# Presentation: 353723

## An Ecological Approach to Family Intervention in Early Childhood:Embedding Services in WIC Thomas J. DishionUniversity of Oregon&Child and Family Center Presented at:Intervening Early Conference, Sept 18-19, 2007

**An Ecological Approach to Family Intervention in Early Childhood:****Embedding Services in WIC**** *****Thomas J. Dishion***University of Oregon&Child and Family Center ***Presented at:****Intervening Early Conference, Sept 18-19, 2007*

## Slide 2

## Challenges in Providing Child and Family Mental Health Services to the Poor. 

**Challenges in Providing Child and Family Mental Health Services to the Poor.**** **

**1-Many services are paid by personal insurance and cover only DSM disorders.**
**2-State funded services are often poorly supported, ineffective, not research based, and in some cases possibly iatrogenic.**
_**3-Solution:**_** Embed affordable and effective interventions in agencies that have wide access and repeated exposure to children and families (Hoagwood & Koretz, 1996)**

## Three Goals of this Talk. 

**Three Goals of this Talk.**** **

**1-Provide an overview of the ecological approach to family intervention and treatment (ecoFIT).**
**2-Review findings from a pilot study applying the ecoFIT to high risk young families participating in WIC services.**
**3 - Review initial findings from a multi site outcome study applying the ecoFIT to high risk young families participating in WIC services.**

## What is an ecological approach to child and family therapy?

**What is an ecological approach to child and family therapy?**

## The Ecology of Self Regulation

**Entrained**
**Biosocial**
**Response**
**Patterns Relationship Dynamics**

**Child **
**Adjustment**

**Relationship Dynamics**

**Behavior Settings**

**Teachers**

**Parents **

**Peers**

**Spouses**

**Siblings**

**Schools**

**Home**

**Neighborhood**

**The Ecology of Self Regulation**

## Six Features of An Ecological Approach to Child and Family Interventions (Eco FIT)(From Dishion & Stormshak, 2006)

**Six Features of An Ecological Approach to Child and Family Interventions (Eco FIT)****(From Dishion & Stormshak, 2006)**

**is based on an *****empirically based model***** of child and adolescent problem behavior;**
**is *****family-centered*****, addressing adult leadership and support in the change process;**
**is *****assessment driven*****, with decisions regarding intervention needs following careful assessments;**
**targets *****social interactions***** with parents and peers to make long lasting change; **
**addresses *****client motivation to change***** as a core component;**
**utilizes a *****health maintenance model***** delivered in service settings that involve children and families;**

_**An ecologial approach....**_

## Parent-Child Relationship

- Parent Guided Socialization

- Peer Network Coalitions

**   ****Early                                Middle**
**Childhood                    Childhood                Adolescence                         **

**A Developmental Model for the Influence of Family and Peers on Child Adjustment **
**(from Dishion & Patterson, 2006)**** **

## +

**Potentially**

**Harmful**
**—**

**Beneficial**
**+**

- Unsupervised
- Peer Groups
**Peer Contagion**

- Child Self Regulation
- Adult Involvement
- Positive Relationships
- Behavior Management
- Skills

**A Broad Overview of Intervention Outcome Literature**
**(Dishion & Stormshak, 2007)**

## Research on the Effectiveness 

**Research on the Effectiveness **
**Interventions that Target Parenting**

## <date/time>

## Interventions that Address 

**Interventions that Address **
**Motivation to Change**

## An Overview of the ecoFIT Strategy 

**An Overview of the ecoFIT Strategy **
**(Dishion & Stormshak, 2007)**

## Service Systems Affecting Mental Health

- ORI, May 2002

**Service Systems Affecting Mental Health**
**of Children and Adolescents**

- Developmental
- Stage
- Early
- Childhood
- Childhood
- Early
- Adolescence
- Adolescence

- Public School
- Setting
- Community
- Programs:
- Treatment and
- Rehabilitation

**WIC, Preschools**

## Early Steps Pilot Project Research Design (N=120)

**Early Steps Pilot Project Research Design (N=120)**

**W.I.C. Services**
**Screening**
**Assessment**
**Random Assignment**

**FCU**

**Control**

## Three Year Effects on Parent Report Problem Behavior in Early Childhood.(Shaw, Dishion, Supplee & Gardner 2006)

**Three Year Effects on Parent Report Problem Behavior in Early Childhood.****(Shaw, Dishion, Supplee & Gardner 2006)**

- Effect size at age 4 = .45  sd

## Three Year Effects on Observations of Parent Monitoring in Early Childhood(Shaw, Dishion et al, 2006)

**Three Year Effects on Observations of Parent Monitoring in Early Childhood****(Shaw, Dishion et al, 2006)**

- Effect size at age 4 = .48  sd

## Early Steps Multi-site Research Design (N=731: Eugene, Pittsburgh & Charlottesville)

**Early Steps Multi-site Research Design ****(N=731: Eugene, Pittsburgh & Charlottesville)**

**W.I.C. Services**
**Screening**
**Assessment**
**Random Assignment**

**FCU**

**Control**

## Design of the Early Steps Multi Site Project (Dishion, Gardner, Shaw & Wilson)

**Design of the Early Steps Multi Site Project**** (Dishion, Gardner, Shaw & Wilson)**

_**Study Sample**_: 731 WIC Families with 				Toddlers
_**Design**_**:** Longitudinal follow-up age 2 to 5
_**Retention**_: 89% from ages 2 to 3
_**Ethnicity**_**:** 50.1% European American (n=366)
- 	       27.9% African American (n=204)
- 	       13.4% Hispanic/Latino (n=98)
- 		  8.6% Other (n=63)
_**Gender**_:    50.5% Male (n=369)
- 	       49.5% Female (n=362)

## Primary Caregiver ratings on Problem

**Primary Caregiver ratings on Problem**
**Behavior ****(Dishion, Shaw et al, under review)**

- 18
- 17
- 16
- 15
- 14
- 13
- 12
- 11

**Age 2****	****               Age 4**:

**  ****Age 2****	****              ****	****Age 4**

- 18
- 17
- 16
- 15
- 14
- 13
- 12
- 11

**I = Intervention**
**C = Control**

**Intensity T scores**

**I**

**I**

**C**

**C**

**I**

**I**

**C**

**C**

**High Risk**

**Typically Developing**

_**Intervention Effect (.16)**_

## Intervention Outcomes on Direct Observations 

**Intervention Outcomes on Direct Observations **
**of Parent Positive Reinforcement**

## Changes in Observed Parenting Mediates Reductions in Children’s Problem Behavior. 

**Changes in Observed Parenting Mediates Reductions in Children’s Problem Behavior. **

**Observed**
**Parent**
**PBS**
**Age 2**

**Observed**
**Parent**
**PBS**
**Age 3**

**Int PB**

**Slope**
**PB**

**.88***

**-11***

**Age 2 Ey.**

**Age 3 Ey.**

**Age 4 Ey.**

**(from Dishion, Shaw, Connell et al, under review)**

**Proactive**
**Ratings**

**Parent Invol.**
**Ratings**

**Observed**
**Pos. Rein**

**Observed**
**Int. Eng.**

**Proactive**
**Ratings**

**Parent Invol.**
**Ratings**

**Observed**
**Pos. Rein**

**Observed**
**Int. Eng.**

## Concluding Comments. 

**Concluding Comments. **

**1 Embedding family interventions within agencies such as WIC is feasible and cost effective (average # hours=3 for toddlers);**
**2 The families that are the most at risk are the most likely to engage in the FCU (single parents, teen mothers, low education, low income)**
**3 Although effect sizes are small, they are enduring overtime**
**4 Future work on the ecoFIT model will focus on improving engagement in skill-building interventions that focus on parents ‘positive behavior support’. **

**For more information: **
**tomd@uoregon.edu**
**http://cfc.uoregon.edu**

**Also See: ****Dishion, T. & Stormshak, E. (2007). **
_**Intervening in Children’s Lives: An Ecological, **_
_**Family-centered Approach**_**. APA: Washington DC**