Niels Peter Rygaard Fair Start. Clinical Psychologist , auth . by DPA, Denmark. ISSPD member

1. FAIR STARTLINKING SCIENTISTS AND CAREGIVERS:NON PROFIT ORPHANAGE STAFF AND FOSTER FAMILY DEVELOPMENT AND EDUCATION- research applied in childcareToday: Project background. Program design and rationale.Demonstration of session elements Niels Peter Rygaard Fair Start. Clinical Psychologist, auth. by DPA, Denmark. ISSPD member

2. PRESENTER • Since 1981 I have worked as a child psychology consultant with deprived and maltreated children, their families and their professionals. Some research, I mostly practice. • In a state treatment home, with foster care families, adopted children, and as a consultant for treatment organizations (Government adoption staffs, special needs schools and institutions, adoptive families, youth prisons, etc.). • My area of interest is how the organization of social work affects child brain and personality development. • After writing a book about attachment disorder treatment, I was invited to orphanages and universities globally 2005 - 2007.

3. Translations in: • Romanian • German • Spanish • Italian • Portuguese • French • (& Turkish and Russian, unpublished) WWW.ATTACHMENT-DISORDER.NET

4. AFTER 30 YEARS I ASKED MYSELF: • Can you support orphan caregivers with science-based psychology knowledge in: • - child neurology research on stimulation • - attachment based care giving principles • - organizational development research • Paper describing the scientific rationale behind the project: • http://www.clinicalneuropsychiatry.org • “quick search”: Rygaard.

5. PROJECT BACKGROUND2006-08Analysis of the orphan population.Analysis of the situation for the organizations and professionals who are in care of the world orphans. Research surveys, -network, educational design The basic ideas for educating/ involving care givers and improve the way they organize daily care.

6. The orphan population:The Invisible People • Globally 2003: 143.000.000 children (= same size as the entire population of Russia) The number is increasing: perhaps 170 mio. now • Europe: 1.500.000 children are orphans • Younger than three in public care: 45-90.000 • More than 80 % have live parents! • (make programs to help parents keep newborns after birth) This population frequently has problems even before being placed in public care: poor genetic, pregnancy and birth circumstances.

7. Long term consequences of low quality care andpoor organization of daily child care.(From Rutter’s study of orphans adopted from Romania) • Howmanychildrenadoptedbefore age 2 with a problem still had this problem at age 4: • ADHD-likebehavior: 92 % • ”InstitutionalAutism” behavior: 91 % • Stereotypies (repeatsmeaninglessbehavior) 71 % • Aggressive behavior 69 % • Indiscriminate social contact 67 % • Self-mutilating 60 % • Extremewithdrawal 50 % • Sleeping problems 43 % • Eating problems 38 % • Apathicbehavior 21 % • In general: delays in physicalgrowth, lack of braindevelopment, unstable CNS function, impairedsensory and motor development, severedelays in emotional, social and cognitivefunction. Conclusion: intervention should start before age 3.

8. Effects of deprivation: girl at age 17(from the Bucharest Intervention Study)

9. The situation for professional care givers - they often: • Have low social status and no public attention • Little access to professional care education • Work from outdated organizational concepts (harmful to child development) • Often change jobs • Have little job satisfaction and payment • Face many prejudices about orphans • Work with a very difficult group of children

10. 3 CONCLUSIONS AND 1 IDEA • A: The most important period for intervention is from the start of pregnancy to age 3. • B: Early care can be much improved at no extra cost by relevant organization/ re-conceptualization of child care. • C: Care givers are often isolated, have low social status, work from outdated organizational principles and have no access to education. • Idea: Why not make a free internet based education/ development program - in local languages, produced by local participants, based on psychology knowledge?

11. ECONOMIC POVERTY IS NOT THE MAIN ISSUE - SOCIAL POVERTY IS! • To live in - and belong to - a social group is more important for child development than anything else - economic status, ethnicity, etc. • To have a few continuous caregivers from birth to school age is just as important. • Child poverty: Not having caregivers and being excluded from society. • Look what they did in Arequipa! Only 5 caregivers around the clock, and 36 orphan girls in the midst of poverty and slum:

13. Fair Start Project Organization 2008 - 2010:Who?When?Where?How?

14. PROJECT START 2008 • PRESENTER STARTED A PROJECT GROUP WITH: • The School for Social and Health Education, the media department, Aarhus, Denmark (project management and EU grant application). • Supported by The Danish Psychologist Association, DPA and the State Adoption Council. • We invited EU project partners from 7 European countries – and local orphanage/ foster family leaders from 5 countries.

15. Fair Start Program 2008-2010 • 2 year program supported by the European Union Leonardo Division with 200.000 Euro. • Goal: To design and real life test programs for quality care in European orphanages and foster families. • On this basis: recommend European standards for education in care for children 0-3 placed outside home.

16. PROJECT ORGANIZATION • Method: Unite the three important groups - • – Care givers and their leaders: • - Decision makers: • - Scientists: • If they don’t all involve and cooperate, projects tend to fail.

17. AN INTENTION OF THE EU Leonardo Division: The Lifelong Learning concept • Learning starts at birth! Social competence and learning skills depend on the quality of early care. • Orphans are often excluded from lifelong learning and productive citizenship – because the number of stress factors in early life prevent normal emotional and social development. 57 % never get a job. • They are socially excluded from their families, and often from society in general. • Many programs address older children – but by age 7, many orphans already suffer severe damage from neglect, deprivation, and lack of quality care.

18. PROJECT PARTNERSThe Danish project group & EU partners and their orphanage/ foster family leaders from: • Romania • Turkey • Spain • Italy • Crete • Austria (project consulting, Die Berater) • Switzerland (project consulting, Seedlearn.org)

19. RESEARCH SURVEY & NETWORK: orphans, treatment, the organization of care and outcomes • Dr. René Hoksbergen from the Netherlands, University of  Utrecht, Faculty of Adoption studies. Charles Zeanah of Tulane University, U.S. of A. who conducted the Bucharest Intervention Study (moving children from “Hospital” orphanages to foster care families), C. Hamilton-Giachritsis, Psychology at Birmingham Un.,  Robert McCall & Christine Groark, University of Pittsburgh, Office of Child Development. Mary Dozier, Delaware Un. (foster family attachment studies and training), AnnikaMelinder, Child Psychology Department, Un. of Oslo. SheylaBlumen, Psychology Dpt. Of Universidad PontificaCatolica in Lima, Peru, Jorge Barudy and Maryorie Dantagnan from Spain/ Chile (children exposed to violence), Michael Rutter group, FemmieJuffer, van Ijzendoorn & many others.

20. TYPES OF APPLIED RESEARCH • EARLY STIMULATION AND BRAIN DEVELOPMENT – How does physical stimulation and the environment affect infant brain development? • STUDIES OF ORPHAN CARE PRACTICES AND CHILD DEVELOPMENT OUTCOMES - attachment theory and research concerning secure style caregiver behaviour? • ORGANIZATIONAL DEVELOPMENT RESEARCH – how does leadership, leader/staff relations and staff relations affect child attachment quality and peer relations?

21. THE 7 FAIR START PROJECT PHASES • Phase I 2008 – March 2009: • Setting up: a project management group, EU partners, practitioner group, media group, quality standard group, scientist network group. • Website www.fairstart.net , research survey, partner meetings, partner´s establish network of local institutions/ foster family managers who want to practice the program and create local models. Setting up preliminary quality indicators for: Care, relations, group level, organization, EU standards

22. PHASE 2: 9 MONTHS • Involving local institution and foster family leaders from the 5 partner countries in the program. • Developing local models for training and development. Partners start local initiatives and focus groups. • 4 day training for leaders/instructors in Denmark: How to be a leader and instructor in the program.

23. PHASE 3 – 9 MONTHS • Testing first version of program in partner countries. Program locally translated. • Producing further digital material – examples from institutions using the program, participants produced video demonstrations of quality care practices. • Discussions of preliminary results and adjustments.

24. PHASE 4 - 15 MONTHS • Leaders test the program in their workplaces. • Local institutions evaluate their work with the program. • Adjustment of materials and quality indicators. • Establishing a transnational community of professional caregiver organizations: NGO and government organizations.

25. PHASE 5 – 15 MONTHS • 2 day participant´s evaluation feedback and further training in Denmark. • Testing 2nd version of materials. • Final set of recommendations for the Fair Start Model. • Final set of evidence based Quality Indicators.

26. 5 Level Quality Indicators • Government involvement. • Focus group involvement: local politicians, researchers, learning institutions, professionals. • Local institutions and foster family organizations involvement. • Leader, instructor and staff motivation and cooperation competence. • Staff/ child group relations and daily care routines. • Individual staff/ child relation care practices.

27. PHASE 6 – 22 MONTHS • Preliminary recommendations: suggesting EU standards for professional care development and education. Fair Start conference Istanbul, 14. – 15. Sept. 2010. 3 conference groups participated: Scientists, decision makers, practitioners.

28. PHASE 7 – 22 MONTHS • Final recommendations for quality standards, indicators and educational methods. • Final version of local organizational development program. • Final version of internet training program in English, Turkish, German, Romanian, Greek, Italian and Spanish/ Catalan.

29. Next step: The Global Project • 10 – year project based on voluntary work. The Fair Start edition is the platform so far. Fair Trans project applied for. • For 3rd World orphan care education, in local languages (Chinese, Spanish, Bahasi, Hindi, Arab, etc.), internet based. Starting in Ethiopia and Greece 2011. Will be used in 8000 Indonesian orphanages. Is currently being translated to French, Russian, Ethiopian, Indonesian, Polish, Brazilian Portuguese, etc. by Translators Without Borders and private volunteers. • Various funding, so far 30.000 Euro from Danish Grundfos. • www.globalorhanage.net , click “video”, choose your language and watch one of 4 tutorials.

30. II: Program design & rationale- from research to quality care practices

31. Program principles • To maintain that local partners in the program (orphanages, foster families, etc.) areactive co-developers of good practice. Participants share the basics and theory of quality care and organization – they alone decide how to practice these principles in their foster families/ institutions. • To increase early brain activity and development by daily stimulation. • To develop coherent care and long term caregivers in order to promote secure attachment in children. • To develop family like groups for the children in order to promote normal attachment and social skills. To promote individual identity development. • To support peer relations in family groups for attachment and social development. • To provide basic social, emotional and cognitive learning opportunities for children, preparing for school learning competences. • To let the children participate in society life and create communication between the institution/ foster family and the local environment.

32. Program design –how to use the e-learning site or DVD Go to www.fairstart.net/training or open DVD, choose language. Open “Handbook for leader and instructor” as printable PDF file. Leader appoints an instructor: the leader is responsible for planning and monitoring the education. The instructor is responsible for planning educational sessions and supporting implementation in daily work. Leader: Secure Base Scorecard to assess staff motivation, relations and attitudes prior to start and after education. Instructor: Secure Base Scorecard to assess daily care practices and routines before and after. In dialogue, leader and instructor decide three organizational and three care practice focus goals for the educational curriculum.

33. PRESENTING THE PROGRAM FOR STAFF OR FOSTER FAMILY GROUP • Leader and instructor present co-operational and care practice goals decided to be focus points. • The entire program takes 1-2 years. Leader and instructor can also decide to use only specific sessions to achieve partial goals decided upon. • The program is used in the workplace during 2 hour extended staff meetings or work sessions. • Technical equipment required: a projector with a sound connection. A room to work in.

34. The 15 Sessions • Each session is divided into • First part: Understanding theory, discussing and comparing how theory demonstrated is related with current practices and concepts in the workplace. • Second part: discussing and planning how you will practice what you learned when you leave the room. Including how you can video or take photos of “before” and “after” changing practice. Users are active practice designers. • When you start a new session, the assembly is asked to evaluate cooperation since the last sessions.

35. IMPORTANT ELEMENTS • Program design does not just aim at new care practices. It invites participants to design care. • It aims at creating an open, trustful and reflective discussion forum in staff, and between leader and staff. • A common set of values, knowledge and a video “library” for education and documentation. • It aims at developing professional dialogue, concepts and attitudes in the workplace with a common understanding of roles, challenges, solutions and responsibilities.

36. Program contents and progression • From individual staff knowledge about child care, loss, attachment and small practical tasks, the program gradually moves to a professional understanding of attachment: • Attachment theory. • How to practice attachment based care. • How to understand child behaviour as responses to loss and separation. How to respond to insecure attachment behaviours.

37. Program contents • Why the Hospital Model of care is harmful to child development – how to revise your practices and attitudes towards The Secure Base Model of care. • Designing infant brain stimulating routines in daily practice planning. • Supporting permanent caregiver/ child relations development by revising the work plans. • Supporting peer relations development in child groups.

38. Program contents • Activities for supporting basic learning abilities necessary for school level learning. • Breaking down social barriers between workplace and the local community. • Evaluating the entire development process of the institution (re-scoring the original goals) • Planning future initiatives and developments. • All is supported by video examples, trial and error questions, discussion and reflection setups, etc.

39. INFO Project site: www.fairstart.net To open training program: www.fairstart.net/training Background paper: www.clinicalneuropsychiatry.org , search “Rygaard” • Global Orphanage Program: www.globalorphanage.net click “video”, choose language, choose between 4 tutorials • Book: “Severe Attachment Disorder”: • www.attachment-disorder.net Click flag – links to local Amazon pages in different languages. Turkish: "Çocukluk döneminde ağır bağlanma bozukluğu pratiğe yönelik terapiye giriş”Unpublished. Romanian: ”Tulburarilesevere de Atasament in copilarie” Polirom. For program use, project description, research and EU recommendations papers please mail: npr@erhvervspsykologerne.dk Video: Rygaard about attachment and orphan care on Youtube: http://www.youtube.com/results?search_query=la+teoria+dell%27attaccamento+rygaard&aq=f