The Buffering Toxic Stress (BTS) Consortium: Testing Parenting Interventions in Early Head Start (EHS)

1. The Buffering Toxic Stress (BTS) Consortium:Testing Parenting Interventions in Early Head Start (EHS) Sponsored by the Office of Planning, Research & Evaluation (OPRE) within the Administration for Children & Families (ACF)

2. Goals • Each site must: • Work to empirically validate the assessment of toxic stress • Test a promising intervention(s) • Evaluate intervention implementation • Include assessments of the hormone cortisol

3. Research Sites & Principal Investigators • New York University: Clancy Blair & C. Cybele Raver • University of Colorado: Michelle Sarche & Misty Boyd • University of Delaware: Rena Hallam, Myae Han, Jason Hustedt, & Jennifer A. Vu • University of Denver: Sarah Enos Watamura • University of Maryland: Lisa Berlin & Brenda Jones Hardin • Washington University: John N. Constantino

4. Intervention Required Components • Each site selected their own intervention based on their sites specific needs and resources, and their estimation of the research body behind each • All interventions target parents as the first critical support for infants and toddlers – and the barrier between what is tolerable and what is toxic • Families served must be attending Early Head Start programming of some type (home visitation, center care etc.)

5. Interventions by Site • New York University: Play and Learning Strategies (Pals) • University of Colorado Anschutz Medical Campus: Parent-Child Interaction Therapy (PCIT) & Mindfulness-Based Emotional Availability Intervention • University of Delaware: Promoting First Relationships (PFR) • University of Denver: Filming Interactions to Nurture Development (FIND), and FIND+ Parent Focused Support • University of Maryland: Attachment & Biobehavioral Catch-up (ABC) • Washington University: Incredible Years Toddler Basic Parenting Program (IYT)

6. New York University • Intervention Name: Play and Learning Strategies (PLAY) • Intervention Developer: Landry • Population: primarily low income Latina mothers and children • Location: New York City • Intervention components: • Family coaches deliver the intervention by visiting families on a weekly basis over the course of three months • Each session includes a discussion of the parent's practice during the preceding week; introduction of the new topic; viewing of educational videos demonstrating the skill; guided, videotaped practice using the skill with her own child; review of the videotaped practice; and planning for practice during the upcoming week.

7. University of Colorado Anschutz Medical Campus • Intervention Name: Parent-Child Interaction Therapy (PCIT), and Mindfulness Based Emotional Availability Intervention (MEAI) • Intervention Developers: PCIT - Eyberg; MEAI – Beringen • Population: American Indian • Location: A mid-western state (not Colorado) • Intervention components: • PCIT first mastery is obtained with following the child’s lead in play; then behavioral management strategies are taught • MEAI is a 4-session group format parent training in stress management and being in the moment to support emotional availability to children

8. University of Delaware • Intervention Name: Promoting First Relationships (PFR) • Intervention Developers: Kelly, Zuckerman, Sandoval, Buehlman) • Population: 45% African American; 35% Hispanic/Latino; 15% White • Location: Delaware • Intervention components: • 10 sessions, videotaped feedback, strengths based, focused on 5 components (offering love and attention every day; responding with empathy and understanding; providing comfort when upset; offering a predictable world; and promoting play and exploration

9. University of Denver • Intervention Name: Filming Interactions to Nurture Development • Intervention Developer: Phillip Fisher • Population: 60% immigrant families; majority Hispanic families • Location: Denver metro area • Intervention components: • Video-coaching method; 10 sessions; strengths-based; uses micro interactions and very short clips to illustrate them; works on 5 building competencies (sharing the focus of attention; supporting and encouraging; naming; back and forth; endings and beginning)

10. University of Maryland • Intervention Name: Attachment & Biobehavioral Catch-up (ABC) • Intervention Developer: Dozier • Population: • Location: Maryland • Intervention components: • Videotaped, uses highly trained coaches, near continuous “in-the-moment” coaching feedback, focuses on nurturance, following the child’s lead, and non-frightening caregiving behavior

11. University of Washington • Intervention Name: Incredible Years Toddler Basic Parenting Program (IYT) • Intervention Developer: Webster-Stratton, Reinke, &Herman • Population: • Location: Youth in Need sample drawn from urban, suburban, & rural Missouri • Intervention components: • 4-8 sessions depending on child age; emphasis on child-directed play, emotion “coaching,” praise and encouragement, management of common early childhood tasks, and parental self-control

12. Shared Intervention Components • Careful assessment of family characteristics • Attachment/positive parenting focus • Theoretically grounded • Most are relatively short interventions (4-16 weeks) • Most include videotaping • Most involve coaching

13. Differing Intervention Components • Strengths based only vs. strengths based and corrective • Who delivers the intervention (EHS providers, outside coaches etc.) • Level of training needed for interventionists • Sample sizes and populations served • Type of control or comparison group • Study location

14. BTS Consortium Timeframe • $12,000,000 awarded in September, 2011 • Study length: 5 years • Expected conclusion date: August 2016 • First data available: 2014 • Complete data available: 2017