Children with challenging behaviours Working in Partnership with Families
The challenge of challenging behaviour Disruptive behaviour is the most common reason for mental health referrals in children and youth (Kazdin 2003) Severe antisocial behaviour in children is one of the strongest predictors of poor long term outcomes in adulthood Fewer than 10% of children who need mental health services actually receive them Even fewer of these children receive evidence-based interventions
Brainstorm What is it like to be a child with challenging or difficult behaviour? What is it like to be the parent of a child with challenging behaviour?
Implications for us? How do families/whānau want to be treated? What do they need from us as professionals?
What do we know works best for families? Viewing children as one part of a larger family system Intervening early in the life of children and in the life of the problem Working alongside families Acknowledging the family s strengths and building resilience
What works best for families? Sharing expertise, but not being the expert Being responsive and flexible, offering choices Using evidence-based best practice models
Brainstorm what interventions have you found work well? What are your successes?
Child Focused Interventions Play therapy Sand Tray Therapy Behavioural modification approaches Occupational therapy CBT (older children)
Research Evidence Generally single-subject research designs, such as case studies Meta-analyses of single subject designs - Bratton, Ray et al 2005 suggest outcomes most positive when parents are included in childfocused interventions
Parent-based Interventions Based on a model in which parenting skill and parent-child relationships are seen as playing a major role in the development and maintenance of behaviour problems. Focus on building parenting skills and parent-child attachment Evidence from randomised control trials Cost effective and build in ongoing support networks
Evaluating Evidence Based Programmes Blueprints for Family Violence: www.colorado.edu/cspv/blueprints/ Programmes are evaluated on - o Research design o Size of effect (impact) o Sustainability of impact o Independent replication?
Parent programmes with evidence of significant positive impact for families Parent-Child Interaction Therapy (PCIT) Triple P Positive Parenting The Incredible Years Toddler, Preschool, School-age programmes Combining parent programmes with broad-based family training and support models
Why use evidence based programmes? clear implementation process predictable outcomes supporting to deliver programme with fidelity maximising the best outcomes for families
Maximising outcomes by enhancing the delivery of an evidence-based programme
What is The Incredible Years? an evidence-based parent programme developed by Carolyn Webster-Stratton works in collaboration with parents to build strengths and consider new solutions focuses on supporting and developing the parent-child relationship aims to reduce behavioural challenges and increase prosocial behaviours in children
Research Outcomes from Incredible Years Parent Programme
Highlights of this model Collaborative, working in partnership with parents Self reflective, experiential approach Strength-focused, not an expert model Variety of learning modes including DVD modeling, role plays, home activities, group discussion Manual based but flexibility in delivery Quality implementation assured through accreditation for facilitators Responsive to different cultural needs
Providing a broad-based approach Teacher-based intervention Child-based interventions Parent-based interventions
How can we be responsive and flexible to the unique needs of whānau while maintaining the fidelity of an evidence-based programme?
Working in Partnership Annual Incredible Years Maori Hui Experienced Maori parent group facilitators Incredible Years Maori reference group Kaumātua
Weaving together two worlds - maximising outcomes for Māori Development of a series of programme enhancements to improve engagement and more effectively meet the needs of Māori in The Incredible Years programme
He Whiria, He Whatu Weaves together two worlds by - o Explicitly acknowledging the vital importance of Te Ao Māori in the delivery of the programme to Māori o Maximising the benefits of providing an evidence-based programme o Aligning core concepts from Te Ao Māori and Incredible Years
Maori DVD whānau sharing their experiences
Some Key messages Effective intervention programmes need to be responsive to a diversity of needs and encompass various levels of microsystems and ecosystems Family/whānau, community, school, peers, tamariki/child. The value of working in a partnership to meet the unique needs of whānau adds value and maximises outcomes
Tania Anstiss Practice Advisor, The Werry Centre Phone: (09) 9234205 or 021 432974 Email: t.anstiss@auckland.ac.nz