# Presentation: 813308

## Integrating specialized mental health services into child welfare settings  

- Mary Dozier 	            Carole Shauffer
-     University of Delaware                               San Francisco

## Research support

- NIMH R01 52135
- NIMH  K02 74347
- NIMH Network grant (Gunnar PI)

## Dissemination support

- Foundations (Casey, Skillman, Stewart, Pierce)
- Youth Law Center

## Attachment and Biobehavioral Catch-up

- 10 session intervention delivered in foster parents’ homes
- Targets issues identified empirically as challenging
- Videofeedback central
- Critical issues
- Identifying times when parents are motivated
- Strength based
- Talented interventionists

## Targets several key issues

- 1. Babies in foster care especially need nurturing care
- 	a. Babies in foster care often push caregivers away
- 	b. Caregivers’ own issues often get in the way of their providing nurturing care
- 2. Babies in foster care need help developing self-regulatory capabilities

## Issue 1a: Babies in foster care behave in ways that push caregivers away

- Sequential analyses reveal that child’s behavior reliably elicits complementary behavior from parent

## Targeting issue 1a: Re-interpreting children’s cues

- Child needs you even though he or she may not appear to need you

## Issue 1b: Caregivers’ own issues get in the way

## Targeting Issue 1b: Caregivers’ own issues get in the way

- Over-ride issues
- Become aware of “voices from the past”

## Issue 2: Foster children have difficulty regulating behavior and physiology 

- Behavior
- 	Problem behaviors
- 	Deficits in inhibitory control
- Physiology
- 	Atypical production of cortisol

## Cortisol production

- Preschoolers and infants/toddlers differ from comparison children
- Among preschoolers in foster care:
- Many have low levels in the morning
- Some have high levels at one or more times
- 	(Fisher et al., Dozier et al.)
- Among infants in foster care:
- Many have high levels at one or more times
- 	(Dozier et al.)

## Wake-up and bedtime cortisol levels of infants and preschoolers in foster care

## Targeting issue 2: Help young children regulate behavior and physiology

- Following the child’s lead in play;
- attending to child’s signals
- (Barnard, 1998; Van den Boom, 1994)

## Targeting issue 2: Help young children regulate behavior and physiology

- Touching, holding child (Field, 1994)

## Targeting issue 2: Help young children regulate behavior and physiology

- Facilitating expression of emotions (Izard, 2003)

## Efficacy data 

- Randomized clinical trial
- 	150 children randomly assigned to:
- 	Attachment and Biobehavioral Catch-up
- 	Educational intervention

## Attachment quality among Attachment and Biobehavioral Catch-up and control intervention children

## Problem behaviors among children in Attachment and Biobehavioral Catch-up and treatment control children

## Cortisol production among children in Attachment and Biobehavioral Catch-up and treatment control groups

## Cortisol production among children in Attachment and Biobehavioral Catch-up, treatment control, and non-foster comparison groups

## Attachment and Biobehavioral Catch-up

- Effective, efficient prevention program
- There’s a need for it
- “If you build it, they will come” (Field of Dreams)

## Why Sell The Program

**Notes:**
It’s Worth Selling The Program
What administrators don’t know can hurt the children they care for
undignified

## The Need

## Who are the decision makers?

- Child Welfare Administrators
- Political Figures
- Community leaders
- Foundations
- Advocates
- Staff

## B

*B*

## Reasonable time frames

- Change takes time
- but
- Times change

## Permanency for Youth
Teens leaving care
Education

- Teens leaving care
- Education

- Tipping

- ......points

## The Time for Babies is Now