Technology in Service Delivery Poll #1

Transcription

1 Technology in Service Delivery Poll #1 How Technology Can Enhance the Effectiveness of Evidence-Based Interventions for Children and Families Kathryn Bigelow, Ph.D. Juniper Gardens Children s Project University of Kansas What technologies have become part of your daily life? Early Childhood Forum, April 28, 2011 The Reach of Technology Technology has been beneficial as an enhancement to intervention in a wide range of disciplines Smoking cessation Compliance in use of HIV medications Diabetes care Mental Health Parenting Health behaviors Brain injury Cancer support Use of Technology: Examples Assessment and Intervention Cell phones Internet Telemedicine Video games Video/DVD Juniper Gardens Chlidren's Project 1

2 How We Think about Technology A tool in our tool box; a resource, not a replacement Can help us make or maintain contact Transient nature, unpredictable schedules of some families Lack of consistent land line service Can help us connect and relate Rural families; increased opportunities to communicate Can help us learn about families Formal assessment What is learned anecdotally from increased contact Can help us share information Feedback Training Can enhance professional development Research Incorporating Technology at Juniper Gardens Children s Project Using cell phones to enhance parent engagement in a parenting intervention Streamlining the process of giving feedback to providers, teachers, and parents via electronic data collection and computer-generated reports and graphs Online training for parents of children with Autism Online progress monitoring and decision making support using ECI data for intervention aimed at promoting communication Interactive, web-based intervention aimed at promoting social-emotional development with low-income families and child care providers Using Cellular Phones to Engage and Retain Families in Parenting Interventions A collaboration between the University of Kansas Juniper Gardens Children s Project, the University of Notre Dame Center for Children and Families, and the Centers for Disease Control & Prevention Division of Violence Prevention Evidence-Based Parenting Programs Good news about parenting interventions: Empirically supported parenting programs that improve positive parenting behavior are viable for addressing child physical abuse and neglect. Several behavioral parent training programs have been shown to be effective in preventing child maltreatment Kathryn Bigelow and Judy Carta Juniper Gardens Children s Project Schiefelbusch Institute for Life Span Studies University of Kansas Juniper Gardens Chlidren's Project 2

3 Evidence-Based Parenting Programs Bad News, we still have some challenges Engagement: Lack of engagement of parents during the intervention Attrition: Parents fail to complete the program Generalization: Parents fail to learn to incorporate newly learned skills into everyday routines Fidelity: Inadequate implementation of intervention The Challenge and Our Goals To keep families with multiple risks Enrolled Actively engaged Implementing parenting strategies and engaged with their child throughout the day and week during routine activities Poll #2 Are engagement and/or retention a challenge for your program? We expect cell phones will: Improve attendance and our ability to keep families from dropping out of the parenting intervention Keep families more actively engaged in the intervention Help families learn to apply the parenting skills throughout their daily interactions with their children Support parents correct use of the intervention correctly Offer reminders to use the intervention more often (thus, increasing the dosage of the intervention) Juniper Gardens Chlidren's Project 3

4 Why Cell Phones? Poll #3 Pervasive Inexpensive Easy to use/learn Easy to fit into daily routine, including in community Seen as a necessity, by many Used previously for supporting interventions, and even as a stand-alone intervention To what degree are you already using cell phones as part of your program? Sample: Cohort 1 First-time mothers and first-born children N = 89 55% African-American, 28% White Non- Hispanic, 14% Hispanic, 3% Multi-racial 48% Single 44% Employed 32% with evidence of mild to severe depression Strong belief in corporal punishment Intervention Design Random assignment to 1 of 3 groups: Planned Activities Training (PAT) 5-7 home visits Mastery criterion of 90% in 3 activities Cell Phone Enhanced PAT PAT, plus cell phone/service for duration of PAT Twice daily text messages and phone calls once a week Wait-List Control Assessments at pre, post, 6 mos, 1 year Juniper Gardens Chlidren's Project 4

5 Planned Activities Training Focus on engaging child in daily routines, setting the occasion for good behavior Teach positive interactions, preparing in advance, simple rules Assess parent s concern about child s behavior Begin with a simple parent-selected activity Model the activity based on the PAT steps Have parent practice the steps with the child Give feedback Have mom & child practice throughout the week Planned Activities Training Steps: Strategies Applied to Each Activity Prepare in advance Explain activity Explain rules Explain rewards Give choices Talk about what you re doing Good interaction skills Ignore minor misbehavior Positive feedback Rewards What do you feel are barriers to using technology? Poll #4 Parents in CPAT group: Cell phone and service provided for free Receive twice daily text messages and weekly phone calls Use phone to schedule/confirm visits Can also use the phone to call/ text their coach and for other reasons Cannot go over their allotted minutes (1000) Cell Phones Juniper Gardens Chlidren's Project 5

6 Text Message Prompts Daily text messages prompt parent to use one aspect of PAT or engage in a particular skill or activity Try to catch your child being good today. It can be hard, but try to ignore those minor problem behaviors. Remember to keep rules simple and easy to follow Try to make some time today to look at books together One or two messages each week will contain friendly and fun prompts Tips, quotes, upcoming community activities or resources Text Message Example Coach: Talking about what you are doing is one of the best ways to get your children involved in the activity. Mom: That is so true because that is what we did today. Text Message Questions Daily text message question asks about use of one aspect of PAT, their interactions with their child, or their child s behavior On a scale of 1-10 (10 is best), how did a mealtime go today? Did you have fun with your child today? What is one cute thing your child did today? How did you catch your child being good today? Parents asked to respond when they can, but not required Messages designed so responses can be brief Text Message Example Coach: Did you remember to take time to listen to your kids today? Even if it doesn't seem very important to you, your children are talking about things that are so important to them. Mom: I do need to take more time to just listen to them. Juniper Gardens Chlidren's Project 6

7 Cell Phone Calls Talk about use of PAT, child behavior, or other parenting issues Family coach prompts parent to discuss these issues if parent does not report on them Coaches follow parents lead in how calls are structured Will not go more than 3-4 days without phone contact Parents can call coaches, and calls returned within 24 hours if not immediately How do you think your agency might incorporate cell phones into service delivery? Poll #5 Higher Retention Rate for CPAT and Control Group Keys to Interactive Parenting Scale: Total Score Pre and Post Differences Drop-out d Complete CPAT PAT CPAT PAT WLC Pre-Test Post-Test 6-Months 12-Months Juniper Gardens Chlidren's Project 7

8 Comments from Families PAT: I think these strategies are awesome. They are simple and easy and quick that I rarely forget the steps and use them many times a day. Additionally, they are effective just about every time I use them. Texts: It really kept us prepared on what we were to be working on with our children, so it helped us a lot during the program, so I really liked it. Cell Phones: Real great to receive a positive call or text when a day may not be going so smooth. Parent Satisfaction Families rated use of cell phones and text messaging highly When asked about the frequency of text messages, parents said that two text messages a day was just right. Results Retention: CPAT families had higher retention rate, with 76% of CPAT families completing the intervention, and 53% of PAT families completing the intervention. Parent-Child Interactions: Responsive parenting strategies increased for both PAT and CPAT mothers, compared to control mothers at post-test and 6-month follow-up. Improvements in parenting behavior observed for both CPAT and PAT groups. Hug Story I was at a home visit and I asked the mom how she felt about the text messages. Yes, they help. The other day I was having a bad morning with Andrew. I was so frustrated with him. I just walked away and went to go sit on the sofa. Then I got your text that said "Give Andrew an extra hug today." I looked at it and said, "Ahh, he's not that bad." So I got up and gave him a hug. And had a better day with him. I think cause I was calmer. Juniper Gardens Chlidren's Project 8

9 Discussion How can we promote further retention and engagement with cell phones? Other technologies? How can cell phones/text messaging enhance effectiveness of other types of interventions? Poll #6 What other technologies are you interested in exploring? Questions? Discussion How are you using cell phones? Other technology? What challenges is your program facing? How might technology be beneficial to program implementation, evaluation, or outcomes? How can cell phones enhance other types of programs? Kansas Model Demonstration Center for Promoting Language and Literacy Readiness in Early Childhood Juniper Gardens Chlidren's Project 9

10 KS Model Demonstration Center Goals Build the capacity of parents and educators to promote the communication of their infants and toddlers Increase parents /teachers use of evidence-based strategies across routines Document use of intervention strategies with Part C and B providers delivering intervention to parents/teachers Measure growth in children s communication Who is Involved with the KS Model Demonstration Center? 130 children recruited in Part C and received intervention Parents and Teachers Part C Infant-Toddler Programs Topeka(TARC) Wyandotte County Infant-Toddler Services Infant-Toddler Services of Johnson County Part B Early Intervention Programs or Preschools Building the Capacity of Parents and Teachers to use Evidence-Based Strategies Intervention coaches introduce communicationpromoting strategies and support providers in incorporating them into visits Provider collaborates with parents/teachers on strategies and routines; supports them in embedding communication strategies into routines Provider reviews progress and provides feedback at each visit and supports parents/teachers in use of strategies across routines Measures and Modes of Feedback Parent/Teacher Fidelity: GRAs observe use of strategies monthly Parent/Teacher Self-Checklist: Self-report of strategy use Provider Observation Checklist: Selfreport checklist documents what components of intervention were discussed and observed during visit Juniper Gardens Chlidren's Project 10

11 Provider Observation Checklist Filled out by provider after each meeting with parent or teacher Documents intervention delivery strategies, routines addressed, and strategies used by parent or teacher during the visit Report created in Microsoft Access to assist with keeping track of what families have received and what provider reports that family is doing related to the intervention Total visits with checklist to 18 Most recent checklist entered: 4/15/2010 (Date of Visit) Strategies Addressed with This Parent So Far Activities in Which Strategies Were Addressed # Visits # Visits Environmental arrangement 8 Play 16 Following child's lead / 7 Meal / snack time 4 Commenting / labeling 10 Toileting / dressing / personal 6 Imitating / expanding 13 Household routines 8 Open-ended questions 3 Reading / looking at books 9 Positive attention and praise 7 Circle time 0 Providing choices 9 Outings 0 Fill in blank / time delay 9 Outdoors 0 Other 1 Other 2 Strategies Observed During Visits Report Date: 5/26/2010 # Visits Group: No Graphs Environmental arrangement 12 Following child's lead / 16 Intervention Commenting / labeling 17 Start:Date: 4/25/2009 Imitating / expanding 17 Notes: Open-ended questions 13 Positive attention and praise 17 Providing choices 5 Fill in blank / time delay 4 Other 0 Report provided monthly to providers, offering feedback on strategies and routines addressed and observed Reports inform intervention coaches on where additional support may be needed Early Communication Indicator (ECI) Child Rates of Communication Juniper Gardens Chlidren's Project 11

12 Behind the Scenes Use of Technology Represents use of technology to support providers in their work Data collection Interpreting data Providing visual feedback to families Progress monitoring to inform professional development and intervention Discussion How can you infuse technology into professional development activities? Evaluation? Are you already using similar technology, and can these resources be used in new ways? Poll #7 Discussion I think my program can incorporate technology into our service delivery in some manner that would be helpful, and timeand cost-effective. Juniper Gardens Chlidren's Project 12

13 For inquiries, please contact: Kathy Bigelow, Ph.D. Juniper Gardens Children s Project kbigelow@ku.edu Juniper Gardens Chlidren's Project 13