Helen Henningham School of Psychology

1. Using Government Services to Improve the Development andBehaviour of Young Jamaican Children: Interventions for the Home, the Clinicand the School Helen Henningham School of Psychology

2. Why is early childhood important? • Brain development most rapid and vulnerable from conception to 5 years. • Experiences in early childhood can have lasting effects on children’s ability to learn and their behaviour. • Interventions are more cost-effective than at other ages. • Without quality early childhood care children arrive at formal schooling with deficits in cognitive and social skills. This detrimentally affects their school progress.

3. Millions of children < 5y not fulfilling their potential in development (WHO, 2006; UNICEF 2006) 219m (39% of children <5y) 156m 126m Stunted + Poverty not stunted StuntedPovertyDisadvantaged < -2z scores < $1/day (Poor &/or stunted) HAZ

4. Loss of yearly adult income • Deficit in grades attained (Brazil) • Deficit in learning per grade (Phillipines, Jamaica) • Estimate total deficit (1+2) 20 % loss of yearly adult income

5. Conclusion Loss of children’s potential is an enormous problem affecting >200million It has economic and social costs both to individual and nations

6. Interventions for the Home

7. Importance of stimulation • Unstimulating environments and lack of quality parent-child interaction are major risk factors for poor development

8. Stimulation:Weekly 1hr home visits by community health aides. Play session with mother and child. • Focus on: • Enhancing maternal-child interactions • Language • Praise • Showing mother how to promote development through play

10. In Jamaica, we have shown benefits of psychosocial intervention to children’s development as well as mothers’ child rearing knowledge and practices

11. Children enrolled at age 9-24 months received 2 years of intervention Followed up at age 22 years

12. Benefits of Stimulation at age 22y: IQ p=0.02 p=0.003 p=0.004

13. Benefits of Stimulation at age 22y:Education p=.005 p=.004 p=.014 Reading Maths General Knowledge

14. Benefits of Stimulation at age 22y:Psychological Functioning p=.03 p=.05

15. Benefits of Stimulation at age 22y:Reduced violent behaviour p=.06 p=.04

16. Interventions for the Clinic

17. Parenting DVDs Developed 9 modules (3 minutes each) • Love • Comfort • Talk to baby • Bath time • Toys • Praise • Books • Drawing • Puzzles

18. Health Centre Intervention • 3 modules were shown at each Child Health clinic when the subjects: • 3 months • 6 months • 9 months • 12 months • 18 months

19. Group discussion & demonstration with mothers • Discuss the video with caregivers • What did they see on the video • What can they do with their baby • Practice • Praise caregivers and label what they are doing • Song or Game • Homemade toy • How to make it • How to use it

20. During Nurse Consulation • Nurse asks mother what she saw on the video and what she thinks she could try • Gives mother a message card and reads it through with her • Encourage mother to try these behaviours at home • If the mother has not yet seen the video encourage her to watch it

21. Supplements to DVD –Message cards, Books and Puzzles

22. Interventions for the School

23. School entry Children with social, emotional and behavioural problems • Poor parent-teacher relationships • Poor relationships with teachers • Peer rejection • Low participation in the classroom • Continuing behavior problems • Low level of bonding to school • Associate with deviant peers • Low academic achievement Primary school

24. Primary school Aggressive & disruptive behaviour Juvenile delinquency Truant / dropout from school Substance abuse Depression & suicide ideation Adolescence Crime and violence Antisocial personality disorder Low educational and economic attainment Adulthood

25. Content • How to create an emotionally supportive classroom environment • Praise, incentives, play, following child’s interests • How to be proactive to prevent problems • Classroom rules and routines, keeping children engaged, ‘with-it-ness’ • Dealing with child misbehaviours • Ignore, redirect, consequences • Teaching social skills to children • Sharing, asking, waiting, trading

26. Process • Video vignettes of Jamaican classrooms • Group discussion • Role plays • Practical activities • Small group work • Classroom assignments • In-class support: modelling, coaching & praising

27. Build on Teachers’ Previous Knowledge • Brainstorm at the beginning of each new topic: • Advantages, disadvantages, barriers • What are the advantages of attention, encouragement and praise: • To children • To teacher-parent relationships • To teacher-child relationships • What are the barriers to praising children: • In general • For the more difficult children

28. Small Group Activities • Activities given to small groups: • e.g. Scenarios involving child misbehaviour and group must decide what strategies they would use • Groups role play their solutions for the whole group • Detailed feedback on strategies used by the group: • What was good • Why was it good • Whole group brainstorms other strategies that may be used

29. Classroom Rules: Quiet hand up Walking feet Inside voice Eyes on teacher Friendship Skills: Sharing Waiting Asking Taking turns Teaching Skills to Children

30. Explicitly teach children examples and non-examples of the skill Have a visual aid Let children role play the skill Practice the skill in different contexts during the day Promote children’s use of the skill – e.g. praise children who are using the skill throughout the regular school day How to Teach a Skill

31. In-Class Consultations • Boost teacher confidence and motivate them to use the strategies consistently • Help teachers to problem-solve • Help tailor strategies to fit the classrooms • Promote continued use of strategies over time

32. Classroom Assignments • Practice a specific skill taught in workshop • E.g. Labelled praise, ignore minor misbehaviour • Record on prepared sheet • What child was doing • What teacher said / did • Observe and record the effect on child/ren • What child did or said • How child was feeling

33. Results: benefits to children

34. Change in conduct problems in intervened and control classrooms Teacher Report Observations p<0.01 p<0.01 Parent Report p<0.05 Intervened Control

35. Change in friendship skills in intervened and control classrooms Teacher Report Observations p<0.001 p<0.001 Parent Report p<0.05 Intervened Control

36. Results: benefits to teachers

37. Change in observations of teachers’ classroom behavioursin intervened and control classrooms Teacher Negatives Teacher Positives p<0.001 p<0.001 Intervened Control p < 0.001; Values are median frequency / 90 minutes of observation

38. Change in observed teacher interactions to high risk children in intervened and control classrooms Teacher Positives Teacher Negatives p<0.001 p<0.001 Intervened Control p < 0.001; Values are median frequency / hour of observation

39. Percentage of teachers using physical punishment through observation % ns

40. New Initiatives • Developing and evaluating an integrated intervention to promote child development from conception to age 5 to be embedded in existing government services in rural Colombia (with University de los Andes, Bogota & Institute of Fiscal Studies, London) • Developing and evaluating a combined intervention of CBT for depression and early stimulation for depressed mothers and their infants in rural Bangladesh (with the International Centre for the Diarrhoeal Disease Research, Bangladesh)

41. New Initiatives in Jamaica • Simplify and scale-up teacher training intervention for Jamaican preschool teachers • Pilot a consultative model of teacher training with Jamaican primary school teachers • Develop training materials and package the Jamaican home-visiting early stimulation curriculum for global dissemination on-line

42. Thank you for your attention DiolchynFawrIawn