositionalandimpulsivebehaviors).Theprogramshavebeenevaluatedas“selected”preventionprogramsforpromotingthesocialadjustmentofhighriskchildreninpreschool(HeadStart)andelementarygrades(uptogradethree)andas“indicated”interventionsforchildrenexhibitingtheearlyonsetofconductproblems.
ProgramContentThisseriesofprogramsaddressesmultipleriskfactorsacrosssettingsknowntoberelatedtothedevelopmentofConductDisordersinchildren.Inallthreetrainingprograms,trainedfacilitatorsusevideotapescenestoencouragegroupdiscussion,problem-solving,andsharingofideas.TheBASICparentseriesis“core”andanecessarycomponentofthepreventionprogramdelivery.Theotherparenttraining,teacher,andchildcomponentsarestronglyrecommendedwithparticularpopulationsthataredetailedinthisdocument.
IncredibleYearsTrainingforParentsTheIncredibleYearsparentingseriesincludesthreeprogramstargetingparentsofhigh-riskchildrenand/orthosedisplayingbehaviorproblems.TheBASICprogramemphasizesparentingskillsknowntopromotechildren’ssocialcompetenceandreducebehaviorproblemssuchas:howtoplaywithchildren,helpingchildrenlearn,effectivepraiseanduseofincentives,effectivelimit-settingandstrategiestohandlemisbehavior.TheADVANCEprogramemphasizesparentinterpersonalskillssuchas:effectivecommunicationskills,angermanagement,problem-solvingbetweenadults,andwaystogiveandgetsupport.TheSUPPORTINGYOURCHILD’SEDUCATIONprogram(knownasSCHOOL)emphasizesparentingapproachesdesignedtopromotechildren’sacademicskillssuchas:readingskills,parentalinvolvementinsettinguppredictablehomeworkroutines,andbuildingcollaborativerelationshipswithteachers.
IncredibleYearsTrainingforTeachersThisseriesemphasizeseffectiveclassroommanagementskillssuchas:theeffectiveuseofteacherattention,praiseandencouragement,useofincentivesfordifficult
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behaviorproblems,proactiveteachingstrategies,howtomanageinappropriateclassroombehaviors,theimportanceofbuildingpositiverelationshipswithstudents,andhowtoteachempathy,socialskillsandproblem-solvingintheclassroom.
IncredibleYearsTrainingforChildrenTheDinosaurCurriculumemphasizestrainingchildreninskillssuchasemotionalliteracy,empathyorperspectivetaking,friendshipskills,angermanagement,interpersonalproblem-solving,schoolrulesandhowtobesuccessfulatschool.Thetreatmentversionisdesignedforuseasa“pullout”treatmentprogramforsmallgroupsofchildrenexhibitingconductproblems.Thepreventionversionisdeliveredtotheentireclassroombyregularteachers,twotothreetimesaweek.
ProgramOutcomesMultiplerandomizedcontrolgroupevaluationsoftheparentingseriesindicatesignificant:
■ Increasesinparentpositiveaffectsuchaspraiseandreduceduseofcriticismandnegativecommands.
■ Increasesinparentuseofeffectivelimit-settingbyreplacingspankingandharshdisciplinewithnon-violentdisciplinetechniquesandincreasedmonitoringofchildren.
■ Reductionsinparentaldepressionandincreasesinparentalself-confidence.■ Increasesinpositivefamilycommunicationandproblem-solving.■ Reducedconductproblemsinchildren’sinteractionswithparentsand
increasesintheirpositiveaffectandcompliancetoparentalcommands.
Multiplerandomizedcontrolgroupevaluationsoftheteachertrainingseriesindicatesignificant:
■ Increasesinteacheruseofpraiseandencouragementandreduceduseofcriticismandharshdiscipline.
■ Increasesinchildren’spositiveaffectandcooperationwithteachers,positiveinteractionswithpeers,schoolreadinessandengagementwithschoolactivities.
■ Reductionsinpeeraggressionintheclassroom.
Multiplerandomizedcontrolgroupevaluationsofthechildtrainingseriesindicatesignificant:
■ Increasesinchildren’sappropriatecognitiveproblem-solvingstrategiesandmoreprosocialconflictmanagementstrategieswithpeers.
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■ Reductionsinconductproblemsathomeandschool.
IndependentreplicationsinEngland,Wales,Norway,Canada,andtheUSconfirmthesefindings.
ProgramCostsThecostsofcurriculummaterials,includingvideoorDVDs,comprehensivemanuals,booksandotherteachingaidsfortheParentTrainingProgramare$1,300fortheBASICprogram,$775fortheADVANCEprogram,$1250fortheSCHOOLprogram;$1,250fortheTeacherTrainingProgram;and$1250fortheChildTrainingProgram.Discountsareavailableforpurchasesofmorethanonesetofanyprogram.Trainingandtechnicalassistancecostsarechargedbasedonadailyfee.
ProgramBackgroundThemissionoftheIncredibleYearsTrainingSeriesistopromotepositive,effective,andresearch-basedparentingandteachingpracticesandstrategieswhichstrengthenyoungchildren’ssocialcompetenceandproblem-solvingstrategiesandreduceaggressionathomeandatschool.Therearethreetypesofinterlockingtrainingcurriculums,whicharetargetedatparents,teachersandchildren(agestwotoeightyears).Initially,inthe1980’s,theBASICparentprogramwasevaluatedandfoundtobeverysuccessfulinpromotingpositiveandlastingimprovementsinparent-childinteractionsandinreducingchildren’sbehaviorproblemsathomeforatleasttwo-thirdsofchildren.However,afollow-upevaluationthreeyearslaterindicatedthatapproximatelyone-thirdofthechildrenwerestillhavingconsiderabledifficultiesatschoolandwithpeergroups.Improvementsathomedidnotnecessarilygeneralizetoschoolsettingsortopeerinteractionsforsomechildren.Inparticular,stressfulfamilysituations(e.g.,maritaldistressandpoverty)wererelatedtopooreroutcomes.Asaresultofthesefindings,twonewcomponentsweredeveloped:(1)theADVANCEparentprogramfocusingoncommunication,angermanagementandproblem-solvingskillsand,(2)thechildprogram(DinaDinosaurCurriculum)designedtotrainchildreninsocialskills,problem-solvingstrategiesandemotionallanguage.Evaluationofthesecomponentsindicatedthattheprogramsenhancedeffectsintermsofpeerrelationships,socialproblem-solvingandmaritalcollaboration.However,itwasstillevidentthataportionofthechildrenandtheirfamilieswerehavingdifficultiesmanagingtheschoolexperienceandworkingsuccessfullywithteachers.Inparticular,about40percentofthechildrenwerefoundtobeco-morbidforotherproblemssuchasAttentionDeficitHyperactivityDisorder,aswellaslanguageandlearningdelays.Theseproblemscreatedparticulardifficultiesforthechildrenintheclassroom,withteachersandwithpeers.Moreover,parentsofthesechildrenwerehavingdifficultyknowinghowtosuccessfullycollaboratewithteachersin
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planningfortheiracademicandsocialneeds.Consequently,forthepastsixyears,ateachertrainingcurriculumhasbeendevelopedandevaluatedforuseinteachingpositiveclassroommanagementskillsandpromotingsocial,emotionalandacademiccompetenciesintheclassroom.Inconjunctionwiththisprogram,theSupportingYouthChild’sEducation(SCHOOL)programforparentswasdevelopedtohelpparentslearnhowtofosteracademiccompetenceathome(e.g.,readingskillsandstudyhabits)andhavesuccessfulconferenceswithteachersatschool.Recentevaluationsoftheseprogramsindicatedsignificanteffectsindecreasingclassroomaggressionandincreasingacademiccompetence.
Thesecurriculumsmaybeusedinschools(e.g.,HeadStart,daycare,andkindergartenthroughgradethree)asearlypreventionprogramsforhigh-riskchildrenandtheirfamiliesandaredesignedtobuildprotectivefactors(e.g.,angermanagement,empathyskills,positivedisciplineandhome-schoolcollaboration)andreduceriskfactors(e.g.,earlysignsofaggressionandpeerrejection)thatresearchhasshowntoberelatedtolaterviolence.Additionally,thesecurriculumsmaybeusedinmentalhealthcentersastreatmentprogramsforchildrendiagnosedwithearly-onsetOppositionalDefiantDisorder(ODD)orConductDisorder(CD)andAttentionDeficitHyperactivityDisorder(ADHD).Thelongrangegoalofthesepreventionprogramsistoenhanceyoungchildren’ssocial,emotional,andacademicdevelopment,aswellaspreventandreduceconductproblemsinordertodecreaseviolence,drugabuse,anddelinquencyinlateryears.
ConductProblemsinYoungChildrenTheincidenceofaggressioninchildrenisescalating—andatyoungerages.Studiesindicatethatanywherefrom7to20percentofpre-schoolandearlyschoolagechildrenmeetthediagnosticcriteriaforOppositionalDefiantDisorder(ODD)andConductDisorder(CD).Theseratesareevenhigherforlow-incomefamilies.ResearchonthetreatmentandpreventionofConductDisordershasbeenidentifiedasoneofthenation’shighestpriorities.Thisagendaisvitallyimportantbecausethewidespreadoccurrenceofdelinquencyandescalatingviolenceinadolescenceresultinahighcosttosociety.“Earlyonset”ODD/CD(intheformofhighratesofoppositionaldefiance,aggressiveandnoncompliantbehaviors)isastabletraitovertimeformanypreschoolchildrenandappearstobethemostimportantbehavioralriskfactorforantisocialbehaviorforboysandgirlsinadolescence.Suchbehaviorhasrepeatedlybeenfoundtopredictthedevelopmentofdrugabuseinadolescence,aswellasotherproblems,includingjuveniledelinquency,depression,violentbehavior,andschooldropout.
Theoriesregardingthecausesofchildconductproblemsincludechildbiologicalanddevelopmentalriskfactors(e.g.,attentiondeficitdisorders,learningdisabilities,andlanguagedelays);familyfactors(e.g.,maritalconflict,depression,
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drugabuse,andcriminalbehavior);ineffectiveparenting(e.g.,harshdisciplineandlowparentalinvolvementinschoolactivities);schoolriskfactors(e.g.,teachers’useofpoorclassroommanagementstrategies,classroomlevelofaggression,largeclasssizesandlowteacherinvolvementwithparents);andpeerandcommunityriskfactors(e.g.,povertyandgangs).
SinceConductDisorderbecomesincreasinglyresistanttochangeovertime,interventionthatbeginsintheearlyschoolyearsisclearlyastrategicwaytopreventorreduceaggressivebehaviorproblemsbeforethey“ripple”toresultinwell-establishednegativereputations,academicfailure,andescalatingviolenceinadolescence.Recentprojectionssuggestthatapproximately70percentofthechildrenwhoneedservicesforconductproblems—inparticular,youngchildren—donotreceivethem.Andveryfewofthosewhodoreceiveinterventioneverreceiveaninterventionwhichhasbeen“empiricallyvalidated.”
HighlightsoftheIncredibleYearsParent,TeacherandChildTrainingSeries
■ Comprehensive(includesintegratedtrainingforparents,teachersandchildren)
■ Proactive,collaborativeapproachbuiltonthe“strengthmodel”■ Flexibleindeliveryusingsequencedmodules(26topicsintotal)■ Culturallysensitive(availableinSpanish,Britishdialect,andNorwegian,as
wellasmulti-ethnicvideotapeactorsandpuppets)■ Appropriateforpreventionprogramsforhigh-riskchildren,aswellasfor
treatmentofchildrenwithconductproblems■ Userfriendly—usesacombinationofbooks,videotapes,extensivefacilitator
manuals,andhomeandschoolactivities■ Developmentallyappropriateforyoungchildren—includespuppets,gamesand
activities■ Providesextensiveprogramsupportfortrainingfacilitators,schoolpersonnel,
andorganizations,includinggroupfacilitatortraining■ Providescertificationforfacilitatorstoassurequalityimplementation■ Evidence-basedandreplicatedbyindependentresearchers
TheoreticalRationale/ConceptualFrameworkThetheoreticalrationaleforthethreecurriculumsforparents,teachers,andchildrenisdescribedbelow.
TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsParentTrainingSeriesParentinginteractionsareclearlythemostwellresearchedandmostimportantproximalcauseofthedevelopmentofconductproblemsinyoungchildren.
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Parentingpracticesassociatedwiththedevelopmentofconductproblemsincludepermissive,inconsistent,irritable,andharshdisciplineandlowmonitoring.DishionandLoeber(1985)andothershavefoundthatparentalmonitoringanddisciplinearelowforadolescentsubstanceabusers;moreover,theseparentalconstructsatagetenpredictedlaterantisocialbehavioranddrugabuse.ThemostinfluentialdevelopmentalmodelfordescribingthefamilydynamicsthatunderlieearlyantisocialbehaviorisPatterson’ssociallearningtheoryregardingthe“coerciveprocess”(Pattersonetal.,1992),apatternwherebychildrenlearntoescapeoravoidparentalcriticismbyescalatingtheirnegativebehaviors.This,inturn,leadstoincreasinglyaversiveparentinteractionsandescalatingdysregulationonthepartofthechild.Thesenegativeparentresponsesdirectlymodelandreinforcethechild’sdeviantbehaviors.
Inadditiontosociallearningtheory,attachmenttheory(Bowlby,1980)andnewmethodsofmeasuringattachmentbeyondthetoddlerhoodperiodhaveemphasizedtheimportanceoftheaffectivenatureoftheparent-childrelationship.Considerableevidenceindicatesthatawarm,positivebondbetweenparentandchildleadstomorepositivecommunicationandpositiveparentingstrategiesandamoresociallycompetentchild,whereashighlevelsofparentalnegativeaffectandhostilityisdisruptivetochildren’sabilitytoregulatetheiremotionalresponsesandmanageconflictappropriately.Forexample,researchhasshownthattherelationshipbetweenharshdisciplineandexternalizingproblemsoccursonlyamongchildreninhomesinwhichawarmchild-parentrelationshipislacking(Deater-Deckard,Dodge,Bates,&Pettit,1996).Likewise,inarecentreviewofresearchonriskandresilience,DollandLyon(1998)concludethatawarmrelationshipwithatleastonecaregiverisastrongprotectivefactoragainstthenegativeinfluencesoffamilydysfunction.Thisfindingissupportedbyresultsofalargenationalstudyofadolescentdevelopmentthatshowedthatyouthwhoreportpositiverelationshipsandbondingwiththeirfamiliesandschoolsengageinlessriskyandfewerantisocialbehaviors(Resnicketal.,1997).
Otherfamilyfactors,suchasdepression,maritalconflict,andhighnegativelifestress,havebeenshowntodisruptparentingskillsandcontributetoparentalhighnegativeaffect,inconsistentparenting,lowmonitoring,emotionalunavailabilityandinsecureattachmentstatus.Familyandparentingriskfactorresearchsuggeststheneedtotrainparentsineffectivechildmanagementskillsandassistthemincopingwithotherfamilystressors.
TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsTeacherTrainingSeriesOncechildrenwithbehaviorproblemsenterschool,negativeacademicandsocialexperiencesmakekeycontributionstothefurtherdevelopmentofconduct
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problems.Aggressive,disruptivechildrenquicklybecomesociallyexcluded,leadingtofeweropportunitiestointeractsociallyandlearnappropriatefriendshipskills.Overtime,peersbecomemistrustfulandrespondtoaggressivechildreninwaysthatincreasethelikelihoodofreactiveaggression.Evidencesuggeststhatpeerrejectioneventuallyleadstothesechildren’sassociationwithdeviantpeers.Oncechildrenhaveformeddeviantpeergroups,theriskfordrugabuseandantisocialbehaviorisevenhigher.
Furthermore,Rutterandcolleagues(1976)findthatteacherbehaviorsandschoolcharacteristicssuchaslowemphasisofteachersonacademicwork,lowratesofpraise,littleemphasisonindividualresponsibility,andhighstudent-teacherratioarerelatedtoclassroomaggressivebehaviors,delinquency,andpooracademicperformance.High-riskchildrenareoftenclusteredinclassroomswithahighdensityofotherhigh-riskstudents,thuspresentingtheteacherwithadditionalmanagementchallenges.Rejectingandnon-supportiveresponsesfromteachersfurtherexacerbatetheproblemsofaggressivechildren.Suchchildrenoftendeveloppoorrelationshipswithteachersandreceivelesssupport,nurturing,andinstructionandmorecriticismintheclassroom.Someevidencesuggeststhatteachersretaliateinamannersimilartoparentsandpeers.WalkerandBuckley(Walker,1995;Walker&Buckley,1973)reportthatantisocialchildrenarelesslikelytoreceiveencouragementfromteachersforappropriatebehaviorandmorelikelytobepunishedfornegativebehaviorthanwell-behavedchildren.Aggressivechildrenarealsofrequentlyexpelledfromclassrooms.Inourownclinicstudieswithconductproblemchildrenagedthreetosevenyears,over50percenthadbeenaskedtoleavethreeormoreschoolsbysecondgrade.Thelackofteachersupportandexclusionfromtheclassroomexacerbatesnotonlythesechildren’ssocialproblems,butalsotheiracademicdifficulties,andalsocontributestothelikelihoodofschooldropout.Finally,recentresearchhasshownthatpoorlymanagedclassroomshavehigherlevelsofclassroomaggressionandrejectionthat,inturn,influencethecontinuingescalationofindividualchildbehaviorproblems.Aspiralingpatternofchildnegativebehaviorandteacherreactivitycanultimatelyleadtoparentdemoralization,withdrawalandalackofconnectionandconsistencybetweenthesocializationactivitiesoftheschoolandhome.Whilemostteacherswanttobeactivepartnersinfacilitatingthebondingprocesswithparents,manylacktheconfidence,skills,ortrainingtoworkcollaborativelywithfamilies.Teachereducationprogramsalsodevotescantattentiontobuildingrelationshipsandpartnershipswithparentsorimplementingsocialandemotionalliteracycurriculums.
Thisliteraturesuggeststhatapreventivemodelneedstopromotehealthybondsor“supportivenetworks”betweenteachersandparentsandchildrenandteachers.Strongfamily-schoolnetworksbenefitchildrenduetoparents’
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increasedexpectations,interestin,andsupportfortheirchild’ssocialandacademicperformance,andcreateaconsistentsocializationprocessacrosshomeandschoolsettings.Thenegativecycledescribedabovecanbepreventedwhenteachersdevelopnurturingrelationshipswithstudents,establishclearclassroomrulesaboutbullying,preventsocialisolationbypeers,andofferacurriculumwhichincludestrainingstudentsinemotionalliteracy,socialskills,andconflictmanagement.Considerableresearchhasdemonstratedthateffectiveclassroommanagementcanreducedisruptivebehaviorandenhancesocialandacademicachievement.Well-trainedteacherscanhelpaggressive,disruptive,anduncooperativechildrendeveloptheappropriatesocialbehaviorthatisaprerequisitefortheirsuccessinschool.Teacherbehaviorsassociatedwithimprovedclassroombehaviorincludethefollowing:highlevelsofpraiseandsocialreinforcement;proactivestrategiessuchaspreparingchildrenfortransitionsandsettingclear,predictableclassroomrules;effectiveuseofshort,clearcommands,warnings,reminders,anddistractions;tangiblereinforcementsystemsforappropriatesocialbehavior;team-basedrewards;mildbutconsistentresponsecostsforaggressiveordisruptivebehaviorincludingTimeOutandlossofprivileges;anddirectinstructioninappropriatesocialandclassroombehavior,problem-solvingandself-managementskills.
TheoreticalRationale/ConceptualFrameworkfortheIncredibleYearsChildTrainingSeriesMoffit(Moffitt,1993;Moffitt&Lynam,1994)andothershavearguedthatsomeabnormalaspectofthechild’sinternalorganizationatthephysiological,neurological,and/orneuropsychologicallevel(whichmaybegeneticallytransmitted)islinkedtothedevelopmentofConductDisorders,particularlyfor“lifecoursepersisters”(i.e.,thosewithachronichistoryofearlybehavioralproblems).
Childrenwithconductproblemshavebeenreportedtohavecertaintemperamentalcharacteristicssuchasinattentiveness,impulsivity,andHyperactivityAttentionDeficitDisorder.Researchersconcernedwiththebiologicalaspectsofthedevelopmentofconductproblemshaveinvestigatedvariablessuchasneurotransmitters,autonomicarousalsystem,skinconductanceandhormonalinfluences,andsomefindingssuggestthatsuchchildrenmayhavelowautonomicreactivity(i.e.,lowphysiologicalresponsetostimuli).OtherchildfactorshavealsobeenimplicatedinchildConductDisorder.Forexample,deficitsinsocial-cognitiveskillscontributetopooremotionalregulationandaggressivepeerinteractions.ResearchhasshownthatchildrenwithODD/CDmaydefineproblemsinhostileways,searchforfewercueswhendetermininganother’sintentionsandfocusmoreonaggressivecues.ChildrenwithODD/CDmayalsodistortsocialcuesduringpeerinteractions,generatefeweralternativesolutionstosocialproblems,and
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anticipatefewerconsequencesforaggression.Thechild’sperceptionofhostileintentinothersmayencouragethechildtoreactaggressively.Researchrevealsthataggressivebehaviorinchildreniscorrelatedwithlowempathyacrossawideagerangewhichmaycontributetoalackofsocialcompetencyandantisocialbehavior.Additionally,studiesindicatethatchildrenwithconductproblemshavesignificantdelaysintheirpeerplayskills;inparticular,difficultywithreciprocalplay,cooperativeskills,turntaking,waiting,andgivingsuggestions.
Finally,reading,learningandlanguagedelaysarealsoimplicatedinchildrenwithconductproblems,particularlyfor“earlylifecoursepersisters”(Moffitt&Lynam,1994).Forthesechildren,lowacademicachievementoftenmanifestsitselfduringtheelementarygradesandcontinuesthroughhighschool.Pooracademicachievementalsopredictsadolescentdrugabuseinbothcross-sectional(Jessor,1987;Newcomer,Maddahian,&Bentler,1986)andlongitudinalsamples(Smith&Fogg,1978).TherelationshipbetweenacademicperformanceandCDisbi-directional.Academicdifficultiesmaycausedisengagement,increasedfrustration,andlowerself-esteem,whichcontributetothechild’sbehaviorproblems.Atthesametime,noncompliance,aggression,elevatedactivitylevels,andpoorattentionlimitachild’sabilitytobeengagedinlearningandachieveacademically.Thus,acycleiscreatedinwhichoneproblemexacerbatestheother.ThiscombinationofacademicdelaysandconductproblemsappearstocontributetothedevelopmentofmoresevereCDandschoolfailure.
Thedataconcerningthepossiblebiological,socio-cognitiveandacademicordevelopmentaldeficitsinchildrenwithconductproblemssuggesttheneedforparentandteachertrainingprogramswhichhelpthemunderstandchildren’sbiologicaldeficits(theirunresponsivenesstoaversivestimuliandheightenedinterestinnovelty)andsupporttheiruseofeffectiveparentingandteachingapproachessothattheycancontinuetobepositiveandprovideconsistentresponses.Thedataregardingautonomicunderarousaltheorysuggeststhatthesechildrenmayrequireoverteaching(i.e.,repeatedlearningtrials)inordertolearntoinhibitundesirablebehaviorsandmanageemotion.Parentsandteacherswillneedtouseconsistent,clear,specificlimit-settingthatutilizessimplelanguageandconcretecuesandreminders.Additionally,thisinformationsuggeststheneedtodirectlyintervenewithchildrenandfocusonsociallearningneedssuchasproblem-solving,perspectivetaking,andplayskillsaswellasliteracyandspecialacademicneeds.
BriefDescriptionofInterventionTheIncredibleYearsSeriesisacomprehensiveprogramforparents,teachers,andchildrenwiththegoalofpreventing,reducing,andtreatingbehavioralandemotionalproblemsinchildrenagestwotoeight.Thecoreoftheprogram
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istheBASICparenttrainingcomponentwhichemphasizesparentingskillssuchasplayingwithchildren;helpingchildrenlearn;usingeffectivepraise,incentives,andlimit-setting;andhandlingmisbehavior.AdditionalparenttrainingcomponentsincludeanADVANCEserieswhichemphasizesparentinterpersonalskillssuchaseffectivecommunication,angermanagement,problem-solvingbetweenadults,andwaystogiveandgetsupport,andaSCHOOLserieswhichfocusesonparentingapproachesdesignedtopromotechildren’sacademicskills.
Tofacilitategeneralizationfromhometotheschoolenvironment,atrainingseriesforteachersprovidingeffectiveclassroommanagementskillswasaddedtotheIncredibleYearsSeries.Thelastadditionwasthetrainingseriesforchildren(DinaDinosaurCurriculum),a“pullout”treatmentprogramforsmallgroupsofchildrenexhibitingconductproblems.Thiscurriculumemphasizesemotionalliteracy,empathyandperspectivetaking,friendshipdevelopment,angermanagement,interpersonalproblem-solving,followingschoolrules,andschoolsuccess.
TheBASICcomponent,whichisthecoreprogram,MUSTbeimplemented,andothercomponentsmaybeaddedaccordingtotheparticularfamilyandchildriskfactors.Abriefdescriptionoftheparent,teacher,andchildprogramsisprovidedbelow.
ParentTrainingProgramsBASIC.TheBASICparenttrainingprogramisguidedbythecognitivesociallearningandattachmentrelationshiptheoriesdescribedabove.Itisa12to14weekprogramforparentsinvolvingfacilitator-ledgroupdiscussionsof250videovignettes.Theprogramteachesparentschild-directedinteractiveplay,empathy,andreinforcementskills,whichhelpparentsachievearealistic,develop-mentallyappropriateunderstandingoftheirchildrenandtheirtemperamentsinordertofosterattachmentandnurturingrelationships.Thelatterhalfoftheprogramfocusesonnonviolentdisciplinetechniques,including“TimeOut”and“Ignore,”logicalandnaturalconsequences,andproblem-solvingstrategies.Finally,theprogramteachesparentsappropriatemonitoringstrategiesandhowtorespondtochildreninclear,predictableways.Theschool-ageversionoftheBASICparenttrainingseries(developedwithamoreculturallydiversepopulation)isdesignedforusewithparentsofchildrenuptoageeight(gradethree).
SCHOOL.TheSupportingYourChild’sEducation(SCHOOL)programwasdesignedtoteachparentstostrengthentheirchild’sreadingandacademicreadinessandpromotestrongconnectionsbetweenhomeandschoolbydevelopingpartnershipswithteachers.
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ADVANCE.TheADVANCEparenttrainingprogramisalsoguidedbycognitivesociallearningtheoryandutilizeseffectiveaspectsofmaritalanddepressiontherapy(Jacobson,Schmaling,&Holtzworth-Monroe,1987).Thisprogramisa10to12weeksupplementtotheBASICprogramandaddressesotherfamilyriskfactorssuchasdepression,maritaldiscord,poorcopingskills,andlackofsupport.Theprogramcontentincludesteachingcognitiveself-controlstrategies,problem-solving,communicationskillsandwaystogiveandgetsupport.Figure1.ParentingPyramid
Allofthetrainingprogramsutilizeacollaborativetrainingprocessofgroupdiscussionguidedbytrainedfacilitators,andprogrammaterialsincludevideotapes,detailedmanualsforfacilitators,parentbooksandaudiotapes,andhomeactivitiesandrefrigeratornotes.
Problem Solving
CooperationSelf Esteem
Attachment
Social Skills
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TeacherTrainingProgramTheteachertrainingprogramincludesasix-day(or42-hour)workshopforteachers,schoolcounselors,andpsychologiststhatinvolvesgroup-basedtrainingtotargeteffectiveclassroommanagementstrategiesfordealingwithmisbehavior;promotingpositiverelationshipswithdifficultstudents;strengtheningsocialskillsintheclassroom,playground,bus,andlunchroom;andteachers’collaborativeprocessandpositivecommunicationwithparents(e.g.,theimportanceofpositivehomephonecalls,regularmeetingswithparents,homevisits,andsuccessfulparentconferences).Forindicatedchildren(i.e.,childrenwithConductDisorder),teachers,parents,andgroupfacilitatorswilljointlydevelop“transitionplans”thatdetailclassroomstrategiesthataresuccessfulwitheachindividualchild;goalsachievedandremaining;characteristics,interests,andmotivatorsforthechild;andpreferredmethodsofcontactingparents.Thisinformationispassedontothefollowingyear’steachers.Figure2.PyramidforBuildingRelationships
Respect
Enjoyment
LoveAcceptanceEmpathy
Coo
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BENEFIT FOR OTHER PERSONSELF
Involvement
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Playing &
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Prespective
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Understanding
Generating
solutions
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New solutions
Gettin
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Politeness
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Additionally,teacherslearnhowtopreventpeerrejectionbyteachingtheaggressivechildappropriateproblem-solvingstrategiesandhelpinghis/herpeersrespondappropriatelytoaggression.Teachersareencouragedtobesensitivetoindividualdevelopmentaldifferences(i.e.,variationinattentionspanandactivitylevel)andbiologicaldeficitsinchildren(e.g.,unresponsivenesstoaversivestimuli,heightenedinterestinnovelty),aswellashowtorespondtothesedifferencesinpositive,acceptingandconsistentways.Physicalaggressioninunstructuredsettings(e.g.,playground)istargetedforclosemonitoring,instructionandincentiveprograms.Figure3.TeachingPyramid
ChildTrainingProgram(DinosaurCurriculum)DinaDinosaur’sSocialSkillsandProblem-SolvingCurriculumwasguidedbychildriskfactorresearchandaimstoenhancechildren’sappropriateclassroombehaviors(e.g.,quiethandupandlisteningtoteacher),promotesocialskillsand
Problem Solving
CooperationSelf Esteem
Social Skills
Thinking Skills
Motivation
Responsibility
PrediciabilityObedience
Dis
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Beh
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BENEFITS FOR CHILDTEACHER SKILLS & STRATEGIES
Praise
Encouragement
Incentives
Celebrations
Clear Limits
Classroom Structures
Non Verbal Cues
Positive Verbal Redirect
Distractions
Re-engagement Strategies
Con
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Talking
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positivepeerinteractions(e.g.,waiting,takingturns,askingtoenteragroupandcomplimenting,etc.),helpchildrendevelopappropriateconflictmanagementstrategies,andreduceconductproblems.Inaddition,theprogramteacheschildrenwaystointegrateintotheclassroomanddeveloppositivefriendships.Thecurriculumisusedasa“pullout”programfortreatingsmallgroupsoffivetosixchildrenwithconductproblems.Thesesmallgroupsessionscanbeofferedtwiceaweekforanhouroronceaweekfortwohours(see“FutureDirections”forhowprogramisusedasaclassroom-basedcurriculum).Finally,thechildprogramisorganizedtodovetailtheparentandteachertrainingprograms.
SummaryEachofthethreetypesoftrainingprogramsdescribedabovetargetsdifferentantecedentsofConductDisorderinthehome,classroom,andschoolsetting,aswellasintheindividualchildandhis/herpeergroup.Eachofthethreesetsofcurriculumshasbeendesignedtobepractical,“userfriendly,”andimplementedbytrainedfacilitatorsincludingschoolpersonnel.Initially,thesefacilitatorswillreceiveextensive,group-basedtrainingtoconducttheclassroomandparentinterventions.Additionally,self-administeredmanualshavebeendevelopedfortheteacherandparenttrainingprogramssothatparticipantscanmake-upmissedsessionsinacost-effectivemanner.
Eachofthethreeinterventionsincludesa500pagemanualoutliningcontent;groupfacilitatorscripts(includingquestionsforgroupdiscussions);homeworkorclassroomactivities;refrigeratorandblackboardnotesoutliningkeypoints;videos;andbooksforchildren,parents,andteachers.
Trainedgroupfacilitatorsusethevideotapedvignettestofacilitatediscussion,problem-solving,andsharingofideasamongteachers.Groupfacilitatorshelpparticipantsdiscussimportantprinciplesandpracticenewskillsthroughrole-playingandclassroomassignments.
EvidenceofProgramEffectiveness
IncredibleYearsParentTrainingStudieswithChildrenDiagnosedwithOppositionalDefiantDisorderand/orConductDisorderOverthepast20years,theBASICprogramhasbeenevaluatedextensivelyasatreatmentprograminaseriesofsixrandomizedstudieswithmorethan800childrenreferredtotheprogramforconductproblems.ThesestudieshaveshownthattheBASICprogramresultsinsignificantlyimprovedparentalattitudesandparent-childinteraction,areductioninparents’useofviolentformsofdiscipline,andreducedchildconductproblems.Effectshavebeensustaineduptothreeyearsafterintervention(Webster-Stratton,1990b).
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TheADVANCEprogramhasbeenshowninarandomizedstudytobeahighlyeffectivetreatmentforpromotingparents’useofeffectiveproblem-solvingandcommunicationskills,reducingmaternaldepression,andincreasingchildren’ssocialandproblem-solvingskills.TheseeffectswereobtainedoverandabovethesignificantchangesobtainedintheBASICprogram(Webster-Stratton,1994).LaterstudiescombiningBASICandADVANCEreplicatedthesefindingsandhaveshowneffectslastinguptoone4year(Webster-Stratton&Hammond,1997).Usershavebeenhighlysatisfiedwithbothprograms,andthedrop-outrateshavebeenlowregardlessofsocioeconomicstatus.
IncredibleYearsParentTrainingStudieswithHigh-riskFamiliesTheBASICprogramwasalsoevaluatedasaselectivepreventionprogramintworandomizedtrialswithover500HeadStartfamiliesrepresentingamulti-ethnic(50percentminority)populationlivinginpovertysituations.Inthefirststudy,resultsindicatedthattheparentingskillsofHeadStartparentswhoreceivedtrainingandthesocialcompetenceoftheirchildrensignificantlyimprovedcomparedwiththecontrolgroupfamilies.Thisdatasupportedthehypothesisthatstrengtheningparentingcompetenceandincreasingtheparentalinvolvementofhigh-riskwelfaremothersinchildren’sschool-relatedactivitieshelpstopreventchildren’sconductproblemsandpromotesocialcompetence(Webster-Stratton,1998b;Webster-Stratton&Reid,1999a).Mostoftheseimprovementsweremaintainedoneyearlater.ThesecondstudyreplicatedthefindingsofthefirststudywithHeadStartparentsandalsoevaluatedaddingasecondyearboosterparentinterventionutilizingabbreviatedcomponentsoftheADVANCEandSCHOOLprograms(Webster-Stratton,Reid&Hammond,inpress).Two-yearfollow-upresultsofthisstudyarecurrentlybeingconducted.
Thesefindingshavebeenindependentlyreplicatedinthreeotherstudieswithfamiliesofchildrenwithconductproblems(Scott,1999;Taylor,Schmidt,Pepler,&Hodgins,1998;Miller,Kamboukos,Klein,&Coard,1999)andinthreepreventiontrialsinlowincomechildcarecenterswithprimarilyAfricanAmericanfamiliesinChicago(Gross,Fogg,&Tucker,1995;Gross,Fogg,Webster-Stratton,&Grady,1999),withSpanish-speakingHeadStartfamiliesinNewYork(Miller&Rojas-Flores,1999),andwithamulti-ethnicgroupofHeadStartparentsinMassachusetts(Arnoldetal.,inprogress).
IncredibleYearsTeacherTrainingStudiesTheteachertrainingprogramwasfirstevaluatedinarandomizedtrialwith133childrendiagnosedwithconductproblems,andanalysescomparedchildtrainingandparenttrainingwithandwithoutteachertraining.Post-treatmentclassroomobservationsofteacherbehaviorconsistentlyfavoredconditionsinwhichteachersreceivedtraining.Trainedteacherswerelesscriticalandlessharshthancontrol
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teachers.Trainedteachersusedmorepraiseandweremorenurturing,lessinconsistent,andreportedmoreconfidenceinteachingthancontrolteachers.Resultsalsoindicatedthatinclassroomswhereteachersweretrained,childrenwereobservedtobesignificantlylessaggressivewithpeersandweremorecooperativewithteachersthanchildreninuntrainedteacherclassrooms.Trainedteachersalsoreportedthatchildrenhadincreasedacademiccompetencecomparedtochildrenincontrolclassrooms(Webster-Stratton&Reid,1999).Nearlyidenticalfindingsemergedinarandomizedtrialwith272HeadStartchildrenwhereinteachersandparentsreceivedthetrainingprogramsandwerecomparedwiththosereceivingregularHeadStartservices.Additionally,inclassroomswhereteachersreceivedtraining,childrenwereobservedtohavehigherschoolreadinessscores(engagementandon-taskbehavior)andincreasedpro-socialbehaviors,aswellassignificantlyreducedpeeraggression.Teachers’reportsofparentbondingandinvolvementinschool,aswellaschildren’ssocialcompetence,werealsosignificantlyhigherfortrainedteachersthanforuntrainedteachers.
ThesefindingshavebeenindependentlyreplicatedbyArnold(inprogress)inarandomizedstudyinvolvingeightdaycarecenters(12interventionand8controlclassrooms).Resultsindicatedthatteachersintheinterventionclassroomsreportedusingmoreeffectiveteachingstrategiesandlesslaxdisciplinethanteachersincontrolclassrooms.Moreover,interventionteachersreportedfeweraggressivebehaviorsthandidteachersincontrolclassrooms.
IncredibleYearsChildTrainingStudies—DinaDinosaurCurriculumTheDinaDinosaurCurriculumforchildrenwasevaluatedintworandomizedtrialswithconduct-disorderedchildrenagesfourtoeight.Thefirstofthesestudiesshowedthatthe20to22weekchildtrainingprogramresultedinsignificantimprovementsinobservationsofpeerinteractions.ChildrenwhohadreceivedtheDinosaurCurriculumweresignificantlymorepositiveintheirsocialskillsandconflictmanagementstrategiesthanchildrenwhoseparentsreceivedparenttrainingonlyorservedasuntreatedcontrols.Resultsshowedthatthecombinedparentandchildtrainingwasmoreeffectivethanparenttrainingaloneandthatbothweresuperiortothecontrolgroup.Oneyearlater,thecombinedparentandchildinterventionshowedthemostsustainedeffects.
Inthesecondstudy,theeffectsofthe20to22weekchildtrainingprogramwerereplicatedintermsofimprovedpeerconflictmanagementskillsincomparisontochildrenwhoonlyreceivedparenttraining(Webster-Stratton&Reid,1999).Whenchildtrainingwascombinedwithteachertraining,therewereimprovedreductionsinaggressivebehaviorintheclassroom.
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SummaryofResultsTheIncredibleYearstrainingprogramshavebeenshowntoaffectthefollowingriskandprotectivefactors:
Parents■ Increasedpositiveandnurturingparentingstyle■ Decreasedharsh,inconsistentandunnecessarydiscipline■ Increasedpraiseandeffectivediscipline■ Decreasedparentalstressanddepression■ Increasedpositiveparentcommandsandproblem-solving■ Increasedparentbondingandinvolvementwithteachers
Teachers■ Increasedproactiveandpositiveclassroommanagementskills■ Decreasedharshandcriticalclassroommanagementstyle■ Increasedpositiveclassroomatmosphere■ Increasedbondingwithparents
Child■ Increasedpositiveconflictmanagementskillsandsocialskillswithpeers■ Decreasednegativebehaviorsandnoncompliancewithparentsathome■ Increasedsocialcompetenceatschool■ Decreasedpeeraggressionanddisruptivebehaviorsintheclassroom■ Increasedacademicengagement,schoolreadinessandcooperationwith
teachers
Thesefindingshavebeenreflectedinteacherandparentratings,childtestingandinterviewing,independentobservationsinthehomeandatschool,andlaboratoryobservationsofpeerinteractionsandinteractionswithparents.
Thisinformationwasexcerptedfrom:
Webster-Stratton,C.,Mihalic,S.,Fagan,A.,Arnold,D.,Taylor,T.,&Tingley,C.(2001).BlueprintsforViolencePrevention,BookEleven:TheIncredibleYears:Parent,TeacherAndChildTrainingSeries.Boulder,CO:CenterfortheStudyandPreventionofViolence.
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TRIPLEP-POSITIVEPARENTINGPROGRAM
ProgramOverviewTheTripleP(PositiveParentingProgram)isacomprehensive,community-widesystemofparentingandfamilysupport.Thefiveinterventionlevelsweredesignedtoenhanceparentalcompetenceandpreventoralterdysfunctionalparentingpractices,therebyreducinganimportantsetoffamilyriskfactorsbothforchildmaltreatmentandforchildren’sbehavioralandemotionalproblems.Atthepopulationlevel,theexistingworkforcecrossingseveraldisciplinesandsettings(suchasfamilyandsocialsupportservices,preschoolandchildcaresettings,elementaryschoolsandothercommunityentitieswithdirectcontactwithfamilies)istrainedtodelivertheTriplePsystemofinterventions.Thisworkforceisthenresponsiblefordeliveringtheprogramtoparents.
ProgramTargetsThecommunity-wideversionofTriplePtargetsparentswithchildrenyoungerthaneightyearsofage,andtheinterventionisdeliveredcommunity-widethroughmultipleproviders.
ProgramContentThemultilevelsystemincludesfiveinterventionlevelsofincreasingintensityandnarrowingpopulationreach:
Universal Triple P (Level 1)usesmediaandinformationalstrategiesthat:■ destigmatizeparentingandfamilysupport■ makeeffectiveparentingstrategiesavailabletoallparents■ facilitatehelpseekingandself-regulation
Selected Triple P (Level 2)normalizesparentinginterventionsthrough:■ briefandflexibleconsultationwithindividualparents■ parentingseminarswithlargegroupsofparents
Primary Care Triple P (Level 3)managesdiscretechildbehaviorproblemsthrough:■ fourbriefconsultationsthatincorporateactiveskillstraining■ selectiveuseofparentingtipsheetsoncommonproblemsofyoungchildren■ generalizationenhancementstrategiestoapplyskillstootherareas
Standard and Group Triple P (Level 4) benefitsindicatedpopulationsofchildrenwithdetectableproblemsby:■ teachingparentsavarietyofchildmanagementskills■ combiningprovisionofinformationwithactiveskillstrainingandsupport
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■ teachingparentstoapplyskillstoabroadrangeoftargetbehaviorsinnumeroussettings
Enhanced Triple P (Level 5)isdirectedatfamilieswithadditionalriskfactorsandincludes:■ optionalmodulesonpartnercommunication,moodmanagementandparent
copingskills■ additionalpracticesessionsaddressingparent-childissues
ProgramOutcomesComparedtocontrolcounties,positiveeffectsintheTriplePSystemcountieswereseenforratesof:■ substantiatedchildmaltreatment■ childout-of-homeplacements■ hospitalizationsoremergency-roomvisitsforchildmaltreatmentinjuries
NoteOnlyTripleP,whenimplementedasatotalsysteminacommunity,isbeingcertifiedbyBlueprints.EvaluationsofindividuallevelsofTriplePimplementedalone,suchastheLevel4Standard,Group,orSelf-Directedformats,havenotmetBlueprintscriteria.
ReferencesPrinz,R.J.,Sanders,M.R.,Shapiro,C.J.,Whitaker,D.J.,andLutzker,J.R.(2009).Population-BasedPreventionofChildMaltreatment:TheU.S.TriplePSystemPopulationTrial.PreventionScience,10,1-12.
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Parent-ChildHome
TheProgramModelTheimportanceofParent-ChildinteractionAllchildren’sfirstyearsshouldbefilledwithverbalstimulationtobuildlanguageandliteracyskills.Eachdayshouldbefullofdiscoveryandofferopportunitiestogainnewskillsandlearnnewconcepts.Fosteringverbalinteractionbetweenparentsandtheiryoungchildrenisacriticalcomponentofhealthyandsuccessfuldevelopment(Bruner,1964and1966;Vygotsky1962).Theimportanceofthisinteractionhasbeenfurthervalidatedbythebrainandlanguagedevelopmentresearch(Hart&Risley).FormativeresearchonTheParent-ChildHomeProgram’s1965pilotproject(thenTheMother-ChildHomeProgram)affirmedthatthiscriticalparent-childinteractioncouldbestrengthenedbymodelingreading,play,andconversationforparentsandchildrenintheirownhomes(LevensteinandSunley1968).
Schoolreadiness:BridgingthepreparationgapAcrossthecountry,millionsofchildrenbeginkindergartenunprepared.Theyare“leftbehind”asearlyasthefirstdayofschool.Thesechildrenhavenotadequatelyexperiencedqualityverbalinteractionorbooks.Theyhavenotbeenexposedtoplayandinteractiveexperiencesthatencourageproblem-solvingandappropriatesocial-emotionaldevelopment.Theydonothavethelanguageskillstheyneedtosuccessfullyinteractwiththeirteachersandtheirclassmates.Theymaynotbeabletocontroltheirbehaviorsoremotionsaswellasotherstudents.Theymayhaveheardmorediscouragementsthanencouragements.Withouttheskillstheyneedtosuccessfullyadjusttotheclassroom,theybegintheiracademiccareersbehindtheirpeers.Manyofthesechildrenwillnevercatchup.
TheParent-ChildHomeProgrambridgesthis“preparationgap”byhelpingfamilieschallengedbypoverty,limitededucation,languageandliteracybarriers,andotherobstaclestoschoolsuccesspreparetheirchildrentoenterschoolreadytobeintheclassroom.
Theapproach:Modelingvs.teachingTheParent-ChildHomeProgramutilizesanon-directive,non-didacticapproach,modelingbehaviorsforparentsthatenhancechildren’sdevelopmentratherthanteachingbehaviors.HomeVisitorshelpparentsrealizetheirroleastheirchildren’sfirstandmostimportantteacher,generatingenthusiasmforlearningandverbalinteractionthroughtheuseofengagingbooksandstimulatingtoys.Parentsarenevergivenhomeworkorassignmentstocompletebutareencouragedtocontinuequalityplayandreadingbetweenvisitswiththebooksandtoystheyreceive
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eachweek.The“lighttouch”employedbyParent-ChildHomeProgramHomeVisitorsisnon-intimidatingandempowersparents,allowingthemtopreparetheirchildrenforschoolsuccess,andtakeprideintheircommitmentto,andimpacton,theirchild’seducation.EveryParent-ChildHomeProgramlocalsiteadherestoacarefullydevelopedandwell-testedmodeltoensurehighqualityservicesandconsistentresults:
Site Structure: ■ EachsiteisrunbyaSiteCoordinatorhiredbythelocalpartneragencyand
trainedbyTheParent-ChildHomeProgram’sNationalCenter.■ TheSiteCoordinatorsarethenpreparedtorecruitandtraintheirlocalHome
Visitors.■ Traininginmulticulturalawarenessandtheethicsofhomevisitingare
importantcomponentsoftheParent-ChildHomeProgram’strainingcurriculumforSiteCoordinatorsandHomeVisitors.Respectandunderstandingarecriticalforsuccessfulhomevisitingrelationships.
■ Familiesparticipateinthetwo-yearprogramwhentheirchildrenaretwo-andthree-years-old,completingtheProgramastheyturnfourandtransitionintopre-kindergartenorHeadStart.Achildcan,however,entertheProgramasyoungas16monthsandsomesitesservefamilieswithchildrenupthroughfour-years-oldiftherearenootherpre-schoolservicesavailableinthecommunity.
Home Visit Structure: ■ AHomeVisitorismatchedwiththefamilyandvisitsthemforhalf-an-hour,
twice-a-weekonaschedulethatisconvenientforthefamily.■ Onthefirstvisitofeachweek,theHomeVisitorbringsacarefully-selected
bookoreducationaltoy,thecurricularmaterialfortheweek,whichisagifttothefamily.
■ Inthetwice-weeklyhomesessionswiththeparent(orotherprimarycaregiver)andthechild,theHomeVisitormodelsverbalinteraction,reading,andplayactivities,demonstratinghowtousethebooksandtoystobuildlanguageandemergentliteracyskillsandpromoteschoolreadiness.
■ OverthecourseofthetwoyearsintheProgram,familiesacquirealibraryofchildren’sbooksandalargecollectionofeducationalandstimulatingtoys.
■ EachProgramYearorCycleconsistsofaminimumof23weeksofhomevisitsor46homevisits.
TheParent-ChildHomeProgrammodeldoesallowforsomemodifications,iftheydonotaffectthevalidityofthemodelandareapprovedinadvancebytheNationalCenter,inordertoappropriatelyservefamiliesindiversecommunitiesandawiderangeofcircumstances.
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ReadingRecovery
ReadingRecoveryisaschool-based,short-terminterventiondesignedforchildrenagedbetweenfiveandsix,whoarethelowestliteracyachieversaftertheirfirstyearofschool.Thesechildrenareoftennotabletoreadthesimplestofbooksorevenwritetheirownnamebeforetheintervention.
Theinterventioninvolvesintensiveone-to-onelessonsfor30minutesadaywithatrainedReadingRecoveryteacher,foranaverageof20weeks(abouttwoterms).Theprogrammeisdifferentforeverychild,assessingwhatthechildknowsandwhathe/sheneedstolearnnext.Thefocusofeachlessonistocomprehendmessagesinreadingandconstructmessagesinwriting;learninghowtoattendtodetailwithoutlosingfocusonmeaning.
Childrencompletetheinterventionwhenanindependentobserverjudgesthemasabletoreadandwritewithouthelp,withintheappropriatebandfortheirage.Onaverage,childrenwhohavecompletedhavegonefromtextlevel0toalevel17;thesearebookswithelaboratedepisodesandevents,extendeddescriptions,someliterarylanguage,fullpagesofprint,moreunusualandchallengingvocabularyandlesssupportfromillustrations.Progresscontinuesaftertheintervention,withchildrenmakingonaverageonemonth’sgainwitheachmonththatpasses.
Childrenwhodonotmakethesegainsarereferredbacktotheschoolforlong-termsupport(oneinfive).Howevertheytoomakeconsiderableimprovements,makingoneyear’sgaininsixmonths,andonaveragegoingfromatextlevel0toalevel9;thesearesimplestorybookswithsomerepetitionofphrasepatterns,ideasandvocabulary,severallinesoftextandaround20-40wordsperpage.
ReadingRecoveryisthefoundationinterventionforEveryChildaReader(ECaR).
HistoryReadingRecoverywasfoundedinNewZealandbyMarieClay,basedonherextensiveresearchintoearlyliteracydifficulties
■ In1987MarievisitedCambridgeUniversity,whereshespokeofthedevelopmentofReadingRecoveryinNewZealand.InspiredbyMarie’svisitJeanPrance,anexperiencedprimaryheadteacherandteachereducator,wenttotheUniversityofAucklandtotrainasthefirstUKReadingRecoverytutor(nowknownasteacherleader)
■ In1990thefirstReadingRecoveryteachersweretrainedinSurrey,byJeanPranceandanexperiencedNewZealandtutor,forSurreyEducationAuthority
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■ In1991theInstituteofEducation(IOE)invitedMarietoreturntotheUKwithasmallgroupofNewZealandcolleaguestosetupatutorprofessionaldevelopmentprogramme.SeventutorscompletedthetrainingforlocalauthoritiesinLondonandtheSouthEast
■ In1992thegovernmentcarriedoutathreeyearpilotfundedbyGrantsforEducationSupportandTraining.MariereturnedtotheUKforthefirstyeartosetuptwoparalleltutortrainingcourses,onebasedattheIOEandasecondinSheffield,and24tutorsweretrainedinthefirstyearforlocalauthoritiesacrossEngland.JeanPranceandJuliaDouetilweretrainedasthefirsttrainersfortheUK
■ Bythemid1990sReadingRecoveryhadspreadacrossEnglandandextendedtoschoolsinJersey,Scotland,Wales,NorthernIrelandandtheRepublicofIreland
■ In1995,afterthethreeyearpilotwascomplete,ReadingRecoverybecamelocallyfundedwithgovernmentsupportfornationalcoordinationinEngland
■ ThefirsttutorsforNorthernIrelandweretrainedin1993,forScotlandin1998,andforIrelandandWalesin1999
■ In2003auniversityprofessorfromCopenhagentrainedasaReadingRecoverytrainerattheInstituteofEducationandbeganaredevelopmentofReadingRecoveryintoDanishforimplementationinDenmark
■ InMay2005ReadingRecoverywasincludedintheDEIS(DeliveringEqualityofOpportunityinSchools)ActionPlanfortheRepublicofIreland,withfundingtargetedtochildrenindisadvantagedschools
■ Inearly2005theEuropeanCentreforReadingRecoveryworkedwithcolleaguesfromKPMGFoundationtodevelopEveryChildaReader(ECaR)asanextensionofReadingRecovery
■ InSeptember2005athree-yearECaRpilot,withReadingRecoveryatitscore,wasfundedbyacollectiveofcharitableorganisationsledbyKPMGFoundationandtheDepartmentforChildren,SchoolsandFamilies(DCSF)
■ In2008-11thesuccessoftheECaRpilotledtotheprogrammebeinggovernmentfundedinathree-yearrolloutacrossEngland
In2011governmentfundingforECaRwasplacedintoDedicatedSchoolsGrantforthefullthreeyearsofthe2011-14ComprehensiveSpendingReview,withtheintentiontoshifttheECaRstrategytoamarket-ledmodelProgramDescriptionReadingRecovery®isashort-termtutoringinterventionintendedtoservethelowest-achieving(bottom20%)first-gradestudents.ThegoalsofReadingRecovery®aretopromoteliteracyskills,reducethenumberoffirst-gradestudentswhoarestrugglingtoread,andpreventlong-termreadingdifficulties.ReadingRecovery®supplementsclassroomteachingwithone-to-onetutoringsessions,
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generallyconductedaspull-outsessionsduringtheschoolday.Tutoring,whichisconductedbytrainedReadingRecovery®teachers,takesplacedailyfor30minutesover12–20weeks.
ResearchFourstudiesofReadingRecovery®meetWhatWorksClearinghouse(WWC)evidencestandards,andonestudymeetsWWCevidencestandardswithreservations.Thefivestudiesincludedapproximately700first-gradestudentsinmorethan46schoolsacrosstheUnitedStates.3
Basedonthesefivestudies,theWWCconsiderstheextentofevidenceforReadingRecovery®tobemediumtolargeforalphabetics,smallforfluencyandcomprehension,andmediumtolargeforgeneralreadingachievement.Effectiveness
ReadingRecovery®wasfoundtohavepositiveeffectsonalphabeticsandgeneralreadingachievementandpotentiallypositiveeffectsonfluencyandcomprehension.
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Parent–ChildInteractionTherapy(PCIT)
WhatisPCIT?Parent-ChildInteractionTherapy(PCIT)isanempirically-supportedtreatmentforconduct-disorderedyoungchildrenthatplacesemphasisonimprovingthequalityoftheparent-childrelationshipandchangingparent-childinteractionpatterns.InPCIT,parentsaretaughtspecificskillstoestablishanurturingandsecurerelationshipwiththeirchildwhileincreasingtheirchild’sprosocialbehavioranddecreasingnegativebehavior.Thistreatmentfocusesontwobasicinteractions:ChildDirectedInteraction(CDI)issimilartoplaytherapyinthatparentsengagetheirchildinaplaysituationwiththegoalofstrengtheningtheparent-childrelationship;ParentDirectedInteraction(PDI)resemblesclinicalbehaviortherapyinthatparentslearntousespecificbehaviormanagementtechniquesastheyplaywiththeirchild.
Parent–childinteractiontherapy(PCIT)isaformofpsychotherapydevelopedbySheilaEybergforchildrenages2–7andtheircaregivers.Itusesauniquecombinationofbehavioraltherapy,playtherapy,andparenttrainingtoteachmoreeffectivedisciplinetechniquesandimprovetheparent–childrelationship.PCITevolvedfromConnieHanf’stwo-stageoperantmodelofparenting.
StagesofPCITAlthoughPCITisdividedintotwostages,relationshipdevelopment(child-directedinteraction)anddisciplinetraining(parent-directedinteraction),therearealsothreedistinctassessmentperiods(pre-treatment,mid-treatment,post-treatment).
Child-directedinteractionThechild-directedinteractionportionofPCITaimstodevelopalovingandnurturingbondbetweentheparentandchildthroughaformofplaytherapy.Parentsaretaughtalistof“dos”and“don’ts”tousewhileinteractingwiththeirchild.TheywillusetheseskillsduringadailyplayperiodcalledSpecialTime.
DRIP/PRIDEskillsParentsaretaughtanacronymofskillstouseduringSpecialTimewiththeirchildren.Althoughtheacronymvariesfromtherapisttotherapist,itisgenerallyeither“DRIP”or“PRIDE.”DRIPstandsforthefollowing:
D–DescribeR–ReflectI–ImitateP–Praise
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Likewise,PRIDEstandsforthefollowing:
P–PraiseR–ReflectI–ImitateD–DescribeE–Enthusiasm
MostPCITtherapistscurrentlyusePRIDEbecauseDRIPisawkwardandthe“E”supportsthevalueandimportanceofparentalpositiveaffectiveengagementinparent–childinteractions.
Theseacronymsareremindersthatparentsshoulddescribetheactionsoftheirchild,reflectuponwhattheirchildsays,imitatetheplayoftheirchild,praisetheirchild’spositiveactions,andremainenthusiasticthroughoutSpecialTime.
Parent-directedinteractionTheparent-directedinteractionportionofPCITaimstoteachtheparentmoreeffectivemeansofdiscipliningtheirchildthroughaformofplaytherapyandbehavioraltherapy.Itcanbeusedwithmaltreatedchildren.
UsedPCIThasbeenusedwithabusivefamilies.PCIThasbeenusedwithoppositionalchildren.Parent–childinteractiontherapyisamodelthathasdemonstratedsuccesswithchildrenwithoppositionaldefiantdisorderthathasrecentlybeenappliedtochildrenwithautism.Currently,alotofresearchhasbeendoneonhowPCITcanbeusedtokeepdifficultparentingpopulationsintreatment.ResearchshowsthatskillslearnedinPCITtrainingsessionsgeneralizetothehome.
EfficacyPCIToutcomeresearchhasdemonstratedstatisticallyandclinicallysignificantimprovementsintheconduct-disorderedbehaviorofpreschoolagechildren:Aftertreatment,children’sbehavioriswithinthenormalrange.StudieshavedocumentedthesuperiorityofPCITtowaitlistcontrolsandtoparentgroupdidactictraining.Inadditiontosignificantchangesonparentratingsandobservationalmeasuresofchildren’sbehaviorproblems,outcomestudieshavedemonstratedimportantchangesintheinteractionalstyleofthefathersandmothersinplaysituationswiththechild.Parentsshowincreasesinreflectivelistening,physicalproximity,andprosocialverbalization,anddecreasesinsarcasmandcriticismofthechildaftercompletionofPCIT.Outcomestudieshavealsodemonstratedsignificantchangesonparents’self-reportmeasuresofpsychopathology,personaldistress,andparentinglocusofcontrol.Measuresof
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consumersatisfactioninallstudieshaveshownthatparentsarehighlysatisfiedwiththeprocessandoutcomeoftreatmentatitscompletion.
CosteffectivenessParent–childinteractiontherapyhasbeenfoundtobeacosteffectiveapproach.Thewaythatcosteffectivenesswasmeasuredwasbycomparingratiooftreatmentcoststobehaviorgains,asmeasuredbyclinicallysignificantimprovementontheCBCL(reductionrangingfrom17–61%).
ForasummaryofPCITandinformationaboutthefutureresearchdirectionsofPCITsee:
Zisser,A.,&Eyberg,S.M.(2010).Treatingoppositionalbehaviorinchildrenusingparent-childinteractiontherapy.InA.E.Kazdin&J.R.Weisz(Eds.)Evidence-basedpsychotherapiesforchildrenandadolescents(2nded.,pp.179-193).NewYork:Guilford.
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FathersReadingEveryDay(FRED)
FathersReadingEveryDay(FRED)isanaward-winningUSfamilyliteracyprogrammeheldatlibraries,earlyyearscentres,nurseries,primaryschools,churchesetc.
Fathersreceiveapackcontainingareadinglog,tipsforreadingaloudandrecommendedbooklists.Duringfourweeksthedadsdocumenttimespentreadingtotheirchildrenandthenumberofbooksread.Collaboratingwithapubliclibraryencouragesfatherstosignup,familiarizesthemwiththelibrary,andprovidesaccesstofreebookstouseintheprogramme,aswellasbooksinlanguagesotherthanEnglish.
Morethan7,000fathershaveparticipatedsofarandstatisticallysignificantincreasespre/postinterventionincludetimespentreadingtochildren,numberofbooksread,levelofinvolvementinchildren’seducation,amountandqualityoftimespentwithchildren,andlevelofsatisfactionwiththefather-childrelationship.Thepercentageoffathersreadingtotheirchildrenthreeormoretimesperweekincreasedfrom53%to80%.
Over6,000fathersandchildrenfrom77TexasCountieshaveparticipatedintheFREDprogramsince2002.Outcomesfromtheprogramareverypositive.Participantswhocompletedtheprogramaveragedapproximately9hoursofreadingtimewiththeirchildrenandreadnearly40booksoverthecourseofthefour-weekprogram.
Resultsfromarecentevaluationstudyof300participantsdemonstratedsignificantimprovementsinmanyareas,includingtheamountoftimefathersspentreadingtotheirchildren,numberofbooksreadduringatypicalweek,levelofinvolvementintheirchildren’seducation,amountandqualityoftimespentwiththeirchildren,andlevelofsatisfactionwiththefather-childrelationship.Therewasalsoasignificantincreasefrompretopostinthenumberoffathersobtainingalibrarycard.OthersignificantfindingsfromFREDparticipantsinclude:
■ 61.4%reportedthatFRED“IncreasedthetimeIspentwithmychild.”■ 58.7%reportedthatFRED“ImprovedthequalityofthetimeIspendwithmy
child.”■ 57.2%reportedthatFRED“Helpedmebecomemoreinvolvedinmychild’s
education.”■ 66.2%reportedthatFRED“Increasedmysatisfactionlevelasaparent.”■ 70.3%reportedthatFRED“Improvedmyrelationshipwithmychild.”
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Inopen-endedresponses,manyfathersindicatedthattheynotedimprovementsintheirchild’svocabulary,readingability,andinterestinbooksasaresultofparticipatinginFRED.Somefathersevennoticedimprovementsintheirownliteracyskills.
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TimetoRead
TimetoReadisapairedreadingprogrammeengagingbusinessvolunteersonaone-to-onebasiswithKeyStagetwochildrentodevelopthemsociallyandemotionallyaswellasenhancingtheirliteracyskills.Theprogrammewasestablishedin1999andwasinitiallychampionedbyNorthernIrelandElectricity.theprogrammewasevaluatedbyQueensUniversityusingarandomcontrolgroupdemonstratingitseffectiveness.
TimetoReadisoneofthreeTimeto…programmesdevelopedbyBusinessintheCommunity,inpartnershipwiththelocalEducationandLibraryBoards,tohelpimproveliteracy,numeracyandcomputingskillsinlocalprimaryschools.Theotherprogrammesare:Time2CountandTimetoCompute,the‘Timeto’CompaniessupporttheirstafftovolunteeranhourperweektoworkalongsideKeyStageTwochildren(eight—tenyearolds).
Currently48ofNorthernIreland’sleadingcompaniesparticipateonthe‘Timeto’programmesworkingin63schoolsacrossNorthernIreland,includingOldWarrenandKillowenPrimarySchools.
Suggestedbenefitstothecompanyinclude:■ developsstaffconfidence■ self-esteemandcommunicationskills■ motivatesstaffandenhancesteamwork■ raisesprofileinthelocalcommunity■ buildspartnershipswithlocalschools
Suggestedbenefitstotheschoolsinclude:■ providesaninsightintothebusinessworld■ motivatesanddevelopschildrenacademicallyandsocially■ introduceschildrentoapositiverolemodelfromtheworldofwork■ enableschildrentoworkonaone-to-onebasisimprovingcommunicationskills
Time2Count(notyetrobustlyevaluated)alsofocusesonchildreninPrimary5—Primary7.Theaimofthisprogrammeistomotivatechildrentoenjoymathsandtorecogniseitasaneverydayactivity.Volunteersplaymathbasedgameswiththechildrentoconsolidatemathslearningintheclassroom.NorthernBankleadthisnumeracyprogramme.
TimetoCompute(notyetrobustlyevaluated)hasbeendevelopedtohelpbridgethedigitaldivideinlocalprimaryschools.Businessvolunteersworkonaone-to-oneprogrammewithchildrenaged8-10helpingthemtobecomeliterateinInformation
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andCommunicationsTechnology(ICT).HPhavesupportedtheTimetoComputeprogrammefromitslaunch.
TheCommitmentCompaniesinvolvedagreetoreleasestaffforonehouraweektovolunteerinalocalschool.Initialcommitmentisforoneyearwiththeoptionofextendingandmanyofourvolunteersarenowintheirfifthandsixthyear.CompaniesinvolvedinTimetoReadandTimetoCountalsoagreetocontributefinanciallytohelpprovideresourcesfortheschool(eitherbooksormathsmaterials).
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APPENDIX FOUR
Early Intervention Sites in the UK and Ireland
Nottingham
youngballymun
WestTallaghtCDI
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NottinghamEarlyIntervention
TheEarlyInterventionProjectsAnumberofinnovativedeliveryprojectshavebeentrialledaspartofthebroaderEarlyInterventionProgramme.Theprojectsincludednewworkandlearningfromexistingwork,andhavefocusedontacklingintergenerationalcyclesofdeprivationandcomplexproblemswithinNottingham,drivingtheProgramme’svision.
TheprojectsweredevelopedbythesixThemePartnershipsofOneNottingham,requiringjoined-upworkingtotacklecross-cuttingissues.
■ CrimeandDrugsPartnership• DrugAwareAward• StrongerFamiliesProject• AdultOffendingTeamFamilyInterventionProject
■ Children’sPartnership• DevelopingNaturalLearning• RaisingAspirations UsingCustomerInsighttoEnableEffectiveEngagement PuttingFamiliesattheCentre 11-16LifeSkills iRise FamilyWelfare-ReducingPersistentAbsence
■ HealthandWellbeingPartnership• FamilyNursePartnership• ActiveFamilies
■ NeighbourhoodPartnership• SanctuaryInitiative
TheseprojectsconcludedinMarch2011,withlearningfromthemostsuccessfulelementseitherbeingsustainedthroughmainstreamsystemsorbeingfurtherdevelopedandtested.Thiswillenablethedevelopmentofmorerobustevidenceoftheimpactofthesemodels.
Elementsofthefollowingprojectsarecontinuing:
■ StrongerFamiliesProject■ RaisingAspirations■ 11-16LifeSkills
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■ DrugAwareAward■ FamilyNursePartnership■ ThebroaderFamilyInterventionProject■ ActiveFamilies■ SanctuaryInitiative
Moreinformationwillbeavailablesoonontheseapproachesgoingforward.
CRIMEANDDRUGSPARTNERSHIP
DRUGAWAREAWARDSettingarobuststandardofexcellenceindrugseducationandpolicywithinschoolsandthecommunity.ProvidinganidentifiablebrandthatcanbeusedtodriveforwardthestandardofdrugsandalcoholeducationinNottinghamCityto:
■ EncourageschoolstoreachaboveandbeyondtheHealthySchoolsstandard■ Raisetheprofileofdrugseducationforpupils,parentsandthecommunity■ Ensureeffectivescreeningofdruguseandrisksofdruguse■ Ensureeffectivetargetedinterventionsforthosepupilsassessedas‘atrisk’
throughimprovedreferralpathwaystospecialistservicesandthroughembeddingtargetedinterventionswithinaschoolsettingwithappropriatelytrainedstaff
■ Helpparentstobemorefullyengaged(inbothpolicysettinganddrugseducation)
■ Increasepartnershipworkingwiththeschoolcommunity,NeighbourhoodBeatTeamandTradingStandards
■ InvolvepupilsintheCity-widedrugseducationpolicysetting■ Increasetheskillbaseofkeystaffwithinschools
STRONGERFAMILIESPROJECTStrongerFamilies,deliveredbyWomen’sAid,offersa12-weekprogrammeoffocusedgrouptherapeuticsessionsformothersandchildren(aged4-16)whohavebeenaffectedbydomesticabuse,oncetheperpetratorhasnowleftthefamilyhome.
Mothersandchildrenpartakeinseparategroupsessionswhichrunconcurrently.Thesessionsprovidebothmotherandchildwithasafespaceandtheopportunitytodisclose,processandunderstandtheabusethattheyhaveexperiencedorwitnessed.Mothersaresupportedtobetterunderstandtheirchild’sbehaviour,relatingtotheabuse.
APPENDIX FOUR
Early Intervention Sites in the UK and Ireland
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Theprojectaimstostoptheintergenerationalimpactofdomesticabusebysupportingfamiliestorecoverfromtheabuseanddecreasethelikelihoodofrepeatincidents.
FromAugust2009toDecember2010,therehavebeentwodomesticviolencerelatedrepeatincidentswithinthefirst26families(7.7%)whohavecompletedtheprogramme;significantlylowerthanthenationaldomesticviolencerepeatincidentrateof44%.
Schoolshavereportedimprovementsinthebehaviour,confidenceandinteractionsofyoungpeopleintheprogramme.Therehasbeenincreasedschoolattendanceofchildrenwherethishadpreviouslybeenaproblem.
ADULTOFFENDINGTEAMFAMILYINTERVENTIONPROJECTReducingtheriskofoffendingandentryintothecriminaljusticesystembychildreninthefamiliesofadultoffenders,particularlypersistentandprolificoffenders.Theprojectprovidesstabilityofaccommodation,supporttoreducesubstancemisuse,helptoobtaintrainingandemploymentforrelevantfamilymembersandtoincreasetheacademicsuccessofchildreninthefamily.Theprojectworksholisticallyandintensivelywiththefamiliesofadultoffenderswhoareeitherthemselvesparentsorareoldersiblingslivingwithinorimpactinguponanexistingfamilyunitinordertobreakthecycleofintergenerationaloffendingandreducethecriminalinfluencethatadultoffendershaveuponthechildrenwithwhomtheyhavecontact.Intensivesupportofatleastsixmonthsisprovidedtothefamiliesusing,whereappropriate,a‘coercive’modelofengagement.
Children’sPartnership
DEVELOPINGNATURALLEARNINGTriallingtheForestSchoolsapproachwithsixschoolsintheCity,encouragingchildrentoexploretheirlocalenvironmentanddevelopreasoningskills,analyserisksandpredicttheconsequencesoftheiractions.Theseven-weekoutdoorlearningprogrammepromotesteamwork,listeningskills,risktaking,tooluse,safetyawareness,cooperationandindependence.
Theactivitiescreateopportunitiesforemotional,socialandbehaviouraldevelopment,improvingoutcomesthroughimprovingbehaviourandhigherlevelthinkingskills.Theprojectaimstoembedthelearninginschoolsandprovideopportunitiesforstaffwithintheschooltosharelearningandbestpracticewithotherschoolsandcolleagues.
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Childrenhavereportedthattheprojectincreasedtheirconfidence,socialskillsandtheirabilitytomakebetterdecisionsandhashelpedthemtolearnwhichrisksarewisetotake.Parentsandteachershavealsogivenpositivefeedbackandtherehavebeennoexclusionsinthesegroupssincetheprojectstarted.
RAISINGASPIRATIONSDevelopingandtriallinganaspirations-raisingtoolkit,whichincludesauniqueaspirationsassessmenttool,apackageofinterventionsdesignedtoraiseaspirationandaprocessfordevelopinganaspirationsfocus.AspirationDevelopmentOfficersaredeliveringinterventionsinschoolsandresearchingandplanningfutureinterventions.
Theassessmenttoolisthefirstprimary-ageappropriate,aspirationassessmenttoolnationally.Itallowsschoolstotakeanearlyinterventionapproachtounderachievementandnegativebehaviours.Childrencannowbeidentifiedasbeing‘atrisk’ofmakingnegativedecisionsasaresultoflowlevelsofaspiration.Previouslytherehasbeennoassessmentmechanism.
Earlyindicatorsofimpactfromtheinterventionsbeingtrialledarealreadybeingreportedbyteachers,includingsignificantimprovementsintheconfidence,attitude,behaviourandengagementofpupilsinthecohortwhohadbeenidentifiedashavingverylowlevelsofconfidenceandaspirationatthestartoftheproject.
Theprojectisalsoshowingpositiveimpactonattendanceandattainmentofthosepupilsinvolvedintheproject.Twoschoolshavealreadyreportedthatthecohortreceivingaspiration-raisingsupport,performedwellaboveexpectationintheirSATs,withtwootherschoolsreportingresults10%higherthanpredictionsandinoneschoolanumberofindividualpupilshavemadeup13sub-levelsofprogress,comparedtothepredictedsix.
ItisplannedthatthetoolkitwillbeusedacrossthewiderChildren’sWorkforce.
USINGCUSTOMERINSIGHTTOENABLEEFFECTIVEENGAGEMENTWITHCHILDRENANDTHEIRPARENTSResearchhasbeenundertakenusingExperian’sCustomerInsightdatabase,whichprovidestheunderstandingofneedwithinNottinghamCitythatisrequiredtodelivertherightservicestotherightchildren,youngpeopleandfamilies,throughtherightfacilityattherighttime.Theinformationisbeingusedtoreengineerservicessothatserviceprovisionmeetsneedthrough:
■ Understandinglevelsofneedforserviceswithineachlocality
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Early Intervention Sites in the UK and Ireland
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■ Understandingthechildrenandfamilieswhouseandneedservices,withservicesbeingdeliveredinthemostappropriate,accessibleandeffectiveway
■ Communicationwiththetargetgroupsbeingundertakeninthemosteffectiveway
Effectivelyunderstandingneedwithinlocalitieswillenablecomparisonofserviceprovision,serviceuptakeandneedandthereforeidentificationofefficiencyofservices.Thiswillenablethetargetingofworkatindividualsorfamilieswhoareverylikelytohavedifficultiesorimpairedoutcomeswithouteffectivesupportorintervention.
Furtherdetailoncustomerinsightcanbefoundathttp://www.nottinghaminsight.org.uk/
PUTTINGFAMILIESATTHECENTRE(PARTOFTHECOLLABORATIONFORLEADERSHIPINAPPLIEDHEALTHRESEARCHANDCARE,NOTTINGHAMSHIRE,DERBYSHIREANDLINCOLNSHIRESTRAND[CLAHRCNDL])AnationalNHSandUniversityofNottinghamcollaboration.NottinghamisapartnerintheNDLstrandoftheCLAHRC.Thefocusoftheprojectistranslatingcurrentacademicresearcharoundmentalhealthservicesandchildrenandyoungpeopleintoworkingpracticethroughtwo‘DiffusionFellows’,actingaschangeagentsacrosstheCity.Theworkisexploringtheimpactofuncoveringparentalmentalhealthneedsinordertobettermeettheneedsofthechildandislookingintotheorganisationalbarrierstoajoined-upmodelofadultandchildmentalhealthprovisionintheCity.Proposalstotrialajoined-up,familyfocusedmodelarebeingdeveloped.
11-16LIFESKILLSThe11-16LifeSkillscurriculumprogrammeisdesignedtosupportthedevelopmentoftheskillsandknowledgeneededforyoungpeopletomakethebestlifedecisions,increaseconfidencelevelsandraiseaspirations.
Therearecurrentlyjustunder3000youngpeopleaccessingtheprogrammewithinsixsettings.Atrainingprogrammeandtoolkitforschoolstodelivertheprogrammeisbeingdeveloped,withtheaimofrollingitouttoallsecondarysettingsintheCityearlyin2011.
ThetoolkitwillincludeanumberofPlanningFrameworkmodelsandthenewSEAC(SocialEmotionalAspectsofChange)resourcematerials,whichisbasedonSEAL(SocialEmotionalaspectsofLearning,usedinallprimaryschools)focusingonchangingnegativebehaviours.
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TheNationalFoundationforEducationalResearch(NFER)haveconductedanindependentevaluationoftheproject;theinitialconsultationanddesignprocess,whichinvolved550studentsand218staff,wascitedasexcellentpractice.Theconsultationfoundthatstudentsfeelthatthereisaneedformorecoverageofmentalhealthissues,financialcapability,sexualrelationships,parentinganddemocracy.
Sofar,thefollowingimprovedoutcomesforchildrenandyoungpeoplehavebeendemonstrated;
■ Improvedconfidencetodiscusssensitivetopicswithteachersandformulateandexpressopinions
■ Improvedskilldevelopment,knowledgeandunderstandingoftopicareas■ Studentsreportedthattheyfeltbetterinformedandequippedtomake
decisionsaboutsexandrelationshipsandriskawareness■ Studentshaveimprovedawarenessofhowtoseekhelp,forexample,howto
accesssupportfromtheschoolnurseaboutcontraceptionandSTIs.
Staffhavealsoreportedanincreasedconfidenceinteachingsensitivetopics.
IRISEiRiseworkswithagroupofchildrenandyoungpeopleinKeyStages2-4(ages8-16)inNottinghamCityschools,whoareinthecareoftheLocalAuthority.Theprojectaimsistoincreasetheyoungpeople’sattainmentandaspirationanddeveloptheirsocialandemotionalresilience.Thiswillbeachievedthroughindividuallearningsupport,motivationalpersonaldevelopmentprogrammesfocusingongoalsettingandselfesteemandaspiration-raisingeventstoinformyoungpeopleaboutpost-16educationalopportunities.
ApositivepsychologydevelopmentprogrammehasbeendeliveredtoanumberofyoungpeopleinthecareoftheLocalAuthority.Participantshavereportedthatthecourseisusefulforanumberofareasoftheirlife;mostly‘takingcareofmyself’,‘takinganactivepartinFurtherEducation(FE)’andpersonalgoalsetting-94%saythattheywouldrecommendit.
PartnershipshavebeendevelopedwithAimingHigher,NewCollegeNottinghamandNottinghamCityCouncilSportandLeisureServicestodeliveraspiration-raisingeducationalopportunitiesawarenessevents.Allyoungpeopleinvolvedintheprojecthavereportedthattheseeventshavemadethemawareoftheopportunitiesavailabletothemandthattheyarenowplanningtoaccesspost-16education.
APPENDIX FOUR
Early Intervention Sites in the UK and Ireland
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FAMILYWELFARE-REDUCINGPERSISTENTABSENCEImprovingtheuseofresourcestotacklethecausesofabsenceinschools.Theprojectfocusesontheearlystageinthecycleofabsence,particularlyinprimaryschoolsandYearsSevenandEightofsecondaryschools,aswellasfocusingonfamilieswithyoungchildrenwhohavepoorattendingoldersiblings,inordertobreaktheintergenerationalcycleofnon-attendance.
Asignificantdecreaseinpersistentabsencehasbeendemonstrated.AcrossthesixschoolsspecificallytargetedbytheDepartmentforEducation,betweenSeptember2009andMarch2010,therewasadecreaseof133casesofpersistentabsence;areductionof26%.Summerterm2009statisticsshowareductionof23.5%acrossallSecondaryschoolsandAcademies,and44.9%acrossPrimaryschools.
IndicatorsalsoshowthatpersistentabsenceistackledandresolvedmorequicklywiththeuseoftheLeadProfessionalbudget,astheamountofchildrenoryoungpeoplewhoarepersistentlyabsentformorethanonetermhasshownadecreasingtrendsincethestartoftheproject,from46%inAutumn2008/09to23%inAutumn2009/10.
HEALTHANDWELLBEINGPARTNERSHIPFAMILYNURSEPARTNERSHIPProvidingsupporttofirst-timepregnantteenagersandtheirpartner,inordertopositivelyimpactontheirparentingskillsandoutcomesforthemandtheirchild.
Theprogrammehasdemonstratedimprovedmentalhealthandparentingskills,increasedbreastfeedingandimmunisationtake-upratesandreducedsmokingrates.
AnecdotalevidenceindicatesthatissuesareidentifiedatanearlierstageandthereforeSocialCaresupportismoreeffective.
Nottinghamispartofaninternationaltrialofamodelfordeliverytogroups(currentlyone-to-one)andislookingintothecostandimpactofthis.
Theprojectreceivedadditionalfundingtoexploreengagementoffathersintheirchild’slife.Findingsarenowreadyfordissemination,withkeymessagesincludingthatsomemendonotengagewiththeservicebecausetheybelieveittobejustformothers;howeverthedepthoftherelationshipthenursedevelopswiththefatheriscrucialinachievingsuccessfuloutcomesforthechild.
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ACTIVEFAMILIESIncreasingopportunitiesforfamiliestoengageinphysicalactivity,regularlytogether.Aimingtohalttheriseinobesityandreducehealthinequalitiesandcardiovasculardisease.AvarietyofphysicalactivityandsportsessionsareprovidedeachweekataselectionofleisurecentresacrosstheCity.
310families(1073individuals)haveengagedintheprojectsincethelaunchinMay2009.12%ofthesefamilieshavealreadystartedtoshowcontinuedengagement(5sessionsormoreattended).63%ofthoseengagedarefromareaswithlowlevelsofphysicalactivityandhighlevelsofchildobesityanddeprivation.
Theprojectalsoactsasauniquereferralpathwayforchildhoodobesitybetweentheagesoftwoandfour,andalsoapathwayfromtheGo4It!project.
NEIGHBOURHOODPARTNERSHIPTHESANCTUARYINITIATIVEProvidingadditionalsecuritytothehomesofsurvivorsofdomesticabuse,oncetheperpetratorhasbeenremoved,andapackageoffloatingsupport,includinghomevisits,foruptosixmonths.Theprojectenablesfamiliestostayintheirownhomeandsocialnetworkandthechildrentostayintheircurrentschool.
Evidenceofimpactisdemonstratedbythereducedrateofrepeatdomesticviolenceincidentswithinthecohort(30%),muchlowerthanthenationalrepeatincidentrateofdomesticviolence(44%).Therehasalsobeenareducedprevalenceofhomelessnessapplicationsduetodomesticviolence(NottinghamCityHousingAid)-thishasgonefrombeingthethirdmostprevalentreasonin2006/07tothefifthin2008/09.
APPENDIX THREE
Early Intervention Sites in the UK and Ireland
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youngballymun
youngballymunisoneofthreeprojectsestablishedthroughthePreventionandEarlyInterventionProgramme,jointlysupportedandresourcedbytheOfficeoftheMinisterforChildrenandYouthAffairsintheRepublicofIrelandandtheAtlanticPhilanthropies.
ThePreventionandEarlyInterventionProgrammeforChildrenwasestablishedbyGovernmentinFebruary2006tosupportandpromotebetteroutcomesforchildreninareasdesignatedasdisadvantaged,throughmoreinnovation,effectiveplanning,integrationanddeliveryofservices.
TheProgrammetargetsthreegeographicareasinwhichthereisevidenceoftheneedforearlyintervention-Ballymun,TallaghtWestandDarndale.Thepurposeoftheprogrammeistosupportthedevelopment,implementationandevaluationofstrategiesforchildrenatlocalleveldrawnupbythestatutory,voluntaryandcommunityagenciesoperatingintheareasconcerned.TheProgrammeprovidesfortheintroductionandevaluationofarangeofintegratedinterventionsforchildrenandtheirfamiliesandtestiftheymakeapositivedifferencetochildren.
Thefocusoftheprogrammeisonsupportinginterventionswhichfitwithnationalpolicyobjectivesandhavebeendevelopedinconjunctionwiththelocalcommunity.Learningandevaluationareimportantcomponentsoftheprogrammeandindividualservices,areaprojectsandtheoverallprogrammewillbesubjecttoongoingandrobustreviewandevaluation.
TheOMCYAhaspartneredwiththeAtlanticPhilanthropiesinfundingthisprogrammeandatotalfundofupto€36,000,000isavailableacrossthethreeprojects.GovernmentandtheAtlanticPhilanthropieswillprovide€18millioneachinfunding.
youngballymun,theChildhoodDevelopmentInitiative,TallaghtandPreparingforLifeNorthsidePartnershiptogetheraretheprojectsthatmakeupthePreventionandEarlyInterventionProgramme.ResearchandplanningonpreventionandearlyinterventionmeasuressponsoredbyAtlanticPhilanthropies,hadbeenundertakenintheseareasandtheywereconsideredtobeinanexcellentpositiontotestnewmodelsofservicedelivery.Ifthesemodelsprovesuccessful,theresultsoftheseprojectsmayprovidethebasisforenhancedresourceallocationprocessesandpolicychanges.
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TheoverallprogrammeisbeingmanagedbytheOfficeoftheMinsterforChildrenandYouthAffairsonbehalfoftheGovernment.Approvalhasbeengiventofundallthreeprojects2007-2011/12.
WestTallaghtChildDevelopmentInitiative
IntroductionTheChildhoodDevelopmentInitiative(CDI)beganasaplanninginitiativein2003tosupportbetteroutcomesforchildreninTallaghtWest.Aconsortiumof23membersrepresentingcommunityleaders,residentsandprofessionalslivingandworkinginTallaghtWestdevelopedtheoutcomes-focused10-yearstrategy‘APlaceforChildren’.Basedonthislong-termstrategy,adetailedimplementationwasagreedfor2007-2011,againstwhichamajorinvestmentof€15millioneurowasmade,co-fundedbytheDepartmentofChildrenandYouthAffairs,throughthePreventionandEarlyInterventionFund,andTheAtlanticPhilanthropies.
MissionThemissionofWestTallaghtCDIis“WewholiveandworkinTallaghtWesthavehighexpectationsforallchildrenlivinginourcommunities.Wewantourchildrentolovewhotheyareandtobecherishedirrespectiveofsocialbackground,culturaldifferencesandcountryoforigin.Weseeeverychildandeveryfamilybeingprovidedwithsupport,opportunitiesandchoicestomeettheseexpectations.Weseethewholecommunityowningresponsibilityforthequality,beautyandsafetyofthelocalenvironment.Weseechildrenencouragedandcherishedbythewholecommunity.”
QualityServices,BetterOutcomesWorkbooktheCDIhaverecentlypublished‘QualityServices,BetterOutcomes’whichprovidesapracticalresourceforfrontlinestaff,servicemanagersandorganisationsthatarecurrentlyimplementingorintendtoimplement,evidence-basedprogrammesandservicesforchildrenand/ortheirfamilies,drawingonresearchexamplesofbestpractice.
TheCDIProgrammes■ EarlyYearsService■ DoodleDenProgramme■ Mate-TricksProgramme(hasnowbeenstoppedfollowingpoorevaluation
results)■ HealthySchoolsProgramme■ CommunitySafetyInitiative■ QualityEnhancementProgramme■ SafeandHealthyPlace
APPENDIX THREE
Early Intervention Sites in the UK and Ireland
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■ RestorativePractice■ RestorativePracticeSchedule2011■ CommunityCoachingProgrammeTheirfivemainprogrammesaresubjecttoRCTevaluationsandshouldbeavailableshortly.
GovernanceTheWestTallaghtCDIgovernancestructuresincludethefollowing:■ CDIBoard■ CDIImplementationSupportGroup■ ExpertAdvisoryCommittee■ FinanceandRiskSubCommittee■ ExecutiveSubCommittee■ CommunitySafetyInitiativeSteeringCommittee■ HealthySchoolsSteeringCommittee■ SafeandHealthyPlaceSteeringCommittee■ RestorativePracticeManagmentCommittee
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