c : a a based parenting program for parents of teens …

CONNECT:ANATTACHMENTBASEDPARENTINGPROGRAM

FORPARENTSOFTEENS2017

DAY1 DAY2 DAY3Morning•  Attachment&Adolescence•  TraumaandAttachment•  Aggression&Attachment

Connect–Overview&Evidence

Afternoon•  Connect-Sessions1-4•  PrepforDay2Practice

Session

Morning•  PracticeSessions

1-4Afternoon•  Sessions5-8•  PrepforDay3

Exercises

Morning•  PracticeSessions5-8Afternoon•  Session9•  FeedbackSession•  BoosterSessions•  StartingyourGroup•  ClinicalSupervision•  WrapUp!

2017 CPG TRAINING WORKSHOP MORETTI

English, French, Swedish & Italian

English & Swedish

English & Swedish 2017 CPG TRAINING WORKSHOP MORETTI

ReclaimingConnections

�  Acknowledgesandrespectsculturaldifferencesinchildrearingpractices.

�  Collaborativelydevelopedwithanunderstandingofcolonialism,historicalandcontinuingtraumaofAboriginalpeoples.

TransformingConnections

�  Addressesuniquechallengesofparentsoftransgenderyouth.

�  Tailoredtochallengesencounteredbytransgenderyouth;theirneedforsupportandacceptancefromtheirparents

“...startingduringthefirstmonths…andextendingthroughtheyearsofchildhoodandadolescenceinhisrelationswithboth parents, he builds up working models of howattachmentfiguresarelikelytobehavetowardshiminanyofavarietyofsituations;andonthosemodelsarebasedallhisexpectations,andthereforeallhisplans, for therestofhislife.”(Bowlby,1973,p.418)

2017CPGTRAININGWORKSHOPMORETTI

Ø  Designedtoensuresurvival.

Ø Observedacrossspecies.Ø  Constantsystemthatmonitors‘real’or

‘perceived’threat.Ø  Ifthreatisexperienced,attachmentsystem

dominatesoverothersystems.


�  “CRADLETOGRAVE”BUTITISEXPRESSEDDIFFERENTLY

�  Acrossage&development�  Acrossculture�  Acrossindividualsasaresultoftheirexperiencesin

relationships;theirlearningchallenges;mentalhealthchallenges

� Whenthreatisnotpresent,relationshipscanprovide‘securebase’forexplorationanddevelopment.


� Throughrepeatedexperienceinrelationships,wedevelopa“strategy”totellotherswhatweneedandthisisexpressedinbehavior.�  Easiesttoseewhenwearestressed,e.g.,whenwearesick,afraid,orinconflict.

�  Thestrategydependsonpastexperiences.

“AttachmentSuitcase”� Canbeconsistent,inconsistentordisorganized.� Representsthebestwayeachpersonhaslearnedtohavetheirattachmentneedsmet.


�  VIEWOFOTHER:Canand

willothersrespondeffectivelytocallsforsupportandprotection?WilltheybethereformeifIneedthem?Cantheyhelp?

�  VIEWOFSELF:Istheself

worthyofcareandsupport?AmIlovableorunlovable,despicable…oramIinvisible?


Whenthebalanceistowardsecurity…


PerceivedThreatorDanger

APPROACHSeekproximitytoAttachment

Figure

SoothedReassured

Explore

CaregiversRespondConsistentlyandEffectively•  Developapositiveviewofothersandapositiveviewof

self•  Approachwhendistressed•  SAFEHAVENèSoothing,regulating•  SECUREBASEèExploretheworldknowingothersare

thereifneeded

Ø AttachmentInsults

Ø AttachmentInjuries

Ø AttachmentTrauma


InsecureAttachmentStrategies

InsecureAttachmentPatterns,DisorganizedAttachment,ReactiveAttachmentDisorder

Ø  Level1:Caregiversfailtoattendandrespondtochild’sbidsforcomfortandsupport–passivebreachesinsensitiveresponding.

Ø  Level2.Caregiversrefusetoattendtochild’s

bidsforcomfort–activebreachesinsensitivityandresponsiveness;betrayaloftrust.

Ø  Level3.Caregiversabandonandfailtoprotectachildinthefaceofthreat,asinneglect

Ø  Level4.Caregiversfrighten,threatentohurtorhurtachild,asinemotional,physicalandsexualabuse


Canhavedeepandlastingimpacton:Ø  Beliefschildrenformaboutthemselvesandothers,i.e.,contentoftheir“InternalWorkingModels”

Ø  Implicitknowledge”aboutselfandtheworldØ  “Proceduralknowledge”–strategiestonavigaterelationships,i.e.,“attachmentstrategies”

Ø  “Episodicmemory”–specificmemoriesassociatedwithattachmenttrauma.


Ø  Impactofattachmentthreatdependsonthecapacityofcaregiverstodetectthreatsandrepairtherelationship

Ø  Repairthatisexperientialandaffective–andoccurswithintherelationship–ismosteffectiveinmoderatingtheimpactofthreatstoattachmentsecurity

Ø  Repaircanpotentiallystrengthenattachmentsecurityandpromotegrowthinthecapacityofthechild(andtheparent)totoleratedifficultaffectandtodeepentrust


Whenthebalanceistowardinsecurity…


Caregiversrespondinconsistently…

•  Negativeviewoftheself–I’mnotgoodenoughtosustainlove•  Positiveviewoftheparent–theycan,iftheywish,meetmyneeds•  Hyperactivationoftheattachmentsystem•  ApproachStrategyèvigilance

LIMITEDSAFEHAVENANDSECUREBASE


APPROACH

LIMITEDSAFEHAVEN/LIMITED

SECUREBASE

ANXIETYCURTAILS

EXPLORATION

Anxious Ambivalent/Resistant or Preoccupied




AVOIDLIMITEDSAFE

HAVEN/SECUREBASED

ANXIETYLIMITS

EXPLORATION

Caregiverisconsistentlypunitive,unresponsiveorneglectful…

•  Negativesenseofself–I’mnotlovable•  Negativesenseofothers–caregiversarehurtful•  Hyperactivationofattachmentsystem•  Avoidancestrategy–maskattachmentneeds•  LIMITEDORNOSAFEHAVENORSECUREBASE

Anxious-Avoidant - Fearful



Anxietyisminimized,

suppressed,notexperienced

Donotapproachforsoothing

Donotuseothersforsecurebase

LOWANXIETY–DOESNOTTURNTOADULTS

Caregiverisunavailable,unresponsive,neglectful…•  Falsepositivesenseofself•  Negativesenseofothers–worthless•  Avoidancestrategy–donotseeksafehaveorsecurebase•  Suppressionordeactivationofattachmentsystem

Anxious-Avoidant - Fearful


Infants/Toddlers Teens(e.g.,KarlenRuth-Lyons,GPACS)

• Contradictorybehaviour,e.g.,approachfollowedbyavoidance• Freezing,stilling,andslowed“underwater”movementsandexpressions

• Disoriented,distractedorcontradictorybehaviour(e.g.,stoppinginmidsentence;freezing)• Hostile,punitive,ordevaluingtowardparent(e.g.,criticalorrejecting;sharplydictatinghowparentshouldbehave)• RoleReversal/caregiving-attemptstomanageortakeoverparentrole(e.g.,offeringguidance;defusingtensionwithoverbrightbehaviour).

0

10

20

30

40

50

60

Secure Fearful Preoccupied Dismissing

Percen

tage

AttachmentPatternsAdolescentGirlsandBoysDiagnosedwithSeriousConductProblems

Boys

Girls


*Moretti, M. (2010) Attachment patterns in youth diagnosed with conduct disorder using the Family Attachment Interview

Thinkoftheyouthandfamiliesyouworkwith...

Whichattachmentstrategiesdotheyuse?

Howdoothersrepond?

Doesthispromoteattachmentsecurity?


Changes in: �  Neurological func3oning �  Cogni3ve func3oning �  Social-emo3onal func3oning �  Interpersonal Rela3onships �  Sexual Development

•  Prepubescentincreaseofgreymatter•  Selectivepruning‘frombacktofront’

linkedtosocialcontext•  Myelinationresultsingreatefficiency

inneurotransmission;increasedspeedandcapacityforcomplexinformationprocessing

•  Brainmaturationassociatedwithincreasedcapacityforcognitiveandaffectiveregulation

KendallPowellNeurodevelopment:Howdoestheteenagebrainwork?Nature442,865-867(24August2006)

HowardSercombe(2014)

“…theteenbrainisnotabrokenordefectiveadultbrain.It’sbeenexquisitelyforgedbytheforcesofourevolutionaryhistorytobeaverygoodteenbrain.”Giedd,inConan(2012)

“…attheveryleastthisevidenceindicatesthatasocietysubstantiallyinthehandsofyoungpeoplewouldnotnecessarilybeheadedfordisaster,andreinforcestheprinciplethathumansocietieshavesurvivedbecauseofthecapacitiesoftheadolescentbrain,notinspiteofthem” Sercombe,Howard(2014)."Risk,Adaptation,andtheFunctionalTeenageBrain".

CINAHL(BrainandCognition89):61–69.

�  Lessaggressiveandviolentbehaviors�  Lessexperimentationwithsubstanceuseandriskysexualbehavior

�  Greatercapacityformanagingfrustration�  Popularwithpeersyetlessinfluencedbypeerpressure

�  Betterabletomanagetransitiontohighschool.

�  Protectivebenefitissimilaracrossculture(Hilario,Saewyc,Johnson&Vo,2013).


AbilitytoATTEND,PERCEIVEANDINTERPRETverbalandnonverbalsignalsinachildandtorespondwithempathyandsupport.

Ø  Awarenessofsignals–requiresattentionandengagement.Ø  Interpretationfromanattachmentlens.Ø  Developmentallyandattachmentinformedresponse.

Tobeseen-tobeheard-tobeunderstood.


Ø  Parent’scapacityforreflectiononthechild’smoods,interestsandattachmentneedsandtheiruseofthistoguidecaregiving.

Ø  Parentscapacitytoforma‘sharedpartnerships’withtheirchildinthecaregivingprocess.

Seekingto“guideratherthancontrolactions”ratherthan“interferingorintrusive”carethatmayinterrupt“activity,andthuscausedysregulation”(Ainsworth,1969).



Ø Mothers who showed low sensitivity werelikely to have young children who wereinsecurelyattached.

Ø BUTincreasedmaternalsensitivityaschildrenmovedintoadolescencepredictedashifttowardattachmentsecurityinteens.

Beijersbergen, M. D., Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2012).Remaining or becoming secure: Parental sensitive support predicts attachment continuity frominfancy to adolescence in a longitudinal adoption study. Developmental Psychology, 48(5),1277-1282.


CanInsecurelyAttachedTeensinCareFormSecureAttachmentswithFosterParents?

BiologicalMother

FosterMothers

Secure 9% 46%Dismissing 55% 42%Preoccupied 2% ---Disorganized 35% 12%


Bowlby(1973):

�  Angeristhenaturalandadaptiveresponseinresponse.�  Itsignalsaparentofachild,orapartnerinarelationshipthatsomethingiswrong.

�  Itidentifiedandunderstoodwithempathyitcanpotentiallystrengthentherelationshipbetweenchildandcaregiver.


BowlbyØ  Whenattachmentneedsareignoredorpunished,angercanturninto

aggression.Ø  Althoughoriginallydirectedtowardelicitingproximityandcare,aggression

threatenstheattachmentbond.Ø  “Themostviolentlyangryanddysfunctionalresponses…areelicitedin

childrenandadolescentswho…areconstantlysubjectedtothethreatofbeingabandoned.”



1.  Strongresearchbasefornormativeandclinicalpopulations.

2.  Generatesprinciplesandtherapeuticstrategiesapplicabletoparents,familiesandindividuals.

3.  Givesmeaningtoperplexingandchallengingbehaviour–particularlyaggressiveandantisocialbehaviour–andgeneratestreatmentstrategies.

4.  Increasesawarenessandunderstandingoftraumaonbehaviourandinrelationships.


Fortoddlersandyoungchildren:�  VideoFeedbackInterventiontopromotePositive

Parenting(Jufferetal.);�  CircleofSecurity(Marvin);�  AttachmentandBio-behavioralCatch-up

Intervention(ABC;Dozier).

Forpre-teensandteens:} AttachmentBasedFamilyTherapy(Diamond)} Connect


Goals:1.  Targetsfactorsthatdetermineadolescentmental

health;2.   Strength-focused;3.  Designedtoengage“difficulttoreachfamilies”;4.   Portableacrosscommunitiesandcanbedeliveredby

awiderangeofmentalhealthandeducationpractitioners;

5.   Structuredtopromoteprogramfidelitybutdynamicandflexible;

6.  Designedaroundfeasibilitytopromotestronguptakeandsustainability.


https://youtu.be/nuBOilo5DPU


WhoDoesConnectServe?•  Parentsandcaregiversofpreteens(8-12)andteens(13-18)whoarewanttohelptheirchildwithbehaviourproblems,depression,anxietyandrelatedproblems

•  Manualized–Detailedguidehelpsleaderstomaintainadherencebutaddressgroupdynamicsandculturallytailorcontent

•  Format:• Pre-InclusionInterviews• Welcomemeeting• Ninesessions(1.5hours)• Feedback/integrationsession(45minutes).

•  Groupformat:8-14caregivers

•  Structuredbutflexible,sensitivetotraumaandfocusedonemotionalandrelationalneeds.

Connect–QuickOverview

v Eachweek:Keyattachmentprinciplerelatedtoadolescence,attachmentandparentingguidesroleplays/reflectionexercises.

v Format:Structuredbutwithfocusonlearningthroughexperienceanddialogue–RolePlays&ReflectionExercises

v Collaborative&StrengthFocused:Notprescriptive;notaboutteachingthe‘rightway’butaboutlearningtogether;focusesonstrengthsofeverycaregiverandfamily

ConnectProgramStructure

Pre-InclusionInterview Welcome

Session

1.AllBehaviorHasMeaning

2.AttachmentisforLife

3.ConflictisPartofAttachment

4.Empathy5.AutonomyIncludesConnection

6.BalancingNeeds

7.GrowthandChange

8.CelebratingAttachment

9..TwoStepsForward–OneStepBack–Feedback

Connect–InclusionInterview,10Sessions

&Principles

ReflectiveFunctioning• “SteppingBack”–Mindfulness:Reflectingonwhatisinthechild’smind(feelings&thoughts);Whatisintheparent’smind(feeling&thoughts).

CaregiverSensitivity• “SteppingForward”Skillsneededtothinkaboutthechild’sattachmentneedsandhowthesearecommunicatedthroughbehavior.

DyadicAffectRegulation• Skillsneededtoidentifyandtoleratedifficultemotionalstatesinthemselvesandwiththeirteen.

SharedPartnership&Mutuality• Negotiationandprovidingsafeandsecurebasewhilepromotingteenautonomy

�  Adherencetothestructure,exercisesandgoalsis

essential.Sessionstructureandcomponentsareintentionallysequenced.

�  Changeisengenderedthroughreflectionexercisesandroleplays*withineachsessionthataredesignedandsequencedtoinducespecificfeelings.

�  Exercisesandroleplaysarenotonlyaboutcontent–theyarestrategiesforshiftingparentsfeelingsandthoughts.

�  Focusesonthecaregiver-teenrelationshipasthefoundationforsupportingbehavior.

“FromControltoConnection”

�  Sessionsgraduallyintroducereflectionexercisesthathelpparentstothinkabouttheirinfluenceintheparent-teenrelationship.

�  Roleplaysillustrateextremesoftwotypesofparentalreactionstoparent-teenproblems:

�  Over-engagedorreactivecaregiver�  Disengagedcaregiver

�  Followedbyaroleplaythatillustrateshowparentscanremainavailableandresponsiveduringconflict


1.  Specificallytargetsissuesofattachmentinfostercareforteensandprovidedfoundationaltraining.

2.  Specificallyemphasizestheimpactoftraumaonattachmentandthebehaviourofyouthincare.

3.  Introducesconceptsofattachmentinjuries;thechild’sattachmentsuitcase;andloyaltyconflict


1.  AddressestheUniquechallengesofprovidingfostercare.Ø Balancingcareforbiologicalandfosterchildren;balancingprofessionalandparentalroles;copingwithagingout.

2.  Roleplaysadaptedtoreflectissuesintheparent-teenrelationshipinthecontextoffostercare.

3.  Engagesfosterparentsthroughrespect,empathyandcollaborativepartnershipacknowledgingthechallengesthatfosteringteensentails..


STRUCTUREDROLEPLAYREFLECTIONSDEVELOPNEWPROBLEMSOLVINGSKILLS


CHILD1.  WHATWASTHECHILDFEELING

ANDTHINKING?

2.  LOOKINGATTHEATTACHMENTNEEDSLIST,WHATWERETHECHILD’SNEEDS?

3.  LET’SBECURIOUSABOUTTHE

CHILD’SATTACHMENTSUITCASE.WHATDOYOUTHINKMIGHTHAVEHAPPENEDINTHEPASTWHENTHECHILDEXPRESSEDTHESENEEDS?

PARENT3.  WHATWASTHEPARENTFEELING

ANDTHINKING?

4.  DOYOUTHINKTHEPARENTWASAWAREOFTHECHILD’SATTACHMENTNEEDS?

5.  WHEREDIDITLEAVETHERELATIONSHIPBETWEENTHEPARENTANDTHECHILD?

Moretti, M., & Obsuth, I. (2009). Effectiveness of an attachment-focusedmanualizedinterventionforparentsofteensatriskforaggressivebehavior:TheConnectProgram.JournalofAdolescence,32(6),1347-1357.Moretti,M.M.,Obsuth, I.,Mayseless,O.,&Scharf,M.(2012).Shifting internalparent-child representations among caregivers of teens with serious behaviourproblems: An attachment-based approach. Journal of Adolescent Trauma, 5,191-204.Moretti,M.M.,Obsuth, I.,Craig, S.,& Bartolo,T. (inpress).Anattachmentbased intervention forparentsofadolescentsat risk:Exploringmechanismsofchange.Attachment&HumanDevelopment.FabriziaGiannotta , EnriqueOrtega&Hakan Stattin (2012).An attachmentparentinginterventiontopreventadolescentsproblembehaviors:ApilotstudyinItaly.ChildYouthCareForum.

ClinicalPopulation Outcomes EffectSize(fortreatmentperiod;nosignificanteffectsover

waitlist)

Follow-UpandOtherFindings

Parent/teenhighriskdyads

>50%threatenedtoharmorkillothers

>50%threatenedtoharmself

Aggressivebehaviour

ConductProblems

Internalizingproblems(e.g.depression)

ParentingSatisfactionandEfficacy

.27

.46

.63

.45-.86

Effectsretainedoneyearfollow-

up

Similaroutcomesforgirls/boys


Moretti,M.,&Obsuth,I.(2009).Effectivenessofanattachment-focusedmanualizedinterventionforparentsofteensatriskforaggressivebehavior:TheConnectProgram.JournalofAdolescence,32(6),1347-1357.

ClinicalPopulation Outcomes EffectSize Notes

~300highriskparent-teendyadsrural&urbanmentalhealthsites

ConductProblemsOppositionalInternalizingParentingSatisfactionandEfficacy

.36

.65

.34

.71-.74

Similarresultsacrossgender,caregiverstatusandwhenuseofotherservicesstatisticallycontrolled.

ParentingStrainCTSAggression-TeentoParent- ParenttoTeenTeenAffectDysregulation

.70-.98

.94

.74

.46


Moretti,M.,&Obsuth,I.(2009).Effectivenessofanattachment-focusedmanualizedinterventionforparentsofteensatriskforaggressivebehavior:TheConnectProgram.JournalofAdolescence,32(6),1347-1357.

Pre-Treatment Post-Treatment

M(SD) M(SD) Cohen’sd

ExternalizingSymptoms

72.65(12.94) 67.84(13.07) .37

InternalizingSymptoms

64.43(14.56) 61.67(14.49) .19

AffectDysregulation 3.69(1.09) 3.25(1.13) .40

AttachmentAvoidance

3.42(1.28) 3.14(1.22) .22

AttachmentAnxiety 3.38(1.14) 3.28(1.12) .09


Moretti,M.M.,Obsuth,I.,Craig,S.,&Bartolo,T.(2015).AnAttachmentBasedInterventionforParentsofAdolescentsatRisk:MechanismsofChange.Attachment&HumanDevelopment.

Stattin,H.,Enebrink,P.,Özdemir,M.,&Giannotta,F.(2015,May25).ANationalEvaluationofParentingProgramsinSweden:TheShort-TermEffectsUsinganRCTEffectivenessDesign.JournalofConsultingandClinicalPsychology.

Two-yearFindingsfromaNationalEffectivenessTrial:Effectivenessofbehavioralandnon-behavioralparentingprogramsonchildren’sexternalizingbehaviors.Högström,Olofsson,Özdemir,Enebrink&Stattin(2016),JournalofConsultingandClinicalPsychology.

Fabrizia Giannotta , Enrique Ortega & Hakan Stattin (2012). Anattachment parenting intervention to prevent adolescents problembehaviors:ApilotstudyinItaly.ChildYouthCareForum.

Osman et al., (2017). A Support Program for Somali-born Parents on Children’s BehavioralProblems.Pediatrics,139(3)e20162764;DOI:10.1542/peds.2016-2764

Roothetal.(2017).AnassessmentoftwoparentingtrainingmanualsusedinSwedishParentingInterventions.

2017CPGTRAININGWORKSHOPMORETTI2.5

2.7

2.9

3.1

3.3

3.5

3.7

3.9

Pre-Treatment Post-Treatment OneYearFollowUp

TwoYearFollowUp

Eybe

rgChildBeh

aviorInven

tory(itemm

eanscore)

IncredibleYearsCopeKometConnect


• Helpparentsidentifythoughtsandfeelingsthatmakeparentingdifficult

•  Supportsteppingback&mindfulness

•  Increaseparentalempathy•  Facilitateparent’srecognitionofchild’sattachmentneeds

FacilitateShiftfromParentalFocuson

ControltoInterestinUnderstanding

•  Increaseparentalsensitivityespeciallyduringduringconflict

•  Increaseparentalcapacitytoco-regulatedifficultfeelingswithteen

IncreaseSafeHavenandSecureBase • Promoteshared

partnership• Shiftfocusfromproblemstopositives

• Prepareparentstomanageset-backs(relapseprevention)

StrengthenParent-TeenBondandProtectfrom

Adversity

HowdoyouthinktheConnectParentGroupinfluencedyou?

Father:“Quiteabit,actually.ItgavemeadifferentinsightintohowtodealwithSandy,howtoreactwithhimandhowtoseewhatwasactuallyinhismind,youknow,liketrytoseeitthroughhiseyes,andIthinkthathelpsalot.…itgivesmefoodforthoughtwheneverIseehimdoingsomethingorseeinghimgettingupset,Itryandfigureoutwhyorwhat'shedoing,what'shethinkingsortofthing.Insteadofjustgoinginandsaying,don'tbeangry,don'tbeupset.Thatdoesn'tworkthatwell,soit'shelpedalot.”


Moretti, M. M., Obsuth, I., Mayseless, O., & Scharf, M. (2012). Shifting internal parent-childrepresentations among caregivers of teens with serious behaviour problems: An attachment-basedapproach.JournalofAdolescentTrauma,5,191-204.

Proctor(2011):


GoodOutcomes

Uptake

Sustainability

IMPLEMENTATIONSUCCESS

• Abbotsford(18)

• Ashcroft(1)

• BellaBella(1)

• Castlegar(1)

• Chase(1)

• Chilliwack(9)

• Cranbrook(2)

• DawsonCreek(2)

• FortSt.John(5)

• Gibsons/Sechelt(6)

• GrandForks(6)

• Hope(2)

• Kamloops(28)

• Kelowna(28)

• Kitimat(8)

• Lillooet(1)

• Lumby(2)

• MetroVancouver(245)

• Midway(1)

• Mission(8)

• Nanaimo(2)

• Nelson(4)

• Oliver(1)

• Parksville(21)

• Pemberton(2)

• Penticton(14)

• PortAlberni(10)

• PrinceGeorge(3)

• PrinceRupert(5)

• Quesnel(1)

• RockCreek(1)

• SalmonArm(13)

• Samahquam(1)

• Smithers(4)

• Summerland(3)

• Terrace(9)

• Trail(1)

• Vernon(17)

• Victoria(31)

• Whistler(2)

• WilliamsLake(16)

ConnectParentGroups2006-2015(N=535)


2

9245

54

9

1

32

1

28

8

1

182

2

12

61

16

418

21 1428

6

1317

31

5

1

3

1

2

2

1

110

436

131

132

80

0

50

100

150

200

250

300

350

400

450

500

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

ConnectLeadersTrained–Cumulative(779)

Coast-Fraser Interior Island North2017 CPG TRAINING WORKSHOP MORETTI

91

285

423

516568

737

572604

738702

14

66

74

103

126

177

111110

153140

0

100

200

300

400

500

600

700

800

900

1000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

ConnectParticipants–Annually(e.g.,2015CompletionRate84%completing)

Completed Dropouts2017 CPG TRAINING WORKSHOP MORETTI

3389

1672

870

379

0

500

1000

1500

2000

2500

3000

3500

4000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

CaregiversAttendingConnect–Cumulative6,310

Coast-Fraser Interior Island North2017 CPG TRAINING WORKSHOP MORETTI

AhealtheconomicevaluationofparenttrainingprogramsforchildreninSweden.NatalieZarabi,FilipaSampaio&InnaFeldman,UppsalaUniversity

Ø  Oneofthetwoleastexpensivecomparedtothreealternativeparentmanagementprograms

Ø  Theoretically and practically congruentwithUN

Rights of the Child. Rooth et al. (2017). An assessment of twoparentingtrainingmanualsusedinSwedishParentingInterventions


GettingStarted

� Connectisacopyrighted-protectedmanualandprogram.

� Onlytrainedandcertifiedleadersarepermittedtooffertheprogram.

� CertificationrequirescompletionoftheConnectworkshopandhourperhoursupervisionofthefirstgroupcycleoruntilleadersachieveskillsrequiredforcertification.


�  Ensurethatleadersareavailablefor10consecutivesessionsover10weeks.

� Counton6-8ormorehoursperweekforthetrainingphase(1-2hourprep;1.5hoursrunninggroup;1.5hourstapereview;1hoursupervision;1-2hoursadditionalgroupsupportetc.)

� Oncetrainedleadersrequireabout3-4hoursperweektorunthegroup,includingsetup,takedownandnotes.


Drafttimelinesto:

1.  Buildreferralsources

2.  Completepre-groupmotivationalinterviewswithcaregivers

3.  Organizesite,food,babysitting

4.  Welcomenight,9sessions-preferablywithoutbreaks)

5.  Wrapup


FOURCOMPONENTS:1.BUILDacollaborativerelationshipwitheachpotentialConnect

participant.2.MOTIVATEtofacilitatechangeandgrowth;toinspirehopethat

theprogramwillbehelpful;tocreateinterestinthecaregiver-youthrelationshipandhowitmightbestrengthened.

3.INFORMparentsandcaregiversabouttheupcomingConnect

group(time,location,format,onlinequestionnairesbeforeandattheendofthegroup).

4.PROBLEMSOLVEaroundpotentialbarrierstotreatmentthat

mightinterferewithattendanceorfullparticipationinthegroup.


Introductionofleadersandparents�  Overviewofsessiontopicswhatwillbedoneacrosssessions

�  Discussbalancebetweensharingandlearning;confidentiality;housekeeping

IntroduceBasicConcepts�  WhatisAttachment?�  WhyisAttachmentImportanttoChildDevelopment?�  WhatDoesAttachmenthavetodowithBehaviour?�  WhatdoesthishavetodowithMeasaParent?


�  Themanualisillustrative.Sessiondescriptionsprovideanexampleofhowleadersmightpresenttheinformation.

�  Effectivenessdependsonadherence(structure,exercisesandgoals)butmakethewordsyourown.

�  Besupportivebutstaystructuredandsticktothemanual.

�  Expectittobeeasiertomanagethecontentbutmoredifficulttomanagegroupdynamics.


�  Prepareandpre-arrangetasks;discussflexibilityandcommunicationincludingcuing.

�  Beingintheroomandcommunicatingisasharedresponsibility.

�  Supportyourpartner,butbecarefultokeepthefocusonthewelfareofthegroup.


AllBehaviourhasMeaning

Keygoals:Ø  Parentsbecomeawareofthattheirchild’sbehaviour

isaformofcommunicationabouttheirattachmentneedsintheirrelationship.

Ø  Theystarttolearntostepbackand“read”their

child’sbehaviourfromanattachmentpointofview.


�  KeyGoalsforFosterParents

a)  Recognizedifferenttypesofinsecureattachmentstrategies

b)  Recognizetheimpactoftraumaandattachmentdisruptioninshapingtheexpressionofattachmentneeds

c)  Understandtheconceptofthechild’s“attachmentsuitcase”

d)  Recognizethatchildren‘miscue’caregiversabouttheirattachmentneeds.


Welcome,review&introduceprinciple

1.Attachmentensuressurvival

2.Howdobabiesshowyouwhattheyneed?

3.Howdowerespond?Howdowefeel?

4.Howdoteenscommunicatewhattheyneed?

5.RolePlay

6.“SteppingBack”

7.Whatwesayvs.howwesayit..

AllBehaviorHasMeaning

Attachmentisforlife.

KeyGoalsØ  Parentsbegintounderstandthatattachmentneeds

remainpresentthroughoutdevelopmentbutareexpresseddifferentlyaschildrengrow.

Ø  Parentsreflectontherolethattheirinterpretationandattributionsabouttheirchild’sbehaviourplayindetermininghowtheyreacttotheirchild’sattachmentneeds.

Ø  Parentsreflectontheirexperienceofbeingunderstood(ornot)asateen.


KeyGoalsforFosterParents�  Learnabouttheimpactoftraumaonthestrategiesthatchildrenusetoshowtheirattachmentneeds.

�  Discusshowfosterchildrenshowtheirattachmentneedswhentheyaretoddlers,childrenandteens.

�  Discusstheimpactoftheirchild’sattachmentsuitcaseandtraumaontheirexpressionoftheirneedsintheirneedsandmiscuingfosterparents.


Welcome,review&introduceprinciple 1.Attachment

NeedsList

2.Connectionvs.Independence

3.AttachmentCoin

4.Howdotwoyearoldsshowtheirneeds?

5.Howisyourteenshowingneedsnow?Howdidyoushowyourneedsasateen?

5.Howdiditfeelwhensomedid/didnotunderstandyou?understood?

7.Steppingbackandbeingcurious&findingtherighttimetotalk

AttachmentisforLife

Conflictispartofattachment

KeyGoals:�  Conflictispartofallrelationshipsandpartofattachment.

�  Practiceidentifyingattachmentneedsinconflict.�  Developawarenessofouremotionalreactionstoconflictandhowthisshapesourbehaviour.

�  Practiceemotionalavailabilityduringconflict(SecureBase).

�  Practicesettinglimitsandsafestructureduringconflict(SafeHaven).


KeyGoalsforFosterParents

�  Becomeawareofconflicttriggersforfosterchildren

�  Reflectonhowthisisrelatedtotheirchild’s“attachmentsuitcase”?

�  Whatattachmentneedsareexpressedbychild’sbehaviorduringconflict?


Welcome,Review

SafetyComesFirst

IntroducePrinciple:Conflict

isPartofAllRelationships

OurPastExperiencesShape

ourResponse

RolePlays1-3

GettingStuckandBeingMindful

ConflictisPartofAttachment

Secureattachment:Abalancebetweenconnectionand

independence

Keygoals:� Autonomyisadaptiveandbestachievethroughconnectionwithcaregivers.

� Discussingparentalfeelingsoffear,anxietyandloss.

�  Practicesskillsinsupportingautonomywhilesettinglimitsandensuringsafety.


KeygoalsforFosterParents:� Reflectonroleofpasttraumaandattachmentinhowfosterteensnavigateautonomy

� Helpfosterparentsunderstandtheanxietythatbothseparationandconnectioncreatesfosterteensand‘miscuing’

�  Practicesensitiveunderstanding,autonomysupportwhilesettinglimitsandensuringsafety.


Thinkaboutthechildinyourcare.1.  Whodoyourteensturntoforsafetyand

comfort…andtodrawcourageandstrength?

2.  Howmightyourresponsetoyourchild’sbehaviorinfluencewhethertheyturntoyou?

Emphasize–1.  Mindfulnessoftheattachmentsuitcase2.  Importanceofbeingasafeplace,comfortand

supporttothechild.



WelcomeReview

Introduceprinciple–autonomyincludes

connection

Balancebetweenautonomy&connection

inbabies

“ElasticBand”

Balancebetweenautonomy&connectionin

teens

RolePlays1-3

TurningPoints–Celebrating

AutonomyandMaintainingSafety

AutonomyIncludes

Connection

�  Smallgroupswithyourpartner�  Wewilldeterminetwosessionsegmentsforyouandyourpartnertopractice

�  Howtoprepare:�  Readanddiscussthesessionwithyourpartnersoyouknow

howyourpartrelatestothefullsession.�  Preparetwo10-minutesegmentsbasedonyourassignments.�  Usetheflipchartpapertowritedownsessionexercises/

questions/reflectionandtorecordparentresponsesetc.�  MakesureyouandyourpartnerBOTHparticipateinboth

sessions.�  Whattoexpecttomorrow:

�  BepreparedtostepintotheroleofaConnectleader.�  Whennotpracticingasaleader,youwillparticipateasifyou

wereaparent.�  Bepreparedtoreflect,berespectful,askquestions.�  HAVEFUN!!!


DAY2–SESSIONS5-8

Understanding,growth,andchangebeginwithempathy

KeyGoals:�  Distinguishempathyfromsympathy,sharingsamefeeling,projection.

�  Practicelistening,focusingandrespondingwithoutjudgmentorattemptstosolveproblems.

�  Practiceregulatingtheirownfeelingssotheycanbepresentfortheirchild.

�  Reflectontheirownexperiencesofempathyandhowthesesituationsmadethemfeel.


KeyGoalsforFosterParents:�  Learnthatempathycanprovokeanxietyorotherfeelingsduetoteens’pastexperiences-theymayshowreactionsthatareunusual,concerningorperplexing.

�  Recognizetheprofoundneedofchildrenincaretofeelsafeandsecure,yetthechallengestheyfaceinexpressingtheseneeds.

�  Discussthechallengeofmaintainingempathyalthoughthatonemayneverknowthevalueorimpactoftheircare.


WelcomeReview Introduce

theprinciple.Empathyisexperiencinganother’s

feelingsASIFtheyareyour

own

Temporarilyputtingaside

feelingsandjudgments

Notaboutfixing

problemsorcondoningproblembehavior.

Empathytakes

practice.

RolePlays1-3

Reflections

Reflectionsonour

experiencesofempathy

inrelationships.

Empathy–TheHeartbeatofAttachment

Relationshipsthrivewhenwe

recognizeandbalanceourneedswiththeneedsofothers

Keygoals:�  Developawareness,empathyandacceptanceoftheirownneeds.

�  Developskillsincommunicatingtheirneedswhileusingempathytorecognizetheirteen’sneeds.

�  Practiceregulatingtheirfeelingsandremainingengagedwiththeirteenastheyworktogethertofindbalance.


KeyGoalsforFosterParents:�  Recognizetheimportanceoftheirneedsgiventheirprofessionalroleandpersonalinvolvement.

�  Recognizethattheirfosterteen’sneedsaredifferentfromsameagedpeers–asprofessionalsthebalanceistippedtowardtheirchild’sneeds.

�  Understandthatfosterchildrencannotmeettheirneeds.

�  Discussthechallengesofbalancingtheneedsoftheirfamily,theneedsofbirthchildrenandtheneedsoffosterchildren.


WelcomeReview

Ourattachmentneedsisalsoimportant.

(Oxygenmask)

Whatdoweneedtogrowand

develop?(AttachmentNeedsList)

Whatdoesbalancelooklike

inadultrelationships?

WhatDoesbalancelookLikeinrelationshipswithbabies?

teens?

RolePlays&Reflections

HowCanWeCreateMore

BalancewithourTeensandInOur

AdultRelationships

BalancingOurNeedswiththeNeedsofOthers

Growthinvolvesmovingforwardwhileunderstanding

thepast

KeyGoals:� Reflectonthestoriesweholdforourselvesandothersandhowtheseinfluencechange.

� Reflectonourteen’sstoryofselfandtheirstoryofhowtheirparentseesthem

� Discusshowstorieschallengeorpromotegrowth.

� Developskillstoattendtogrowthandchangeintheirchild,themselvesandtherelationship.


KeyGoalsforFosterParents� Developskillstorecognizeandsupporttheirfosterchild’sattempttochangeandgroweveniftheseattemptsarelimitedandinconsistent.

� Reflectondifficultfeelingsoflossandfearthatwhenateenismovedoutoftheircare.


WelcomeReview

1.Introducetheprinciple–Weallformstoriesfrom

ourexperiences

2.Wewriteourown

storiesbuttheyarewrittenby

otherstooinrelationships

3.OurStoriesHaveaPowerfulImpactontheChoicesWeMake

4.ThroughRelationshipsWeCanAddtoOurStoriesand

Grow

5.RolePlays&

Reflections

6.Howdostoriesgetinthewayofourteen’sgrowth?Howcanwe

growtogether?GrowthInvolvesMovingForward

WhileUnderstanding

thePast

AttachmentbringsJoyandPain

KeyGoals:� Recognizefeelings,beliefsandexperiencesthatblockconnectioninrelationships.

�  Practicetoleranceofanxiety,angerandlossandmaintainopennesstoconnection.

� Developskillsinidentifying,invitingandsustainingconnection.


KeyGoalsforFosterParents


� Recognizetheimpactoftheirfosterchild’spastexperiencesandtraumaonhowtheyreceiveandrespondtoinvitationsforconnection.

� Reflectonfosterparents’feelingsofanxiety,fearofrejectionandlossthatmightblockconnection.

WelcomeReview Introduce

principle.Focusingonproblems

detractsfromconnectingandbuildingstrong

bonds.

Whatgetsinthewayof

connectingandcelebratingattachment?Aschildren

grownanddevelopwe

mayexperienceasenseoffear

andloss.

Wecanmissopportunitiestoconnect.

RolePlays&ReflectionsHowcanwecelebrateour

relationshipsandconnections.

AttachmentBringsJoy&Pain

DAY3

Attachmentallowsustrusttherelationshipevenduringturbulent

times.Adversityisanopportunityfor

learning

� AllBehaviourhasMeaning� AttachmentisforLife� ConflictispartofAttachment� AutonomyincludesConnection� Change:UnderstandingIt�  Empathy:TheHeartbeatofAttachment�  BalancingConnectionandIndependence� CelebratingAttachment� TwoStepsForward–OneStepBack


KeyGoals:�  Practiceusingallattachmentprinciplestogetherforrelapseprevention.

�  Practicereframingsetbacksasopportunitiesforgrowth.

�  Practicetoleratingfeelingsofdisappointmentandangerwhenthingsgoofftrack.

�  Practiceskillstodorepairinrelationships.



Welcome

1.Growth&changeisa

bumpyroad–Themeaningofsetbacksmakesallthedifference

2.Setbackscanbean

opportunityforgrowthifwelearnhowto

repairrelationships

3.Reviewallwehavelearned

andthinkaboutsetbacks

4.RolePlays&Reflections

5.Howdoweuseallwehavelearnedtorepairrelationships?

TwoStepsForward–One

StepBackTrusting

Relationships


Two120-minuteboostersessions:�  BoosterSessionI:firstfourprinciples�  BoosterSessionII:remainingCONNECTprinciples.

�  Principle9alwaysendseachboostersessions


WhoShouldAttend:�  ParentswhohavealreadyattendedtheregularCONNECTprogramandwouldliketoattendabooster(i.e.,optional)

�  Parentsencouragedtoattendbothsessions–ifnotpossibletheymayattendjustone

� Attendasfrequentlyasdesired,unlessleadersfeelthattheirattendanceisnolongerhelpful

� 


When:�  Optimallyparentswillattendfollowingalagofapproximatelyfour(4)monthsaftercompletionoftheregularprogram

�  Besttohave14-16attendeesateachsession,therebyensuringtheattendanceofatleast10-12parents.

�  RequirescontactingparentsfrommorethanonecycleofCONNECTintheircommunity.

�  Ideallyfallandspringsession(i.e.,Booster1infalland2inspring)


CONNECT–BOOSTERSESSIONI(CONNECTPRINCIPLES1-4)

WelcomeparentsbackBrief‘icebreaker’1.  AllBehaviourhasMeaning2.  AttachmentisforLife&AttachmentCoin3.  Conflictispartofattachment.4.  AutonomyIncludesConnection5.  TwoStepsForward–OneStepBack�  FocusisonchangefromendofConnecttoBooster


EXAMPLESOFCHANGEFOCUS:Ø Let’sjotdownsomeofthethingsthatyouhave“changedaboutyourselfortheviewsyouhaveaboutyourrelationshipswithyourchild”sinceyoucompletedConnect.

Ø Let’sreviewyourneedsasaparentsinceyoucompletedConnect?


�  Buildinterestintheprograminyouragency/communityandprovideinformationonhowtorefer.

�  Presentinformationsessionsatyourmentalhealthunit,hospitalorschool.InBCtheConnectTeamcandothisinyourcommunityorwecanprovidepowerpointslidesorhandoutsforyoutouse.

� Weprovidebrochuresforuseinyourcommunityforparentsandotherreferralservices.


� Trynottostackyourgroupwithonlythemostsevereclientsonyourcaseload.

�  Idealgroupnumberisabout12-14participants.Startwithatleast12incasesomeparentsdiscontinue

� Youmustretainaminimumof8duringyourtrainingphasetobecertified.

�  Insmallorremotecommunitiesexceptionswillbemade.


�  Sessionsaredesignedtobuildskillssequentially–thusattendanceatallsessionsisideal.

�  Itisimportanttodeterminetheabilityoftheparent/caregivertocommittoall10weeksoftheprogram.

� Callparentswhomiss!Preventdropout.


ConnectforParentstoPreventPlacement

120

ConnectforFosterParents

ConnectforParentstoSupportReunification

ConnecttoSupportPermanencyPlanning

� ASupervisionAgreementwillbeprovidedtoeachgroupleaderspecifyingthedetailsofsupervisionandmutualresponsibilities.

� Weevaluatethesupervisionexperienceanduseittoimproveoursupervisorrelationshipsandsupervisorypractices.


Ø  Onehoursupervisionbyteleconferenceorinpersoneachweek.

Ø  Reviewyourvideoandidentifyatleasttwosegmentstofocuson,questionsorissuestodiscuss.

Ø  CompleteSessionReflection&AdherenceForm.

Ø  TransfervideotoConnectsupervisorwithenoughtimeforreview.


Ø  Adherencetosessionformatandexercisesasdescribedinmanual?

Ø  Howwelldidgroupsleaderscommunicateinformationandknowledgeabouttheattachmentprinciples?

Ø  Howwelldidgroupleadersfacilitaterapportandpositivegroupprocess?

Ø  Howwelldidgroupleadersensurethatdiscussionwasbalancedbetweenpersonaldisclosureandfocusontheprinciple?


Ø  Bothleadersshouldbefamiliarwiththevideoandhavediscussedthesessionpriortosupervision.

Ø  BepreparedtoprovideanoverviewincludingyourreasonsforyourratingsontheCPGSessionAdherenceFormandsegments.

Ø  Understandthatsupervisionisfocusedonidentifyingchallengesandsolvingproblems;itisbesttoapproachitwithopennessratherthandefensiveness.


Ø  Strivetobeactiveinpartnershipwithyoursupervisor.

Ø  Bespecificaboutwhatissuesyouneedhelpwith.

Ø  Comepreparedwithsuggestedsolutionsforchallenges.

Ø  Askquestions;providefeedbackonwhathelps.

Ø  Beopentotryingnewstrategies.


Ø  Issuesofacuterisk/clinicalneedsshouldbedirectedtoyouron-siteClinicalSupervisorinatimelymanner.

Ø  Clinicalresponsibilityandliabilityforsuchissuesrestswithyouandthefacilityinwhichyouprovideservice.



https://www.youtube.com/watch?v=Xiu59tUfnvw

� Thankyouforcomingandsharingintheprocess!

� Wearealwayslearning–sendusyourfeedbackandsuggestions.


For more informa3on go to: h?p://adolescenthealth.ca/ or www.connectparentgroup.org or contact Marlene MoreE at: [email protected]

Maples Adolescent Treatment Centre

Members of the Adolescent Health Lab, Simon Fraser University and Collaborators


c : a a based parenting program for parents of teens …

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