Objectives Participants will: 1. Understand Conceptual and Empirical Overview of the Family Check-Up (FCU) Anne Mauricio, Ph.D. Arizona State University 2. Know the 3-step Process of the FCU Model ASU REACH Institute anne.mauricio@asu.edu 3. Understand FCU’s Implementation Model for Dissemination Name What is your role in your organization? What do you do? What are your goals for today’s presentation? 1
Parent-centered intervention that decreases child Brief and with long term outcomes, therefore problem behavior by changing family management cost effective, large public health impact practices Focus on the importance of ecology and family in Comprehensive ecological assessment with understanding and treating child and adolescent motivation-enhancement with follow-up to one or problem behavior more services focused on family management Result of 30 years of continuous feedback from basic research Family Management: A set of parenting Evidence-based: Multiple clinical trials have shown practices- positive behavior support, healthy that FCU is efficacious across multiple settings and limit settings, relationship building diverse populations Conceptual Overview: Developmental Cascade Model Economic or Social Stress Family Management: Parent Child & Positive Behavior Support Adolescent substance use Monitoring Adjustment Limit Setting Relationship Building Parent depression/ Marital conflict (Haller el al, 2010; Masten et al, 2005; Dishion et al, 2009; Dodge et al, 2008) 2
The Coercion Model and Escape Conditioning Family Management and Adaptation Child problem behavior Child escalates Child problem behavior Child de-escalates/ improves behavior Parent stays engaged Parent reacts emotionally Parent manages Parent withdraws, escalates Patterson, 1982 Patterson, Reid & Dishion, 1992 1. Reductions in comorbid emotional distress and problem behavior in early childhood 2. Reductions in depression from middle school through early adulthood 3. Reductions in substance use from middle school through early adulthood 4. Reductions in problem behavior and school adjustment from middle school to high school to early adulthood 5. Increases in positive parenting from early childhood through adolescence Connell et al, 2006, 2007, 2009; Dishion et al, 2002, 2003; 2008; Stormshak et al, 2010, 2011) 3
Intervention Effects on Self Reported Changes in Observed Parent Monitoring Substance Use for High Risk Students Portland Public Schools Study Self Reported Substance Use in the Last Month 1 0.9 Intervention 0.8 Control 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 6th Grade 7th Grade 8th Grade 9th Grade (adapted from Dishion, Kavanagh et al, 2002) (Dishion, Nelson & Kavanagh, 2003) Two Year Effects on Parent Report Problem Behavior in Early Childhood Mediated Effects of the FCU on High Risk Adolescents’ Drug Use : : Effect size at age 3 = .65 sd 4 Treatment Control 3 Changed Randomly Observed Assigned 2 Drug FCU Use 1 Age 2 Age 3 Age 4 Dishion, Nelson & Kavanagh, 2003 (Shaw, Dishion, Supplee & Gardner 2006) 4
Intervention Outcomes on Direct Observations of Parent Positive Reinforcement (Age 2-3) Macro Ratings of Positive Reinforcement Positive Behavior Support Mediates Change in Problem Behavior in Early Childhood. 6.4 6.2 Changed Intervention Observed Randomly Changed 6 Control Assigned Positive Problem Behavior FCU Behavior 5.8 Support 5.6 Age 2 Age 3 Dishion, Shaw et al., 2008 (from Dishion, Shaw et al, 2008) Feedback Session Assessment Session Initial Interview Case Conceptualization, Questionnaires and Videotape Feedback 5
Instills a sense of hope about potential changes and plants the seeds for specific intervention strategies Strengths based Ecological focus: Exploring strengths and challenges of the family context Motivational interviewing guides conversation Explain Family Check Up Process Explore strengths, problem areas and concerns Frame concerns into issues of parenting and family management Develop rapport Motivate parent to engage in FCU process and positive behavior changes 6
The Ecology of Child and Adolescent Mental Health What is a “strength - based” approach to Behavior Settings intervention? Schools Relationship Dynamics Home What kinds of assessments lead to “strength - Spouses Child & Peers Adolescent based” intervention? Reply Dynamics Mental Health Teachers Siblings Parents Neighborhood Parent and Youth Questionnaires Why observe families? Teacher Questionnaires • What can you learn from videotaped observation of parent-child behavior? 3-5 5-minute videotaped observations of parent-child • What are strengths and barriers to direct interactions observation • Ex: Child Clean Up -Parent independently directs the child to pick up the toys from the child led task Self-report • What can you learn from videotaped observation of • What can you learn from self-report behavior on parent-child behavior? • What are strengths and barriers to direct observation parenting and child behaviors? Case Conceptualization 7
Youth behavior Youth behavior Peer relations Peer relations School success School success Parental well-being Depression/anxiety Coping skills Marital/relationship quality Effortful control/self-regulation Neighborhood resources Prosocial behavior Financial stress Family conflict Family management Life stressors Family and extra-familial support Strengths-based Validate and affirm parents’ current strengths and identify Caregiver Teacher(s) strengths that can be further developed Perspective Perspective Case conceptualization Family Centered Create a cohesive story, a narrative Case Conceptualization What is the story I want this parent to hear? What is the potential effect of this information for the Youth child? Observations Perspective What are the obstacles for this family? 8
T = Tailor feedback for client H = Harm reduction is top priority I = Integrate information into parenting frame N = Notice and build on parenting strengths K = Know and consider functional family dynamics Research-based feedback to the parent in all of the content areas that were assessed during the Five Clinical Skills To Supported Change: ecological assessment Briefly summarize and “connect the dots” Use open ended questions 1. Self-assessment • To Engage and Check In 2. Overview and explanation of profile • 50% of time parent talks 3. Feedback Use reflective listening to unveil parent perspective • Start with strengths Look for opportunities to affirm and validate • Identify the client’s story based on the Evoke parents’ change talk whenever possible assessment 4. Exploration of menu and goal setting 9
Profile Lists domains of child, parent, and Feedback session begins with parent self family functioning assessment assessed with questionnaires and video tasks Opportunity for therapist and parent to clarify key issues and assess how much awareness parent has about their child’s strengths and challenges Use scored assessment data Why start with self-assessment? and case conceptualization to indicate where “Many parents feel they learned something about their family or child family after the assessment. What did you learn about functioning falls for your child? Was there anything that s/he did that each item. surprised you or stood out for you?” Suggest intervention goals based on Improves Videotaped assessment Uptake & Feedback Effect Sizes Use parent’s words to ‘own’ goal Prioritizing intervention goals based on 1. Shows how a new skill might be useful case conceptualization 2. Improves performance of existing parenting skills Channeling goals into a theme involving 3. Identifies opportunities for using a parenting skill parenting 4. Supports a parenting strength parent may be unaware Fukkink, 2008 ; Kluger & DeNisi, 1996 10
Family Check Up Follow-Up: Menu of Family Management (FM)Training Brief FM Sessions FM Ecological Therapy Initial Feedback Family Interview Session Assessment Child Focused Interventions Dishion & Stormshak, 2007 Ecological Support Research and Education Advancing Children’s FCU Implementation Leadership Network Health (REACH) Newly Established Institute at ASU to support REACH Lead dissemination of FCU and other EBPs Implementation Supervisor on Site Coordinator Works with communities to build capacity to implement and sustain EBPs within existing service Service Consultant systems Providers COACH On Site 11
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