strengthening caregiver practices that build infant social-emotional and social communication...
TRANSCRIPT
Strengthening Caregiver Practicesthat Build InfantSocial-EmotionalandSocialCommunicationCompetencies
KathleenM.Baggett,Ph.D.Associate Professor&Director ofEarly Childhood Social-Emotional Health PromotionResearchMarkChaffin CenterforHealthy DevelopmentDivisionofHealth PromotionandBehavior,School ofPublicHealthGeorgiaStateUniversity
Prepared fortheNationalInstituteofNursingResearch Summit ontheScienceofCaregivingAugust8,2017Bethesda,MDContact:[email protected]
Infant-Net/Baby-NetResearchTeam
KathleenM.Baggett,Ph.D.,GeorgiaStateUniversityEdwardG.FeilBetsyDavisLisaSheeberSusanH.LandryUrsulaJohnson
KathleenM.BaggettEdwardG.Feil,Ph.D.,OregonResearchInstituteBetsyDavis,Ph.D.,OregonResearchInstituteLisaSheeber,Ph.D.,OregonResearchInstituteSusanH.Landry,Ph.D.,UniversityofTexas,HoustonUrsulaJohnson,Ph.D.,UniversityofTexas,Houston
Grant Participants Design1-NIMHR34MH073756 (2006-2008)2-NICHDR01HD1R01HD064870(2010-2014)
40 low-incomemothersandthieir infants159lowincomemothersandtheirinfants
RCT
2-CDCR18CE001705(2009-2012) 13HealthyFamilieshometheirmotherinfantcaseloads Implement.
3- USDE, IESR324A100041 (2010-2013)4- NICHDR21HD06287(2010-2012)
19 EarlyHeadStartteachersand infants21 CommunityChildCareteachers andinfants
FeasibilityPilot
5-HRSAR40MC26822RCT(2014-2017) 36 Low incomemothersandtheirinfantsexitinginnerurbanNICUs
RCT
ADecadeofResearch:AcknowledgmentsandDisclosure
*Disclosure:Thisinformationorcontentandconclusionsarethoseoftheauthorandshouldnotbeconstruedastheofficialpositionorpolicyof,norshouldanyendorsementsbeinferredbyanyoftheentitiesabove.Dr.BaggettisadeveloperoftheInfantNet/Baby-Netprogram.
Epigenetictoxicstresscontributesto earlyinfantvulnerability,whichchallengescaregivingandleadstopracticesthatfurthercompromisehealthanddevelopentoutcomesacrossthelifecourse
• Prematurityandlowbirthweight• Neurodevelopmentalandbehavioralchallenges• Developmentaldelays
EvidenceBasedIntervention 20YearLag
https://www.whatisepigenetics.com/what-is-epigenetics/
CommunityImplementation
ResearchGap
KeyOpportunities
Ø Deployinterventionswiththestrongestevidenceofeffectivenessforimprovingcaregivingpracticesdemonstratedtopromoteinfantsocial-emotionalandsocial- communicationcompetencies
Ø Makethemaccessibletoallcaregivers-especiallythemostvulnerable
Ø Rigorouslyevaluateandrefinethemtobringthemtoscalewhilemaximizingengagementforallcaregivers- especiallythemostvulnerable
Baby-Net(ePALS)isamobileweb-basedadaptationoftheevidence-basedPlay&LearningStrategiesHomeVisitingProgram
Baby-Netgoalsareto:
Strengthencaregivingpractices thatbuildinfantsocial-emotionalhealthanddevelopment
Improveaccess forvulnerablecaregiversandinfantsto:• Skills-basedintervention:Practice– Observe– Reflect–BuildInteractionSkills• 24-hourmobileaccess• Supportivecoachingrelationship
Weeklypost-sessionremotecoachingcallsengageparentsinco-viewingtheirownvideostonotice,celebrate andplanforsuccess
SequencedInterventionStructure
ProgramFeatures• Securelogin• Discovery:Video-basedteachingofnewcontent• Check-InQuestionswithimmediatecorrectivefeedback• SessionReview• GuidedActionPlan• Self-CreatedVideoofparent-infantinteractionskillpractice• RemotePractice-BasedCoachCall• Administrativereportstomonitorparticipantprogress• Secureemail,textforcoach-participantcommunication
SessionStructure
Step1Discover
Step2CheckIn
Step3GuidedActionPlan
Step4Video
Creation
Step5CoachCall
10-12WeeklySkill-BasedSessions
1-2Caregiverlearningmotivation7Linkingwords&actions3Recognizingsignals 8Readingwithbaby4 Sensitiveresponding 91-2Alternatecaregiversessions5 Maintainingfocus 10Beingyourowncoach6Introducingforengagement
SampleDemographics
Mothers• =/<130%fedpoverty• 66%<$20,000/year• 42%Non-White• 38%Hispanic• 46%highschool/less• MeanPDSS>clinicalcut
OtherCaregivers/Providers• Communitychildcareproviders• Earlyinterventioncenterbasedteachers• HealthyFamilieshomevisitors
Infants• Meanage=4months• NICU;VLBW• Identifieddisability• Developmentaldelays• Childmaltreatmentrisk
Conclusions• Programcompletionratesformothersandchildcareproviderswerehigh• EffectsoftheInternet,remotecoachingadaptationofthePALSprogramareencouraging• Considerationsforscalability:• GiventhecontinueddigitaldivideforcomputerInternetaccess,futureeffortsshouldfocusonmoreubiquitoustechnologiessuchassmartphonedelivery• Futureeffortsshouldincludebriefon-linemulti-gatingscreeningproceduresthatassistfamiliesandchildcareprovidersinaccessingtieredinterventionbestmatchedtotheirneed• Opportunitiesforintentionalimbeddingofcaregivermentalhealthfocusedintervention:e.g.,reducingmaternaldepression