INTERVENTION STUDIES WITHIN CHILD SERVICE SETTINGS
SUMMARY
This session was chaired by Amy Goldstein (NIMH). Craig Ramey (Georgetown University) presented some basic principles derived from first-generation prevention research programs, including Abecedarian, Perry Preschool, and Chicago Child Parent Centers; David Olds (University of Colorado) discussed the research trials designed to test and refine the Nurse-Family Partnership, a home visiting nurse program for disadvantaged first-time mothers; Thomas Dishion (University of Oregon) spoke about an ecological approach to intervention in early childhood, The Early Steps Project, which embeds the Family Check-Up intervention into the Women, Infants, and Children (WIC) service setting; and Philip Fisher (Oregon Social Learning Center) presented an early intervention for foster children and looked at children's attachment, stress neurobiology, and long-term placement outcomes. Highlights from the discussion, which was moderated by Harolyn Belcher (Kennedy Krieger Institute), focused on effective interventions that can reach young families through existing service systems, like WIC, Head Start, or foster care, and on how the most vulnerable children and families are often the most motivated and responsive to the interventions.
Principles to Help Guide Next Generation Interventions: Some Examples from Randomized Controlled Trials Concerning School Readiness
Craig T. Ramey, Ph.D.
Principles that support effective early childhood interventions (timing, intensity, direct learning experiences, breadth of services and supports, individual differences, and environmental maintenance) are presented within the context of a comprehensive, multilevel, contextual (biological, social, environmental) developmental model. To illustrate the principles, research findings from the Abecedarian Preschool Program (from 18 months to 21 years); Project CARE, a replication of the Abecedarian program; and the Infant Health and Development Program are presented. For example, findings from the Abecedarian Preschool Program are used to illustrate that the timing of an intervention—when it begins and ends—can influence outcomes. The principles are relevant to developing the next generation of early childhood interventions and the implementation of evidence-based early childhood interventions in service settings.
Using Randomized Controlled Trials to Test and Refine the Nurse-Family Partnership
David L. Olds, Ph.D.
The Nurse-Family Partnership (NFP) is a program of prenatal and infancy home visiting by nurses for socially disadvantaged mothers bearing first children. The nurses have three major goals: (1) to improve the outcomes of pregnancy by helping women improve their prenatal health; (2) to improve the child's subsequent health and development by helping parents provide more competent care of the child in the first 2 years of life; and (3) to help parents become more economically self-sufficient by helping women plan subsequent pregnancies and helping them make appropriate choices about finishing their education and finding work. To evaluate NFP, scientifically controlled trials were conducted first with a sample of White women living in semi-rural Elmira, New York; then with a large sample of Black women living in Memphis, Tennessee; and more recently with a sample that included a large number of Hispanic women in Denver, Colorado. The Denver trial also examined NFP impact when delivered by paraprofessional visitors. Results showed that the program has produced consistent and enduring impacts on each of the domains targeted by the program. Results of each trial were used to focus subsequent trials and to identify areas of program vulnerability so that program improvements can be made. As the program is replicated in new communities throughout the United States, careful attention is given to faithful reproduction of essential program elements. The program is adapted and tested before it is applied to new populations, societies, or cultures.
An Ecological Approach to Intervention in Early Childhood: The Promise of Embedding the Family Check-Up into Service Delivery Settings such as Women, Infants, and Children (WIC)
Thomas J. Dishion, Ph.D.
In this presentation, an overview of an ecological approach to family intervention and treatment (ecoFIT) as applied to the Women, Infants, and Children service setting in early childhood is provided. Also, the Early Steps Project, a randomized trial of the ecoFIT model, is described, and outcome data are presented. The Early Steps Project involved 731 families distributed across rural, suburban, and metropolitan settings. When the children were ages 2 and 3 years, the families were offered a family check-up in addition to linked interventions tailored and adapted to the families' needs. Assessments were conducted at ages 2, 3, and 4 years. The findings from the first 3 years of the project revealed that the intervention improved child behavior problems, especially for the most problematic children; improved direct observation measures of parents' positive behavior support; and reduced maternal depression. Improvements in child behavior problems were mediated by improvements in positive parenting. The effects were observed after approximately 3 hours of contact per year. These findings suggest the effectiveness of brief family-centered interventions delivered in a public health setting to prevent the early emergence of mental health problems in young children.
Early Intervention for Foster Children: Effects on Children's Attachment, Stress Neurobiology, and Long-Term Placement Outcomes
Philip Fisher, Ph.D.
Children in foster care are often perceived as globally at risk for poor outcomes, yet the specific nature of the risks they face and the extent to which outcomes may vary for individual foster children are poorly understood. Key findings of an ongoing research program focusing on foster preschoolers are described: (1) although many children are adrift in the foster care system, others readily achieve permanent placements, although the likelihood of permanency decreases as the number of placements increases; (2) variations in foster children's maltreatment experiences and placement histories are associated with specific deficits in certain neurobiological systems (the hypothalamic-pituitary-adrenal system and the prefrontal cortex), which are, in turn, associated with poor psychosocial outcomes; and (3) early intervention for foster preschoolers works. In the context of a randomized trial to evaluate an intervention, evidence was obtained to support the assertion that early intervention in this population is efficacious in improving and/or stabilizing functioning in neurobiological systems affected by early stress; impacting the elements of caregivers' behavior towards children most critical to the healthy development of these neurobiological systems; increasing foster children's secure attachment-related behaviors; and increasing the likelihood of permanent placements. The intervention that has produced these results (Multidimensional Treatment Foster Care for Preschoolers) is described, and implications of these data for future research and policy are considered.
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