Evidence-informed social and emotional development ...€¦ · Defining social and emotional development and mental health in 0-6 years To contextualize the environmental scan (which

Contents

TOC 1 – Level 1 (see formatting palette / styles)

Evidence-informed social and emotional

development programs for children 0-6

years old

Date: January 2018

Social and emotional development programs

January 2018

2

Suggested citation................................................................................................................................................ 4

Overview of inquiry ............................................................................................................................................. 4

Brain development and the environment ............................................................................................................. 5

Stress and brain development .............................................................................................................................. 6

Executive function and self-regulation .................................................................................................................. 7

Temperament ...................................................................................................................................................... 8

Resilience ............................................................................................................................................................ 8

Positive caregiving relationships ........................................................................................................................... 9

Attachment ....................................................................................................................................................... 10

The importance of play in child development ..................................................................................................... 11

Considerations ................................................................................................................................................... 12

Early prevention and intervention programs for social and emotional development of 0-6 year old children ........ 13

A summary of evidence-informed programs for the social and emotional development of 0-6 year old children .. 14

Tier 2 level programs.......................................................................................................................................... 14

COPEing with Toddler Behaviour (CWTB) ...................................................................................................................... 14

Hand in Hand ................................................................................................................................................................. 17

Nurturing the Seed ........................................................................................................................................................ 19

FUN Friends .................................................................................................................................................................... 21

Make the Connection .................................................................................................................................................... 24

Me, My Baby, Our World ............................................................................................................................................... 26

Minding the Baby ........................................................................................................................................................... 28

Mothers in Mind ............................................................................................................................................................ 30

Promoting First Relationships ........................................................................................................................................ 32

Triple P Positive Parenting Program .............................................................................................................................. 34

Supporting Security........................................................................................................................................................ 36

Tier 3 level programs.......................................................................................................................................... 38

Attachment and Bio Behavioural Catch-Up (ABC) ......................................................................................................... 38

Circle of Security® (COS) Psychotherapy and Circle of Security® Parenting™ ............................................................... 40

Child-centered play therapy (CCPT) ............................................................................................................................... 43

Dyadic Developmental Psychotherapy (DDP) ................................................................................................................ 45


January 2018

3

Filming Interactions to Nurture Development (FIND) ................................................................................................... 48

Group Attachment Based Intervention (GABI) .............................................................................................................. 50

The Incredible Years....................................................................................................................................................... 52

Interaction Guidance (IG) .............................................................................................................................................. 55

Modified Interaction Guidance (MIG) ........................................................................................................................... 58

Parent-Child Interaction Therapy (PCIT) ........................................................................................................................ 60

Parallel Parent and Child Therapy (PPACT).................................................................................................................... 64

Reflective Family Play (RFP) ........................................................................................................................................... 66

Watch, Wait, and Wonder (WWW) ............................................................................................................................... 68

Other approaches and programs for consideration ............................................................................................. 70

Aboriginal Home Instruction for Parents of Preschool Youngsters (HIPPY) Canada ..................................................... 70

Inunnquiniq Parenting Program .................................................................................................................................... 72

Collaborative Problem Solving ....................................................................................................................................... 74

Report context ................................................................................................................................................... 75

Search strategy .................................................................................................................................................. 75

Search terms ...................................................................................................................................................... 75

Current Centre products for 0-6 years ................................................................................................................. 76

References ......................................................................................................................................................... 77

Appendix A: Contact and additional program information................................................................................... 81

Appendix B: Ottawa Infant and Early Childhood Mental Health Initiative definitions in the context of this report 88


January 2018

4

Suggested citation

Ontario Centre of Excellence for Child and Youth Mental Health (2017, December). Evidence-informed social and

emotional development programs for children 0-6 years old. Evidence In-Sight. Retrieved from

http://www.excellenceforchildandyouth.ca/resource-hub/evidence-in-sight-database.

Overview of inquiry

This report provides the results of an environmental scan of evidence-informed programs for children 0-6 years old.

Specifically, evidence-informed programs for Tier 2 and Tier 3 level services were reviewed. Contextual information is

also provided on key factors and messages about the social and emotional development of children ages 0 to 6 years,

including: current definitions of infant and early childhood mental health, the importance of this stage of development,

the linkages between brain development and the environment (as well as the role of stress), executive function and self-

regulation, temperament, resilience, positive caregiving relationships, attachment, play, and cultural considerations.

This resource was developed to help inform community mental health agencies supporting early years development and

can be a valuable prevention and promotion tool for staff to use when interacting with children, caregivers and families.

While this report describes best practices and evidence-informed programs, Evidence In-Sight does not include direct

recommendations or endorsement of a particular practice or program.

Defining social and emotional development and mental health in 0-6 years To contextualize the environmental scan (which begins on page 14), we provide some background information of key

components of social and emotional development to situate the programs described and their goals.

The Zero to Three Task Force (2012) classifies early childhood as beginning prenatally and lasting up to eight years of age

(Siddiqi, Irwin, & Hertzman, 2007); however, this report focuses on development and programs for children between the

ages of 0 months and 6 years of age, and their families and caregivers. Social and emotional health and development in

the early years is the developing capacity of infants and children under six to form close, secure, and supportive adult

and peer relationships; experience, express and regulate a full range of emotions; self-regulate behaviour; and explore

and learn from their environment (Cohen, Oser, & Quigley, 2012).

Social and emotional development starts from birth and is developed through early interactions, experiences, and

relationships. This is especially true for the early relationships formed between baby and principal caregivers, as these

have a lasting impact on future development (Schore, 2005; Suomi, 2004). If a child has experienced adversity during the

early years, this likely influences his/her outcomes, both physical and mental, and both short- and long-term. Cultural

differences should be anticipated, understood and respected within the healthy social and emotional development of

young children (Ungar, Ghazinour, & Richter, 2013; Bornstein, 2012).

http://www.excellenceforchildandyouth.ca/resource-hub/evidence-in-sight-database


January 2018

5

Brain development and the environment

During the early years, the brain is most flexible with the ability to adapt, learn and grow with relative ease. These years

therefore provide an important opportunity for development, but can also be a time of great vulnerability (Center on

the Developing Child at Harvard University, 2016; National Scientific Council on the Developing Child, 2007b).

Prior to school age there is a rapid process of development of important connections within the brain and through early

experiences some connections are reinforced while others fade away without use. The brain develops in response to

two key influences; environment and biological triggers (Center on the Developing Child at Harvard, 2010; National

Scientific Council on the Developing Child, 2004). The early environment and relationships provide a range of stimuli for

the child and their senses, such as visual, verbal, emotional, physical, touch, smell and taste. All these stimuli build and

reinforce connections within the brain. The second influence, biological triggers, refers to the pre-programmed ‘critical

periods’ in brain development. Critical periods are times when specific areas of the brain are ‘turned on’ and become

ready to receive environmental stimuli. During critical periods, connections within the brain are sculpted and

strengthened, promoting optimal development of cognitive (language), sensory, muscular, emotional, behavioural and

social competencies. For example, studies have shown how vision deprivation early in life can lead to lasting

impairment. These critical periods help explain why it can be difficult to restore normal function once development has

been altered (Fox, et al., 2010).

While learning and development continue throughout the lifespan, early experiences, and the environments in which

they take place, shape the brain’s architecture by reinforcing or pruning neural circuits. Sensitive periods are times when

certain neural circuits are particularly responsive to experiences (Tottenham, 2014; Fox, Levitt, & Nelson, 2010). These

periods, which can affect different skills and abilities, start and finish at different times and take place in different parts

of the brain (Center on the Developing Child at Harvard University, 2016).

During the early years, the foundation of the brain’s architecture is established through dynamic interactions between

genes, experiences and the environment (Fox, et al., 2010). Epigenetics is the study of how both positive and negative

early experiences and environments can leave a temporary or permanent chemical signature on genes. This signature

then influences how easily genes are turned on or off or whether they are expressed at all, impacting lifelong

development (Center on the Developing Child at Harvard University, 2016; National Scientific Council on the Developing

Child, 2010). A rich, growth-promoting environment provides adequate nutrients, is free of chemical toxins and full of

positive social interactions with responsive caregivers (Center on the Developing Child at Harvard University, 2016).

Healthy experiences and environments help the brain develop to its full genetic potential while negative experiences

and unhealthy, adverse environments can lead to weak brain architecture and impaired development and capabilities

(National Scientific Council on the Developing Child, 2007b; Center on the Developing Child at Harvard University, 2016).

Brains are built over time and from the bottom up with early learning and experiences providing the foundation for the

development of more complex perceptual, cognitive, behavioural and emotional capabilities (Fox, et al., 2010; National


January 2018

6

Scientific Council on the Developing Child, 2007a). Building high-level skills on a weak foundation is far more difficult

than developing a strong foundation in the first place. So even though brains have the capacity to change and adapt

throughout the lifespan, it is easier and much more cost effective for society to intervene before sensitive periods when

neural circuits become more established and difficult to modify (Fox, et al., 2010).

Stress and brain development

No one is immune to stress or adversity. Learning how to cope with stress is therefore an important part of healthy child

development (Center on the Developing Child at Harvard University, 2016).

There are three standard types of stress and stress responses:

1) Positive stress is normal stress that is essential for development. It is characterized by a brief increase in heart

rate, blood pressure and hormone levels (Center on the Developing Child at Harvard University, 2016). Positive

stress promotes growth by helping children understand and cope with life’s inevitable challenges and hardships

(National Scientific Council on the Developing Child, 2015).

2) Tolerable stress is more severe or long lasting and activates the body’s alert system to a greater degree. If the

response is time-limited and buffered by supportive relationships, the brain and organs can quickly recover

(Center on the Developing Child at Harvard University, 2016). Tolerable stress helps children develop coping

skills needed to respond to adversity (National Scientific Council on the Developing Child, 2015).

3) Toxic stress results from major, frequent or prolonged adversity such as extreme poverty, repeated abuse or

severe maternal depression. A parent’s/caregiver’s mental health can have an influence on the child’s mental

health however there is a considerable amount of research that focuses specifically on the impact of maternal

depression. The absence of a supportive adult is a key feature of toxic stress. Typically, supportive adults can

help buffer the physiological and emotional response and bring children back to baseline. Toxic stress can

disrupt brain architecture and other developing organs and puts individuals at increased risk for stress-related

diseases, cognitive impairment, behaviour problems and physical and mental health challenges (Center on the

Developing Child at Harvard University, 2007; Center on the Developing Child at Harvard University, 2011;

Center on the Developing Child at Harvard University, 2016; National Scientific Council on the Developing Child,

2007a).

As mentioned, supportive and caring adult relationships can buffer against the effects of stress and shift potentially toxic

stress to a more tolerable, manageable level. Adults can help prevent the physiological stress response from activating

or can help to lower children’s heart rate, blood pressure and hormone levels, returning them to baseline more quickly

afterwards (Center on the Developing Child at Harvard University, 2016). Without this buffer and protection, long-lasting

stress responses can lead to a system that is set to fear rapidly, shift into defensive mode with little provocation,

overreact or shut down completely (Center on the Developing Child at Harvard University, 2016). Early interventions

should target the causes of excessive stress and support caring adult relationships to protect children from developing

harmful epigenetic changes and lifelong problems (National Scientific Council on the Developing Child, 2010).


January 2018

7

Executive function and self-regulation

Executive function encompasses a number of high-level cognitive skills such as inhibitory control, working memory and

cognitive flexibility. These skills provide the foundation for as focus and attention, planning and goal setting, rule

following, problem solving, impulse control and delaying gratification, all of which are essential for children to be able

to manage challenging and stressful circumstances, build effective social skills, and succeed in life (Obradović, 2016;

Center on the Developing Child at Harvard University, 2016; Center on the Developing Child at Harvard University, 2015;

Liew, 2012; Moffit, 2011).

Executive function is described as the brain’s air traffic control system as it helps to simultaneously plan, monitor and

manage multiple streams of information allowing individuals to identify mistakes, make decisions, resist frustration,

switch gears, revise and prioritize (Center on the Developing Child at Harvard University, 2016; National Scientific

Council on the Developing Child, 2015; Center on the Developing Child at Harvard University, 2011). These are important

for developing literacy and numeracy skills, working well with others and applying different rules in different settings

(Center on the Developing Child at Harvard University, 2011). Toxic stress can redirect the brain’s focus towards rapid

stress responses instead of planning and impulse control, negatively impacting executive function (Center on the

Developing Child at Harvard University, 2016).

Children rely on the self- and emotion regulation skills of the adults in their life to develop their own skills in this area.

Then, from three- to six-years old, there is a shift with children assuming greater control. To facilitate this transition,

children need opportunities to practice and strengthen their executive function skills in a safe and supportive

environment, where responsive caregivers are modelling the skills and providing the framework for their development

(Center on the Developing Child at Harvard University, 2016; Center on the Developing Child at Harvard University,

2011).

Dr. Stuart Shanker (2013) discusses how self-regulation is not a matter of compliance, but rather an issue of how

efficiently and effectively a child can handle and recover from stress. The sympathetic nervous system produces energy

to deal with stressors, and then the parasympathetic nervous system helps with recovery. There are different types and

levels of stress facing children and youth including: biological, emotional, cognitive, social and prosocial. Each type can

influence and be influenced by the others. When supporting self-regulation in children, it is therefore important to

consider all potential stresses, and their role in producing problematic behaviour, rather than simply dealing with the

behaviour itself. Three steps to supporting children and youth develop and enhance their self-regulation include:

1. Reduce overall stress level. Ensure the child is well slept, fed, and active. Limit or remove stressors and

stimulation such television, radio, video games. Aids such as a weighted bag for the lap, or playdough to squeeze

can help calm children and youth and decrease stress.

2. Help children develop self-awareness of what it feels like to be calm, focused and alter versus hypo- or hyper-

aroused.


January 2018

8

3. Provide tools, and teach skills to help children regain a sense of calm and be focused and alert. Address

experiences they need to learn to manage or avoid (Shanker, 2013).

Temperament

New research is changing how temperament is understood and measured. Temperament traits were initially believed to

be innate or set very early in life, but evidence now shows that some traits only become consistent and stable during the

preschool years. There is also an emerging interest in attention and self-regulation as important temperament traits,

and their role as moderators of more common traits such as activity, reactivity, emotionality and sociability. Historically,

biology was believed to strongly influence temperament with environmental factors becoming more influential over

time. A more common understanding now suggests that temperament results from both biological and environmental

factors working together throughout development. Based on these new findings, an adapted definition of temperament

traits is: early emerging basic dispositions in the domains of activity, affectivity, attention, and self-regulation, that are

the product of complex interactions among genetic, biological, and environmental factors across time (Shiner et al.,

2012).

Resilience

The word resilience stems from the Latin verb, resilire, (i.e., to rebound) (Masten, 2014), and is used to describe why

and how some children do well or even thrive despite experiencing significant adversity (Obradović, 2016; Center on the

Developing Child at Harvard University, 2016; Center on the Developing Child at Harvard University, 2015). For someone

to be considered resilient, there is an inherent assumption that they:

• are doing well with regard to developmental milestones or outcomes such as academic achievement, peer

acceptance, happiness or life satisfaction, and have an absence of mental illness, emotional distress, criminal

behaviour or risk-taking

• have had significant exposure to adversity such as premature birth, divorce, maltreatment, violence, caregiver

illness, poverty, homelessness or war and natural disaster, that would otherwise have put them at risk for

negative outcomes (Masten, et al., 2009).

Resilience is not an innate or fixed trait but rather often arises from ordinary yet powerful processes and protective

factors at the individual, relationship and societal levels. At the individual level, resilience is linked to strong executive

function, self-regulation, adaptability, positive self-perception and self-efficacy; all of these foster a sense of control

over one’s life and a belief that adversity can be overcome (Masten, et al., 2009; National Scientific Council on the

Developing Child, 2015; Center on the Developing Child at Harvard University, 2015; Center on the Developing Child at

Harvard University, 2016). At the relationship level, most resilient children/youth have at least one stable and

responsive caregiver or other caring adult who has buffered some of the stress and adversity, provided support, and

encouraged trust, autonomy, initiative and connection to others (Center on the Developing Child at Harvard University,

2016; Center on the Developing Child at Harvard University, 2015; National Scientific Council on the Developing Child,

2015; Goldstein & Brooks, 2008). External supports at the neighbourhood or societal level that reinforce self-esteem and


January 2018

9

self-efficacy are also important protective factors (Goldstein & Brooks, 2008). These include effective schools, pro-social

organizations, neighbourhoods with high collective efficacy and public safety, good emergency social services as well as

quality public health and health care (Masten, et al., 2009).

There is strong criticism within resilience research and studies for the lack of attention to culture and cultural practices

(including religion) and how they influence individuals and communities. For example, judging resilience by how well

someone is adapting or whether they are successfully reaching developmental milestones is inherently culturally based,

yet rarely examined in this context (Masten, 2014). Additionally, the value of faith and other cultural traditions in

providing hope and stability in the face of adversity (Center on the Developing Child at Harvard University, 2015;

National Scientific Council on the Developing Child, 2015) or of cultural rituals in promoting acceptance and recovery of

individuals struggling with adversity, have often been undermined (Masten, 2014). A social-ecological model of

resilience is therefore encouraged to highlight the role of culture and context in shaping exposures, responses and

expectations of children experiencing adversity (Masten, 2014; Ungar et al., 2013).

Resilience can be promoted and strengthened at any age with programs and practices that help children cope and adapt

(Center on the Developing Child at Harvard University, 2016; Center on the Developing Child at Harvard University,

2015; Masten, 2009; National Scientific Council on the Developing Child, 2015). Rather than focusing on the individual,

however, the primary goal should be promoting relationships and social supports at the level of the community, and

preventing severe hardship and adversity in the first place. Programs and policies that support children and families by

reducing risk exposure, increasing resources and assets, and mobilizing powerful protective systems should be

prioritized (Center on the Developing Child at Harvard University, 2015; Masten, 2009).

Positive caregiving relationships

Strong, supportive and responsive adult relationships are linked to a number of positive outcomes including resilience,

but also self-confidence, mental health, motivation to learn, impulse control, conflict resolution, knowing right from

wrong and the ability to develop and sustain friendships (National Scientific Council on the Developing Child, 2004). In

the early years, responsive adult relationships affect brain architecture through reciprocal serve and return interactions,

like in tennis, where babies reach out (serve) by babbling and making facial expressions and gestures, and adults

respond (return) in ways that reinforce baby’s behaviours. By returning these interactions, the baby’s experiences are

affirmed and new abilities are nurtured (National Scientific Council on the Developing Child, 2007a; National Scientific

Council on the Developing Child, 2004). Severe neglect, inconsistent experiences and frequent disruptions to serve and

return interactions activate children’s stress response systems, and appears to be one of the greatest threats to their

health and development (National Scientific Council on the Developing Child, 2015; Center on the Developing Child at

Harvard University, 2016). Issues such as maternal depression, family violence, and other family stressors can affect

these interactions and may have lasting effects on young children and their development (National Scientific Council on

the Developing Child, 2004).


January 2018

10

The relationship between caregivers and children is critical; society therefore, not only has a role to play, in detecting

and preventing harmful practices, but also in supporting positive caregiving (Mullin, 2012). Caregivers should have

access to programs, services and trainings. Additionally, caregiving environments, such as the home and daycare, should

be rich in language, warm and responsive, and physically safe with a high adult to child ratio (Center on the Developing

Child at Harvard University, 2016). Warm and supportive caregivers can support to greater social competence, fewer

behavioural problems and enhanced thinking and reasoning at school age. The influence of parent and caregiver

relationships spans throughout the life course but the nature of their impact varies by age and developmental status,

with other relationships such as those with peers, becoming increasingly important in later childhood and adolescence

(National Scientific Council on the Developing Child, 2004).

Culture plays a significant role in shaping how caregivers care for their children (Ungar et al., 2013; Bornstein, 2012) and,

in turn, culture is maintained and transmitted through caregiving practices (Bornstein, 2012). It is important to note that

common caregiving beliefs and issues, including what roles and expectations are considered appropriate for male and

female caregivers and their children, are framed by an ethnocentric world view and western bias (Ungar et al., 2013;

Bornstein, 2012). There is no single approach to parenting; culture influences caregiver-child interactions, the

behaviours that are valued and promoted among children and what successful child development looks like (Bornstein,

2012).

Interventions aimed at supporting the social and emotional development of young children are most effective within the

caregiving relationship (Barfield, Dobson, Gaskill, & Perry, 2012). The primary attachment figures of the child are a

source of security and safety which encourage healthy self-regulation and expression of emotions (Zeanah, 2009);

according to Gilliam (2017), the most effective interventions are those that look at the child, the caregiver and the child

caregiving relationship.

Attachment

A child’s, adolescent’s, and, ultimately, an adult’s emotional health and typical reactions to new situations have their

basis in the early relationships between the infant/toddler and the people primarily responsible for his or her care. An

infant develops a capacity for emotional control before his or her first birthday and a sense of ‘attachment’ to his or her

caregivers within the first year. This ‘attachment’ is the extent to which the infant develops trust that the caregiver will

respond promptly and appropriately, thereby providing a sense of security (McElwain & Booth LaForce, 2006).

Attachment is a key feature of positive caregiving and strong, responsive relationships. The postnatal period is critical

when it comes to long-term attachment, caregiving behaviour and the emotional and behavioural development of

children (Giallo, Cooklin, Wade, D’Esposito, & Nicholson, 2013). Attachment theory, developed by Bowlby (1969), talks

about how children are biologically wired from the beginning of their lives to seek physical proximity to their caregivers

and form close emotional bonds, all with the goal of ensuring survival. In return, caregivers instinctually respond to their

children both verbally and non-verbally, and provide a secure base for them to return to for comfort and support (Cooke


January 2018

11

et al., 2016; Palm, 2014; Zilberstein, 2014). Having a strong sense of security allows children to explore more

comfortably and confidently, and develop a positive internal working model of care and protection (Zilberstein, 2014).

This in turn leads to greater emotional competence and understanding (Cooke et al., 2016). Attachment relationships

remain important over the lifespan but look different with age. For example, while infants, toddlers and young children

seek physical proximity and comfort from caregivers when distressed, older children tend to use more verbal strategies

and internalized representations of comfort and security, and teenagers may look to their peers or cope independently

(Zilberstein, 2014).

Attachment literature tends to focus on the mother-child relationship as mothers typically spend more time with

children, particularly during the infant stage (Bornstein, 2012). Historically, fathers were also seen more as playmates

than primary attachment figures. Fathers were believed to be sought out during times of exploration and play, while

mothers provided the comfort and security. Now, it is better understood that both male and female caregivers play an

important role in developing secure attachment relationships, but that these relationships may look and function

differently. A family perspective where caregivers support each other’s roles and contributions is important (Palm,

2014). As a result, family support programs and services are designed to help families meet their children’s specific

needs and cope with stressors that can reduce effective parenting. The specific goals of these family support programs

vary, but often include (Halle et al., 2013):

• increasing parents’ knowledge of child development

• improving parenting skills

• providing employment supports

• reducing parental stress

Specific attachment-focused intervention programs have also been developed and used by family support programs and

services to help form these important early relationships between caregiver and child. The attachment-focused

programs in this report have varying degrees of evidence to support their efficacy.

The importance of play in child development

There is a strong belief in the power of play, with experts (such as those working with the United Nations), recognizing it

as a fundamental right of every child (White, 2012). Play is introduced at a very young age to babies through serve and

return interactions where they quickly learn that it is something joyful and different from real life (Kenney, 2012). As

children grow, they are introduced to and engage in various types of play. Regardless of the form it takes, a typical

definition of play is that it is pleasurable, intrinsically motivated, process-oriented, freely chosen, actively engaged and

non-literal (White, 2012; Lillard et al., 2013).

There are different types of play, all which have their value and period of dominance in a child’s life including, symbolic

play, imaginary, or pretend play, social play, object play, and physical play (Gilmore, 2009; Lillard et al., 2013; White,

2012). Media play is an emergent form of play that can promote positive outcomes such as learning and creativity, but is

still viewed with skepticism and should not completely replace the more traditional forms of play (White, 2012).


January 2018

12

Play is influenced by culture. It is a form of socialization where children learn about their cultural realities and

expectations, and develop internal scripts for how to act (White, 2012). Pretend play is seen across cultures with all

children creating individualized worlds that mirror their own mental organization and internal conflicts (Gilmore, 2011),

but not all cultures view it as important, and as such children from these cultures tend to play much less (Lillard et al.,

2013).

The benefits of play depend on the type of play and the field of study in which it’s being discussed. For example, child

analysts see play as promoting development, whereas psychoanalysts see it as a form of therapy (Gilmore, 2011). While

some suggest there is not enough credible evidence to claim that play is crucial to development (Lillard et al., 2013),

most believe it does support essential cognitive, emotional, social and physical skills. Cognitive skills include language

development, creativity, the creation of narratives, problem-solving, mastery, divergent thinking, self-regulation,

attention, working memory and planning (Kenney, 2012; White, 2012). Play is also believed to foster a lasting disposition

to learn. Through play, children are encouraged to take ownership of knowledge seeking, exploration, hypothesis-testing

and discovery, all within a safe environment. Through social or peer play children learn to compromise, negotiate,

resolve conflicts and manage their emotions. In later years, socio-dramatic play encourages children to take on different

roles and storylines helping them navigate complex emotions and relationships (White, 2012). Finally, physical play helps

to develop fine and gross motor skills, promote a healthy lifestyle, and provide physical benefits such as increased

aerobic capacity, strength, endurance and coordination (Kenney, 2012; White, 2012). Caregivers and other adults can

support learning and development through play by enriching the play environment, joining in the fun, asking questions

and comments and encouraging further exploration (White, 2012). Play therapy modalities involving a trained

practitioner and the child’s caregiver provide a unique opportunity for the child’s cues of dysregulation and patterns of

behaviour to be identified and addressed (Ryan, Lane, & Powers, 2017).

Considerations

The early social and emotional development of children has lasting effects on their overall health and well-being, as well

as the health of communities and the creation of sustainable societies (National Scientific Council on the Developing

Child, 2007a). Programs and services should focus on supporting the development of nurturing and protective

relationships, creating safe and secure environments and intervening as early as possible when there is an issue.

Everyone, not just caregivers, has a role to play in ensuring all children have the best start in life.

Social and emotional development happens within the context of family, community, and culture (Hecht & Shin,

2015). Cultural sensitivity and cultural safety in program design and implementation is crucial to ensure that evidence-

informed programs and services are accessible to all cultural groups. Programs and services that are culturally safe

provide a sense of trust and respect within interactions and are linked to successful outcomes that are also culturally

meaningful (Brascoupé & Waters 2009). Despite the importance of programs to ensure cultural competence, to date,


January 2018

13

many studies have not investigated childcentered outcomes across cultures or looked at culture-specific groups. There

is also a large deficit of programs that are offered to meet the needs of specific populations, or adapted version of

programs for different cultures (such as immigrant families, French-language, Indigenous, First Nations, or Métis

cultures). This is a limitation when evaluating evidence-informed programming and therefore it is recommended that

various cultural groups accessing programs and services are engaged during program design, implementation, and

evaluation.

Early prevention and intervention programs for social and emotional development of 0-6

year old children

Across the literature there is strong evidence that parenting interventions promote parent–child interactions, improve

responsiveness in attending to infants and young children, foster strong attachment, and encourage problem-solving

related to children’s development, and care (Wright et al., 2015). Moreover, evidence suggests that early trauma and

adversity should be addressed through such interventions and considered when working with young children (Ryan,

Lane, & Powers, 2017). Programs that focus on understanding the child in the context of her/his family is a useful

approach when determining risk factors that could contribute to the poor developmental outcomes of a child (Vernons-

Fegans, Garrett-Peters, & Willoughby, 2016).

For the programs included in the environmental scan, each has their own strengths, weaknesses and varying degrees of

research on efficacy. Efficacy refers to programs delivered and tested in tightly managed environments to control for

confounding variables. It is important to note that there appears to be a relationship between the cost of programs and

the quality of evidence for their effectiveness (i.e., more expensive programs have invested more resources on research

into program efficacy, while smaller, regionally developed programs have been less able to produce extensive research

on efficacy).

Tiered approach to child and adolescent mental health service

The goal of prevention and early intervention is to prevent problems or disorders in at-risk groups, promote protective

factors, minimize the impact of mental health problems, and prevent symptoms from worsening (Clinton, Kays-Burden,

Carter, Bhasin, Cairney, Carrey, Janus, Kulkarni, and Williams, 2014). Prevention and early intervention (Tier 1 programs)

can be more effective and less expensive than addressing infant and early childhood mental health issues after they

become more serious (Field, 2011). Primary prevention programs are population-based and intended for recipients who

have more challenges to contend with, and/or who are more at-risk than others for poor outcomes. Secondary

prevention programs are intended for infants and young children exhibiting symptoms of mental health problems, and

also within the context of observed difficulties in relationships with caring adults. Secondary prevention intervenes as

soon as symptoms are observed in order to prevent symptoms from worsening or developing into a mental health

disorder (Clinton et al., 2014).


January 2018

14

Tertiary level support services, or Tier 3, aim to reduce the severity of disorders, improve functioning and prevent the

development of further mental health conditions. Treatment is meant for infants and young children, as well as their

primary caregivers, who meet diagnostic criteria for mental health disorders and/or who exhibit significant symptoms or

disturbances without having a formal diagnosis. The infant parent/caregiver relationship is a primary focus of treatment;

even when the infant-parent/caregiver relationship is not a source of difficulty (e.g., when treating anxiety, autism etc.).

Improved functioning and preventing further problems from developing is the central goal of treatment (Clinton et al.,

2014).

A summary of evidence-informed programs for the social and emotional development of 0-6

year old children

Tier 2 level programs

COPEing with Toddler Behaviour (CWTB) is an evidence-based group parent education program. This program and the

program materials are available in English, French and Spanish. Currently this program is offered in Ontario. CWTB is a

weekly, two-hour program that takes place across eight weeks. It has been implemented in early years centres, child

care settings, children’s mental health centres, children’s treatment centres, family resource centres, churches, schools,

recreation centres, and hospitals.

Target population

• Age: 1-3 years old

• families at-risk for social, emotional, behavioural, or developmental difficulties

Program details

• Core program objectives:

o enhance parent’s/caregivers’ skills in preventing challenging behaviour in toddlers

o provide an opportunity for parents/caregivers to practice skills through structured home practice

assignments and, in the following session, discuss their home practice and get peer support for their

efforts

• Targeted skills:

o develop ability to use an authoritative (“backbone”) parenting style and foster a positive parent-child

relationship

o develop appropriate developmental expectations

o tailor parenting to child temperament

o prevent challenging behaviours by planning ahead, using praise, and giving choices

o respond to challenging behaviour by setting limits, redirecting, and ignoring inappropriate behaviour

o learn how to modify the environment to limit conflict


January 2018

15

Program structure

• large groups of parents/caregivers (12-40) sit at tables of 4-6 parents each and watch video clips of actors who

play parents making exaggerated errors in common parent-child interaction situations

• small group discussions at each table around the errors and the impact of the errors, as well as alternatives and

the benefits of the alternatives

• return to the large group for a discussion

• parents/caregivers are provided homework and assignments to discuss at the weekly meetings

Program implementation

• Number of leads/instructors: 1

• Profession/education required: facilitators are infant development specialists with educational backgrounds in

psychology, early childhood education, or social work with additional training and experience in parent

education and intervention with families of young children at risk

• Required materials: one CWTB manual ($50) and one DVD (or videotape) ($45) are required for each participant

(no exceptions), plus tax and shipping and handling

• Length of training: two-day facilitator training workshops, a detailed facilitator manual, and videotape/DVD

• Cost of training or membership: $3,500 for training plus travel/meals/accommodation for the presenter

Summary of the research

• Main findings:

o reduced child behaviour problems, parental over reactivity and depression

o increased reports of positive parent–child interactions

o effects were significant at both post-test and 1-month follow-up and effects sizes were small to medium

for the intervention group and small for the control group

o CWTB may promote positive parent–child interaction and children’s mental health

• Limitations:

o the generalizability of the findings are limited to mothers who are concerned enough about their child’s

behaviour to register for a parenting course (i.e., it was not a screened, clinical sample)

o further research is needed with larger or clinical samples to address the efficacy of CWTB as a treatment

program for high-risk children (versus a population-based prevention program)

o this study did not conduct longer-term follow-up to assess the effectiveness of CWTB in preventing

disruptive behaviour disorders

APA references

Cunningham, C. E., Boyle, M., Offord, D., Racine, Y., & Hundert, J., Secord, M. & McDonald, J. (2000). Tri Ministry Project:

Diagnostic and demographic correlates of school-based parenting course utilization. Journal of Consulting and

Clinical Psychology, 68, 928-933.


January 2018

16

Niccols, A. (2009). Immediate and short-term outcomes of the ‘COPEing with toddler behaviour’ parent group. Journal of

Child Psychology and Psychiatry, 50(5), 617-626. doi:10.1111/j.1469-7610.2008.02007.x


January 2018

17

Hand in Hand is an evidence-informed parent/caregiver support and education program offered in English. The program

has been implemented in Ontario and other areas of Canada. Hand in Hand offers one-on-one support to

parents/caregivers using a developmental support plan that is maintained through regular check-in meetings and a

developmental screening every three months. Hand in Hand training and resources are offered in both French and

English.

Target population


• families identified at risk through primary screening, child welfare, early intervention, or child protective services

Program details


o support the child’s development by focusing on optimal development milestones

o provide strategies that can foster child’s development while he or she may be waiting for further

assessment or referral to specialists

o provide simple everyday strategies and activities to help a child reach appropriate developmental goals

in a culturally appropriate and strength based way

o provide an opportunity for caregivers and staff members to collaborate on a child’s development

o help parents/caregivers understand the type of experiences their child needs to meet their next

developmental milestone


o developmental support plans help professionals and families to monitor and support the growth of a

child in key areas such as communication, problem-solving, personal-social, gross motor, and fine motor

Program structure

• parents/caregivers will be asked to complete a developmental screening with a social and emotional component

(both the ages and stages questionnaire (ASQ) 3 and the ages and stages questionnaire's social and emotional)

• semi-structured caregiver interview to help the practitioners better understand the child’s developmental status

and developmental needs

• 45 minutes of observing floor time playing with the child (and caregiver) to better understand the child’s specific

strengths, temperament and other factors that can inform the development of a support plan

• share the information discovered through the ASQ, caregiver interview, and observations with the team

involved with the child and determine any next steps

• determine what referrals for further assessment or intervention are needed and process those in a timely

manner using the areas of concern

• develop a Hand in Hand developmental support plan to provide the parent/caregiver strategies to promote

development in areas of concern, while highlighting the child’s strengths (this is provided in a timely manner and

will be used even when a parent/caregiver is on a waitlist for other services)


January 2018

18

• share the developmental support plan with caregivers and other service providers and with the medical team or

all others involved with the child

• establish a schedule to repeat the process three to four months after the previous screen to capture and track

the child’s developmental progress

• continue the process until the child receives the referred support services or diagnosis


• Number of leads/instructors: variable – often clinical staff in communities are trained as a group to implement

and use this program.

• Profession/education required: educational backgrounds in psychology, early childhood education, or social

work with additional training and experience in parent/caregiver education and intervention with families of

young children at risk

• Required materials: user manual and required documents are included in the training costs

• Length of training: Hand in Hand training is often delivered across two days

• Cost of training: average of $3,500 for an agency or group but may vary depending on location and group size


• Main findings:

o a pilot study was conducted to determine the effectiveness of developmental support plans to promote

enhanced development and improved child outcomes in infants and young children (wait-list control

design; n=62)

o a statistically significant decrease from pre to post intervention for mean socio-emotional scores for 19

children in the intervention group was found

o for children under 24 months, no significant differences in socio-emotional scores were found

o standardized screening tools assisted in identifying issues with young children’s development

• Limitations:

o sample identification and sample attrition (e.g., change of placement, adoption) contributed to a small

sample

o a small sample size poses challenges as it reduces statistical power, thereby reducing accuracy

o implementation issues (e.g., time between initial screen and foster parents receiving a developmental

support plan) also threaten the validity of the findings

APA references

Kulkarni, C., Cheung, C., Filippelli, J., Packard, B., & Paolozza, C. (2017, April). Infant wellness and child welfare promoting

mental and physical wellbeing. Poster session presented at the Infant Mental Health Promotion Conference,

Toronto, ON.


January 2018

19

Nurturing the Seed was developed based on the Hand in Hand program model. This program has been implemented in

Ontario and other areas of Canada. Nurturing the Seed offers one-on-one support to parents/caregivers using a

developmental support plan that is maintained through regular check-in meetings and a developmental screening every

three months.

Target population

• Age: Children 0-5 years old

• developed to meet the unique needs of Indigenous infants, children and families

Program details


o in addition to the program objectives of Hand in Hand, Nurturing the Seed aims to build strong and

respectful relationships with Indigenous families and support development using an Indigenous lens

o ensure cultural sensitivity every step of the way by attending to the context and understanding of the

‘holistic’ environment and context of the child (including history and worldviews)

o promote culturally safe and respectful relationships and help build relationships with Indigenous

families and caregivers

o use and share an Indigenous lens on child development including milestones and strategies to reach

those milestones


o developmental support plans help professionals and families to monitor and support the growth of a

child in key areas such as communication, problem-solving, personal-social, gross motor, and fine motor

Program structure

• parents/caregivers will be asked to complete a developmental screening with a social and emotional component

(both the ages and stages questionnaire (ASQ) 3 and the ages and stages questionnaire's social and emotional)

• semi-structured caregiver interview to help the practitioners better understand the child’s developmental status

and developmental needs

• 45 minutes of observing floor time playing with the child (and caregiver) to better understand the child’s specific

strengths, temperament and other factors and useful information that can inform the development of a support

plan

• share the information discovered through the ASQ, caregiver interview, and observations with the team

involved with the child and determine any next steps

• determine what referrals for further assessment or intervention are needed and process those in a timely

manner using the areas of concern

• develop a Hand in Hand developmental support plan to provide the parent/caregiver strategies to promote

development in areas of concern, while highlighting the child’s strengths (this is provided in a timely manner and

will be used even when a parent/caregiver is on a waitlist for other services)


January 2018

20

• share the developmental support plan with caregivers and other service providers and with the medical team or

all others involved with a child

• establish a schedule to repeat the process three to four months after the previous screen to capture and track

the child’s developmental progress

• continue the process until the child receives the referred support services or diagnosis


• Number of leads/instructors: variable – often clinical staff in communities are trained as group to implement

and use this program

• Profession/education required: educational backgrounds in psychology, early childhood education, or social

work with additional training and experience in parent/caregiver education and intervention with families of

young children at risk

• Required materials: User manual and required documents are included in the training costs noted below.

• Length of training: Nurturing the Seed training is often delivered across two days

• Cost of training is an average of $3,500 for an agency or group.


• there is no current evidence available to date

• this program is based on Hand in Hand and was developed in consultation with elders, community members, as

well as an advisory group who provided insight on how to work effectively with Indigenous communities


January 2018

21

FUN Friends is an evidence-based program offered in both French and English languages that is currently delivered

across Ontario, Canada, and internationally. This 1.5-2 hour, weekly program focuses on working with children in a

group setting. Across 8-10 weeks, this program aims to develop social and interpersonal skills needed to effectively cope

with difficult and/or anxiety provoking situations. This program can be implemented in community agencies, classrooms,

or recreational centres.

Target population

• Age: children ages 4-7 years old

• children at-risk for social and behavioural problems, children displaying high levels of anxiousness

• this program can be implanted across classroom settings for all children

Program details


o considers the biological, psychological, and social components of healthy development to promote

resilience

o draws on Cognitive Behavioural Therapy (CBT) techniques to teach children and caregivers effective

problem-solving and social skills

o develops skills for addressing physiological responses to stress and challenge through progressive

muscle relaxation and breathing techniques

o uses a bioecological framework of development and includes teaching skills to children,

parents/caregivers, and educators to promote children’s social and emotional wellness


o life skills to effectively cope with difficult and/or anxiety provoking situations

o help children learn about and identify their emotions and identify negative thoughts and to counter

them with positive thoughts

o relaxation techniques as a way of coping with anxious feelings

o problem solving techniques

o importance of rewards and celebrating successes, even the small ones

Program structure

• weekly sessions, typically 60–75 minutes in a group setting where children learn and practice skills on various

topics using developmentally-appropriate activities

• delivery is flexible across different settings if the sequence, structure and topics are respected

• two information sessions of approximately 90–120 minutes are conducted with caregivers and educators to

provide strategies for enhancing resilience at home, reinforcing program strategies, and behaviour management

techniques


January 2018

22


• Number of leads/instructors: 1 – 3 facilitators depending on the size of the group of children and the size of the

group can be adapted for various settings including community centres, classrooms, and mental health agencies

• Profession/education required: facilitators of the Friends Programs (including FUN Friends) must be registered

Health or Educational professionals or registered School Counsellors or Chaplains

• Required materials: Information was not available in our search

• Length of training: Facilitator training delivered by Licensee Trainers takes approximately eight hours per

program and Licensee Trainers complete a refresher training every three years (through Friends Resilience

online that is four to five hours and simply updates information on new evidence based strategies added to the

Friends Programs

• Cost of training: The cost of training varies per region and number of facilitators

o Licensee Training is exclusively provided by Friends Resilience and can only train facilitators for the

Friends Programs in their licensed territory (this is not a train the trainer approach)


• Main findings:

o participants were randomly assigned to one of three groups (an intervention group receiving Fun

FRIENDS, an active control group receiving an in-school, socio-emotional development curriculum called

You Can Do It, and a waitlist control group)

o children in the Fun FRIENDS group improved significantly compared to children in the two control

groups for behavioural and emotional strength and behavioural inhibition

o children in the Fun FRIENDS and active control groups made significantly greater improvements than

those in the waitlist group from pre-test to post-test

o Higgins and O'Sullivan (2015) conducted a systematic review of seven research studies that were

randomized controlled trials and examined the effectiveness of the FRIENDS program as a preventative

universal intervention

o all reviewed studies found that the program had a positive impact on primary anxiety outcome

measures compared to control groups, with small to medium effect sizes reported

• Limitations:

o high attrition rate at both post-intervention and follow-up leads to a high risk of bias for incomplete

outcome data

o methodological concerns involving correcting for multiple contrasts and ensuring matched control

groups may also have resulted in outcomes being incorrectly identified as significant

o self-report was used for all measures and future research should include data from multiple sources to

ensure a comprehensive and accurate evaluation of treatment effects


January 2018

23

APA references

Anticich, S. A., Barrett, P. M., Silverman, W., Lacherez, P., & Gillies, R. (2013). The prevention of childhood anxiety and

promotion of resilience among preschool-aged children: a universal school based trial. Advances in school

mental health promotion, 6(2), 93-121.

Higgins, E., & O'Sullivan, S. (2015). "What works": Systematic review of the "FRIENDS for life" programme as a universal

school-based intervention programme for the prevention of child and youth anxiety. Educational Psychology in

Practice, 31(4), 424. doi:10.1080/02667363.2015.1086977


January 2018

24

Make the Connection is an evidence-informed parent/caregiver training program that is offered in both French and

English and is currently delivered across Canada. Make the Connection consists of three different programs to meet the

needs of children 0-3 years old including the 0-1 group program, 1-2 group program, and the 1-3 education curriculum.

Make the Connection group programs are delivered to parents/caregivers in 90-minute weekly sessions, across nine

weeks, in both one-on-one and group sessions. Sessions incorporate hands-on parent-baby activities, videotaping and

discussions to help parents/caregivers reflect on key components of secure attachment.

Target population

• Age: birth to 3 years old

• parents/caregivers who may be at risk for poor parent/infant attachment, PPMD, unresolved grief or trauma,

history of insecure attachment, partner conflict, or financial stressors

Program details


o to develop skills and strategies that encourage a secure attachment between parent/caregiver and child

which increases positive outcomes for a child’s social and emotional well-being, learning in school and

contribution to society


o relationship building and attachment through developing trust in the parent’s/caregiver’s

responsiveness, emotional and physiological regulation and a positive sense of self

o language and communication skills, I.e. to develop a responsive relationship through skills in joint

attention and gestural/symbolic language and skills in optimal language input and conversational

practice

o develop skills and practices, with support from a parent/caregiver through "scaffolding", that encourage

motivation to learn, learning through natural curiosity as well as discovery, problem-solving and

imagination

Program structure

• videotaping is an essential medium for learning in this program where parent-toddler tapes are reviewed as part

of two of the nine sessions

• the group facilitator provides positive, supportive feedback to parents/caregivers and helps them to recognize

positive aspects of their interactions with their child and how to be more aware of their child’s signals

• program sessions are structured using the following activities:

o 30 minutes of guided parent –toddler activities including song circle and interactive play stations

o 30 minutes of parent/caregiver reflection and discussion – toddlers who can separate stay with childcare

staff

o 30 minutes where half of the parents/caregivers are videotaped with their toddler while the group gets

together for refreshments


January 2018

25


• Number of leads/instructors: two trained facilitators

• Profession/education required: early years background and other professionals who have experience delivering

group programs (for 6-10 babies) birth to three years old and their families

• Required materials: video recording device, TV, activity materials as necessary

• Length of training: two days

• Cost of training: varies depending on group size

o MTC 0 -1 Baby Program 2-day workshop: $3,000 (base fee for up to 14 participants) + $150 per person

up to max. 24 = $4,500)

o MTC 1-2 Toddler Program 1-day workshop: $2,000 (base fee for up to 14 participants + $100 per person

up to max. 24 = $3,000 for 24)

o MTC 0-1 & 1-2 combined 3-day workshop: $5,000 (base fee up to 14 participants + $250 per person up

to max. of 24 = $7,500)


• Main findings:

o study methodology was a quasi-random control trial - participants are randomized into either a control

(waitlist control group, no intervention) or study group (program participant)

o the goal of the outcome evaluation was to determine whether participation in MTC improves two broad

parenting dimensions: parent-to-infant attachment (i.e., the attitudes held by the parent/caregiver that

support sensitive responding) and parent sense of competence (i.e., the degree to which the

parent/caregiver is engaged and confident in their role)

o results indicated that parents/caregivers who participated in Make the Connection showed improved

parent sense of competence and parent-to-infant attachment relative to a waitlist control group

o parents/caregivers of infants high in negative affect showed the greatest gains following MTC program

relative to those in the control group

• Limitations:

o limited sample and sample size reduces statistical power, thereby reducing accuracy

o currently only a preliminary study is available that demonstrates positive impacts of this program,

further research is necessary

APA references

Currently there is no published literature on this program. Several evaluations have been conducted from 2006-2016.

Recently, a randomized control study of approximately 500 families was completed in partnership with Queen’s

University in 2016 and a research paper has been submitted to the Journal of Reproductive and Infant Psychology in

August 2017.


January 2018

26

Me, My Baby, Our World is an evidence-based program that is currently offered in English across Ontario. This

parent/caregiver and child group program is offered for two hours weekly for 12 weeks. The aim of the group program is

to help young parents/caregivers better understand and use strategies related to developing a secure attachment,

supporting a child’s temperament and being attuned to the relationship with the baby.

Target population

• Age: 0-18 months

• adolescent mothers and their infants who are vulnerable and possibly at risk due to parenting deficits,

depression, other mental health and lifestyle circumstances

Program details


o to provide young parents/caregivers with a better understanding of their relationship with their baby –

and the importance of their role in that relationship

o to encourage sensitive parental responses to children

o to encourage reflexive thinking about the relationship with the child and their own experiences of being

parented


o develop skills to encourage attachment within the parent-infant relationship and build confidence as a

parent/caregiver

o to increase parent’s/caregiver’s positive attributions towards their children and increase parental

empathy and sensitivity

Program structure

• each session includes a music circle, an educational module and scrap-booking

• discussions with youth based on their experiences and expertise about their babies and parenting skills-using

reflective engagement approach


• Number of leads/instructors: 2-3 trained co-facilitators

• Profession/education required: practitioners with experience running groups and are familiar with the concepts

in infant mental health and how it relates to parent/child interactions, i.e. Child and Youth Workers, Social

Workers, Early Childhood Educators and Nurses

• Required materials: varies depending on activates

• Length of training: one day interactive training for facilitators participants to be qualified to offer the group

program their agencies

• Cost of training or membership: information not available


January 2018

27


• Main findings:

o caregivers expressed increased sense of self-efficacy in their parenting role

o increased caregiver understanding of the different areas of their child’s development – social,

emotional, physical, cognitive

o increased caregiver behaviours that communicate sensitivity towards their children

o reduction in caregivers’ atypical behaviours

o increased caregivers’ knowledge about attachment and the importance of their role in their child’s

mental health."

• Limitations:

o current research is limited to a preliminary study and pilot intervention of the program

o small sample size, therefore cannot be considered a formal evaluation of the approach

o the present evaluation only followed the mothers for a six-month period and future research is needed

to examine longer term outcomes

APA references

Stirtzinger, R., McDermid, S., Grusec, J., Bernardini, S., Quinlan, K., & Marshall, M. (2002). Interrupting the inter-

generational cycle in high risk adolescent pregnancy. The Journal of Primary Prevention, 23(1), 7-22.

doi:10.1023/A:101653513138


January 2018

28

Minding the Baby is an evidence-based program currently offered in English. This program is run in New Haven,

Connecticut and Miami, Florida and in Scotland, England, and Denmark. Minding the Baby began as an intensive home

visiting model for first-time young mothers and their families. This program often runs for two years with first-time

mothers typically invited to join during their second trimester or early in the third trimester of pregnancy. Weekly home

visits continue from pregnancy until the baby’s first birthday, at which point families are visited every other week until

the child’s second birthday.

Target population

• Age: 0 -2 years old

• first-time parents/caregivers who are identified as at-risk for attachment difficulties

Program details


o support mothers in developing skills to support their babies in both physical and emotional ways

o enhance protective factors, skills, and strategies

o develop skills for competent and flexible parenting

o increase psychological health in mother, child, and between parent/caregiver and child


o strengthen early parent-child relationships

o home visitations are aimed at helping with stress, supporting positive health, and mental health

o provide support for child growth to support building babies’ brains, skills, and talents

o teach ways to be more thoughtful, responsive, and reflective

Program structure

• home visiting is the primary intervention modality, beginning in pregnancy through to the child’s second

birthday


• Number of leads/instructors: Two - the interdisciplinary intervention brings together a home visiting team

including a pediatric nurse practitioner and a licensed clinical social worker

• Profession/education required: clinicians including registered nurses, advanced practice nurses, social workers,

psychologists, or other mental health clinicians

• Required materials: variable depending on the level of training received. More information can be found

http://mtb.yale.edu/training/summerinstitute.aspx

• Length of training: various levels of training available

o a general, three-day training institute in the Minding the Baby model that training focuses on the

theoretical and conceptual frameworks that guide Minding The Baby, and provides an in-depth



January 2018

29

introduction enhancing parental reflectiveness, and crucial principles of teamwork, consultation, and

supervision

o for those wishing to implement the full Minding the Baby intervention with the evaluation component,

all staff working on the program are required to complete the first level of training described above, in

addition to a combination of on-site and distance consultations over a two-year period


• Main findings:

o lower rates of child protection referrals and the most vulnerable mothers were also significantly more

likely to parent in a reflective rather than reactive way

o higher rates of secure attachment and lower rates of disorganized attachment in the intervention

children compared to the control group

o increases in maternal reflective functioning, especially among the most vulnerable mothers

o initial findings also point to several positive health outcomes, including high retention rates (90%

intervention and 80% control)

o mothers in the intervention group were significantly less likely to describe their children as having

behavioural problems than parents in the control group

• Limitations:

o limited sample - attrition and sample size reduces statistical power, thereby reducing accuracy

o many studies reported incomplete data on the longitudinal measures

APA references

Slade, A., Sadler, L., De Dios-Kenn, C., Webb, D., Currier-Ezepchick, J., & Mayes, L. (2005). Minding the baby a reflective

parenting program. The Psychoanalytic Study of the Child, 60, 74.

Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C. (2013). Minding the baby: Enhancing

reflectiveness to improve early health and relationship outcomes in an interdisciplinary HomeVisiting program.

Infant Mental Health Journal, 34(5), 391-405. doi:10.1002/imhj.21406

Söderström, K., & Skårderud, F. (2009). Minding the baby. mentalization-based treatment in families with parental

substance use disorder: Theoretical framework. Nordic Psychology, 61(3), 47-65.

doi:http://dx.doi.org.proxy.library.carleton.ca/10.1027/1901-2276.61.3.47


January 2018

30

Mothers in Mind is an evidence-informed parent/caregiver group education program offered in English and French. This

program runs over the course of 10 weeks with weekly group meetings for mother and child. This program is

currently offered across Ontario.

Target population


• mothers who have experienced family violence, childhood abuse, neglect or sexual assault, and have children

under the age of four

Program details


o provide early intervention to strengthen parent-child relationships, enhance parenting skills and reduce

parenting stress

o provide an opportunity for parents/caregivers to talk about parenting issues with other mothers who

have had similar experiences

o support mothers in learning ways to manage stress and other challenging feelings, foster healthy self-

esteem and respond to their children in a sensitive, supportive and effective manner


o develop skills for healthy interaction and communication with the child

o discover helpful ways to cope with anger, worry and stress

o increase a parent’s/caregiver’s confidence in responding to the child in a sensitive and caring manner

o learn how to support young children who may have been exposed to hurtful behaviours

o explore what helps children feel safe and secure

Program structure

• mother-child play group where mothers play with their children and have group discussions

• guided discussions where women are able to discuss the impact trauma has had on their parenting i.e., how

they feel triggered when they breastfeed their baby, how their toddler’s tantrum reminds them of their abuser,

and how hugging their child doesn’t always feel good





• Required materials: pre-implementation consultation, two-day Mothers in Mind Core Training, ongoing

consultation, annual licensing, training for new staff and/or refresher training, program delivery space and

supplies


January 2018

31

• Length of training: As part of the licensing agreement, affiliates participate in the Mothers in Mind Two-Day Core

Training. All staff facilitating the program must be trained by the Child Development Institute

• Cost of training or membership: information not available


No research was available to date


January 2018

32

Promoting First Relationships is an evidence-based home-visitation program offered in both English and Spanish and

primarily offered in the US through Washington State University. This program consists of weekly 1 hour sessions across

10 weeks.

Target population


• parents/caregivers who have concerns about the quality of parent-child relationship

• if the child is being reunified after being out of the parent’s/caregiver’s care for a period of time

• parent/caregiver who needs information about infant and toddler social and emotional development or who

needs help developing and expressing empathy towards their young child

Program details


o build a stronger, more secure, and more trusting relationship between caregiver and child

o encourage caregivers to reflect on past interactions to better understand children’s needs, emotions,

and actions

o develop skills to support parents/caregivers in becoming more responsive to the child and promote their

socio-emotional development


o Promoting First Relationships trains early intervention, community mental health, home visiting and

early care and education workers to deliver a home visiting program based on infant mental health

principles

o providers support caregivers’ ability to read their child’s nonverbal cues, empathize with and provide

comfort when their child is distressed, and understand that their child’s difficult behaviour may reflect

underlying social and emotional needs

Program structure

• this program is strengths-based and uses joint observation and reflection on videotaped caregiver-child

interactions to increase caregivers’ confidence and competence

• providers use home visits to provide feedback to caregivers on videotaped interactions between caregivers and

their children, giving insight into the underlying causes of behaviour in infants and toddlers





• Required materials: video tape device, TV

• Length of training: 15 weeks


January 2018

33

o During the first five weeks, trainees will view professionally filmed sessions with caregivers (parents and

child care providers) and young children (infant, toddler, special needs

o the next 10 weeks, trainees will be mentored by a master trainer weekly on-line as they implement this

program with caregiver/child dyads at their own sites

o sessions will include reflection on videos of the dyadic interactions that trainees upload to a secure

website, and discussion about how to implement the core concepts and consultation strategies

• Cost of training or membership: costs for 4.5-Month Mentored Training Program is approximately $2,150 USD

per person when training as part of a pair group or $3,000 per person if trainee is a stand-alone individual (not

part of a pair group)

o this cost Includes 16 contact hours with a master trainer and the initial fidelity certification fee


• Main findings:

o significant improvements in caregiver sensitivity in the intervention group

o child outcomes were not significantly improved

o at post-test, toddlers who received the Promoting First Relationships treatment had a significant

improvement in their socio-emotional competence compared with the control group. However, this

positive impact was not found at the six-month follow-up

o researchers did not find the PFR treatment had any significant negative impacts on children

• Limitations:

o there is limited research available

o current research demonstrates limited results showing positive impact on child outcomes

APA references

Kelly, J.F., Buehlman, K., & Caldwell, K. (2000). “Training and Early Intervention to Promote Quality Parent-Child

Interaction in Homeless Families”. Topics in Early Childhood Special Education, 20(3), pp. 174-185.

Kelly, J.F., Zuckerman, T., & Rosenblatt, S. (2008). “Promoting First Relationships: A Relationship-Focused Early

Intervention Approach”. Infants and Young Children, 21(4), 285-295.

Spieker, S.J., Oxford, M.L., Kelly, J.F., Nelson, E.M., & Fleming, C.B. (2012). Promoting First Relationships: Randomized

trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment, 17, 271-286.


January 2018

34

Triple P Positive Parenting Program contains various levels of targeted prevention and intervention evidence-based

programs. This includes five program levels ranging from promoting literacy surrounding positive parenting skills (Level

1) to family interventions (Level 5) to meet the diverse needs and preferences of families. The length of the program,

frequency, and schedule is variable depending on the level of the program. Triple P is currently offered across Canada

and in Ontario.

Target population

• Age: Triple P programs are suitable for a large age span of 0-12 years

• Triple P offers programs that are appropriate for both universal prevention and targeted populations

Program details


o increase parent’s/caregiver’s behaviour management skills, knowledge, and confidence in their abilities

to raise their children

o promote positive interactions, reducing coercive parenting techniques, decreasing negative symptoms

related to stress, anxiety, and depression, reducing familial conflict, and increasing parent’s/caregiver’s

ability to manage work and family responsibilities


o parenting practices that encourage a safe and engaging environment in which children are encouraged

to play, explore, and experiment

o supportive practices to encourage a positive learning environment in which parents/caregivers respond

to child-initiated interactions in a positive and constructive way

o assertive discipline behaviour management strategies as alternatives to harsh, coercive, punitive, or

ineffective parenting techniques

Program structure

• Universal Triple P (Level 1): A publicity campaign aimed at putting parenting on the public agenda and to

destigmatize and normalize the process of seeking parenting help via radio, newspapers, school newsletters, and

Website information

• Selected Triple P (Level 2): A low-intensity seminar that provides general parenting information and advice to

parents/caregivers with specific concerns about minor developmental or behavioural concerns (e.g., child having

difficulty falling asleep)

• Primary Care Triple P (Level 3): Targeted counseling and active skills training for parents/caregivers of children

with mild to moderate behavioural and developmental challenges where parents/caregivers take part in 3 or 4

individual sessions in person or over the phone or a series of group sessions

• Standard Triple P (Level 4): Targets parents/caregivers who want intensive training to improve their interactions

with their children or learn strategies for targeting specific challenging behaviours


January 2018

35

o this is an intensive 10-hour program that can be completed in individual sessions with a therapist in

person or over the phone; in group sessions; or in self-directed learning modules using a workbook or

online interactive training

• Enhanced Triple P (Level 5): Offers a series of intensive interventions and support for families with serious

challenges, such as parental depression or stress, conflict between parents, parents going through separation or

divorce, parents at risk for maltreating children, parents of obese children.


• Varies depending on type of program: Further information can be found at http://www.triplep-

parenting.ca/ont-en/triple-p/?cdsid=b126e41461fc3ff0883329aa4c9a2640


• Main findings:

o metaanalysis of 101 studies across 13 countries found that each level of the Triple P program positively

impacted children’s short-term and long-term social and emotional behavioural outcomes for children

with and without developmental disabilities

o Triple P has been shown to reduce “problem behaviours” in children, lower parental distress, and

increase parenting confidence in studies conducted with low income parents, parents at risk for

maltreating their children, parents of children with ADHD, parents going through divorce, Australian

Aboriginal parents, parents in remote communities in Australia, and highly stressed working parents

o targeted, treatment, and universal programs all produced significant effect sizes for positive change,

with larger effects in targeted and treatment programs than universal programs

• Limitations:

o few of these studies were randomized controlled trials

o difficult to determine whether the changes observed were a result of participating in the program or

some other factor, such as natural development

o many of the studies were conducted by the program designer

APA references

Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The triple P-positive parenting program: A systematic

review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34(4), 337-

357. doi:10.1016/j.cpr.2014.04.003

http://www.triplep-parenting.ca/ont-en/triple-p/?cdsid=b126e41461fc3ff0883329aa4c9a2640

http://www.triplep-parenting.ca/ont-en/triple-p/?cdsid=b126e41461fc3ff0883329aa4c9a2640


January 2018

36

Supporting Security is an attachment-based intervention that includes an assessment and introduction meeting.

Sessions take place weekly, for two hours, over 12 weeks. This program is currently offered in in some areas of Canada

and in Ontario.

Target population

• Age: 0-1-year-old

• families with children who may be at risk for attachment difficulties

Program details


o support group cohesion by having families engage with each other and the leaders

o teach attachment theory

o teach normal emotional and cognitive development

o increase sensitivity to baby signals

o increase parental feelings and reactions

o reduce misattributions

o support problem solving methods

o improve reflective functioning


o teaching topics include attachment theory, infant emotional and cognitive development, infants’

perceptions in relationships, parental self-regulation, problem solving, parental anxiety, depression and

anger, violence in and choosing alternative caregivers

o the focus of all topics is repeatedly brought back to its relevance to attachment and feelings of security

the family and the neighbourhood

Program structure

• each session lasts two hours

• session structure includes a check-in, discussion of home activity, didactic presentation, break with snack, group

activity: experiential exercise – (infant observation or role-plays), assignment of next week’s home activity,

session evaluation


• Number of leads/instructors: three facilitators for 10 parent-infant dyads or two facilitators for six-seven parent-

infant dyads

• Profession/education required: public health nurses, family home visitors, & social workers

• Required materials: materials for homework and activities (varies), babysitting should be provided

• Length of training: facilitator training ranges from three to five days of intensive classes and 12 once-weekly

supervision meetings over the course of running one series of group sessions


January 2018

37

• Cost of training or membership Information: information not available


No published research available to date


January 2018

38


Attachment and Bio Behavioural Catch-Up (ABC) is an evidence-based home-visitation program that is offered in

English and Spanish. This skills-training program supports parents/caregivers in providing a nurturing environment for

their foster children through 10 weekly one-hour sessions. This program is currently offered across the US and some

international locations.

Target population


• high risk parents/caregivers and alternate caregivers of infants and toddlers

Program details


o increase caregiver nurturance, sensitivity, and delight

o decrease caregiver frightening behaviours

o increase child attachment security and decrease disorganized attachment

o increase child behavioural and biological regulation


o ABC is a manualized intervention that also incorporates video-feedback and homework

o the most crucial aspect of the intervention is the parent coach’s use of “In the Moment” comments that

target the caregiver behaviours of nurturance, following the lead, delight, and non-frightening

behaviours

o when a child behaves in ways that push caregiver away, the caregiver is helped to override tendencies

and develop skills to provide nurturance and responsive care

o if a child is dysregulated at behavioural and biological levels the caregiver is supported to provide an

environment that helps child develop regulatory capabilities

o caregiver is helped to decrease behaviours that may be frightening or overwhelming to the child

Program structure

• ABC consists of 10 weekly sessions and each session is highly interactive and involves:

o the parent/caregiver and trainer discussing concepts

o practicing learned techniques with the baby

o discussing successes and failures in the use of concepts learned in prior weeks


• Number of leads/instructors: one parent coach


January 2018

39



• Required materials: laptop computer, video camera, webcam for supervision

• Length of training: Completion of the three-day training to become a Parent Coach followed by one year of

supervision (1.5 hours weekly, including group supervision and individual supervision in In the Moment

commenting) to become a Certified Parent Coach

o training takes place through University of Delaware with supervision via videoconferencing

• Cost of training or membership: In-person training and year of supervision costs $5,400 USD per trainee and

additional travel costs as well as additional cost for equipment

o coaches need to bring laptops and cameras (including tripod and video editing software) to each visit as

they will be creating video clips to play back to parents/caregivers

o the initial training in ABC takes place in-person and lasts for two to three days

o training for smaller groups is at the University of Delaware or Dr. Dozier and/or Dr. Roben are able travel

to the training site for larger groups


• Main findings:

o 60 foster children between the ages of 0 and 3 years old and their foster parents served as the sample

for an evaluation

o parents in the ABC intervention group reported fewer behavioural problems for toddlers than infants,

whereas parents in the alternative intervention group did not report any differences in behaviour

problems across the two age groups

• Limitations:

o no control group

o the evaluation is based on parental self-report

o multiple informants or various methods for collecting data are important for future studies, and might

add information on the outcomes measured

o since parents were also the targets of the intervention, there is a possibility that after the intervention

they reported higher frequencies of aspects that also were targeted during the intervention

APA references

Dozier, M., Peloso, E., Lindhiem, O., Gordon, M.K., Manni, M., Sepulveda, S., & Ackerman, J. (2006). Developing

evidence-based interventions for foster children: An example of a randomized clinical trial with infants and

toddlers. Journal of Social Issues, 62,767-785.


January 2018

40

Circle of Security® (COS) Psychotherapy and Circle of Security® Parenting™ are two early intervention programs that

use an attachment-based and relational systems of development framework. The program manual and materials are

offered in Spanish, Italian, Japanese, Danish, Norwegian, Swedish, Romanian, Mandarin and English. These programs are

run with small groups (about six) of at-risk parents/caregivers and children. Caregivers meet with a psychotherapist once

a week for 20 weeks or as needed thereafter.

Target population


• families who are at risk due to mental health challenges, history of trauma, involvement in child protection

Program details


o shift caregiver focus from behaviour management to enhancing the quality of relationship

o understand specific steps to build self-reflection in the parent-child relationship

o use video examples to support increased empathy in caregivers

o identify new options to help caregivers manage emotions

o learn step-by-step approaches for promoting secure attachment in children


o bolster the parent-child relationship by increasing attachment security and furthering parent/caregiver

understanding of children’s needs

o help caregivers understand their child’s emotional world by learning to read emotional needs

o support their child’s ability to successfully manage emotions

o Circle of Security-Parenting Intervention was designed with broad implementation in mind by training

community service providers to use a manualized, video-based program to help caregivers provide a

secure base and a safe environment for their children

Program structure

• one three-hour assessment session followed by a 1.5-hour session every two to three weeks

• four home visits (after an out-of-home assessment) over a period of three months

o parents/caregivers are provided with a network of supporting professionals who can assist them as they

work to develop secure attachment with their child

o parents/caregivers are asked to notice “Circle Moments” between sessions: these are moments where

their child shows a need on the Circle

o each meeting starts with asking the parent/caregiver to share what they noticed that week




January 2018

41

• Profession/education required: social workers, marriage and family therapists, mental health counselors, home

visitors, family support workers, outreach workers, behaviour support specialists, and anyone providing

parenting education and/or counseling to parents/caregivers of young children

o Circle of Security® Intensive Training for Clinicians facilitators must be licensed in the mental health field

as social workers, marriage and family therapists, mental health counselors

• Required materials: DVD room for conducting initial evaluation with video equipment to film parent/child

interaction, one-way glass for filming is best but not absolutely needed, laptop computer for editing tape and

presenting to parent/caregiver during home visit

• Length of training:

o Circle of Security® Parenting™ requires a four-day seminar that trains professionals to use an eight

chapter DVD to educate caregivers

o Circle of Security® Intensive Training for Clinicians is a 10day training for licensed clinicians working in

the field of mental health (e.g. social workers, family therapists, mental health workers) on how to use

the attachment based Circle of Security® approach in assessment and treatment planning

• Cost of training or membership:

o Circle of Security® Parenting requires a four-day training which costs $900-1000pp US Dollars (Small

group of 5-9 people - 10% off cost of training, Large group of 10 or more people - 15% off cost of

training)

o Circle of Security® Intensive Training for Clinicians - $700 USD Standard Price per person and a $350

exam fee after completion of the training


• Main findings:

o a study examined the moderating effects of infant irritability and maternal attachment on the

effectiveness of the Circle of Security® four-session, home visitation program at reducing the rates of

insecure infant-mother attachment and found that dyads that were particularly at-risk for insecure

infant attachment (e.g., a dismissing mother with a highly irritable infant) the intervention significantly

reduced the risk of insecure attachment

o participation in Circle of Security® Parenting decreased or diminished father/child's mother resentment,

increased cooperation

• Limitations:

o Randomized controlled trial on Circle of Security® Parenting are needed in order to expand the

preliminary research to better understand the contexts appropriate for its application

APA references

Cassidy, J., Ziv, Y., Stupica, B., Sherman, L. J., Butler, H., Karfgin, A., . . . Powell, B. (2010). Enhancing attachment security

in the infants of women in a jail-diversion program. Attachment & Human Development, 12(4), 333-353.

doi:10.1080/14616730903416955


January 2018

42

Hoffman, K., Marvin, R., Cooper, G. & Powell, B. (2006). Changing toddlers' and preschoolers' attachment classifications:

The Circle of Security Intervention. Journal of Consulting and Clinical Psychology, 74, 1017-1026.

Pazzagli, C., Laghezza, L., Manaresi, F., Mazzeschi, C., & Powell, B. (2014). The circle of security parenting and parental

conflict: A single case study. Frontiers in Psychology, 5, 887. http://doi.org/10.3389/fpsyg.2014.00887


January 2018

43

Child-centered play therapy (CCPT) is an evidence-based developmentally responsive, play-based mental health

intervention that is offered across Canada and internationally. Depending on the therapist child-centered play

therapy is offered as individual or group therapy.

Target population


• children experiencing social, emotional, behavioural and relational disorders.

Program details


o play therapy offers a non-verbal way for children and even adolescents to process their feelings, their

actions, and what is going on in their lives

o develop a more positive self-concept

o assume greater self-responsibility

o become more self-directing, self-accepting, and self-reliant

o engage in self-determined decision making

o become sensitive to the process of coping


o child-centered play therapy is a therapeutic approach that can be adapted depending on the child's

needs

o utilizes play and development of positive therapeutic relationship to provide a safe, consistent

therapeutic environment in which a child can experience full acceptance, empathy, and understanding

Program structure

• weekly individual therapy sessions focused on targeted goals set by the therapist and parents/caregivers

• play therapy sessions may involve building, books, arts and crafts, puppets, figurines, board games, or pretend

games like house, restaurant, doctor, or dress-up



• Profession/education required: Certified play therapist with a minimum of a Master’s Degree in an appropriate

discipline or a Medical Degree from an accredited institution and must have completed child-centered play

therapy core under-graduate or graduate level course work

• Required materials: Variable

• Length of training: Various levels of training offered and more information can be found at

https://cacpt.com/play-therapy-certificate-program/

• Cost of training or membership: costs vary depending on level of training

https://cacpt.com/play-therapy-certificate-program/


January 2018

44


• Main findings:

o meta-analytic review of 52 controlled outcome studies between 1995 and 2010

o both parents/caregivers and teachers indicated that children with externalizing behaviours who received

intensive child-centered play therapy showed a significant decrease in those behaviours

o child-centered play therapy has demonstrated beneficial treatment effects

o child-centered play therapy is a developmentally and culturally responsive counseling intervention

effective across presenting issues

• Limitations:

o low number of studies in specific categories of study characteristics and cultures

o missing information or attrition presented an issue in some studies

APA references

Lin, Y., & Bratton, S. C. (2015). A MetaAnalytic review of ChildCentered play therapy approaches. Journal of Counseling

& Development, 93(1), 45-58. doi:10.1002/j.1556-6676.2015.00180.x

Ritzi, R. M., Ray, D. C., & Schumann, B. R. (2017). Intensive short-term child-centered play therapy and externalizing

behaviours in children. International Journal of Play Therapy, 26(1), 33-46. doi:10.1037/pla0000035


January 2018

45

Dyadic Developmental Psychotherapy (DDP) is an evidence-based parent-child therapy currently offered across Canada

and internationally. Training is offered in English but the program may be offered in various languages

depending on the provider. The length of this program varies depending on the needs of the child and family.

Target population

• Age: 0-5 years

• children who have been hurt and/or neglected within their families in their early years, and those who have

experienced trauma and find it difficult to feel safe and secure within their families

Program details


o uses a focus on both the caregivers’ and therapists’ own attachment strategies

o the therapist setting a healing pace to therapy by being playful, accepting, curious, and empathic

o therapist generates and regulates with empathy (and playfulness when appropriate) any emerging

affect that is associated with events being explored

o the parent/caregiver creates a healing environment by being playful, loving accepting, curious, and

empathic


o Increase caregivers use of attachment-facilitating interventions that meet the developmental

needs and state of the child

o support practices that facilitate safety, emotional communication, reflection, conflict resolution skills,

and the ability to both seek and receive comfort and guidance

o strong emphasis on maintaining an intersubjective relationship with the child, deep acceptance of the

child's affect and experience, nonjudgmental curiosity about the meaning the child has given to the

events of the child’s life, and greater emphasis on experience and process rather than on verbalization

and content.

o support the parent and child in developing a sense of safety in emotional and physical domains

o support the caregiver in developing empathy, unconditional positive regard, acceptance

Program structure

• the therapist will begin by working with the parents/caregivers and will want to ensure that the they are

comfortable with the dyadic developmental psychotherapy parenting approach and to provide them with help

to develop this further if necessary

• the therapist will then actively prepare the parents/caregivers for their role in the therapeutic process by getting

to know the parents, building trust and respect on both sides

• the therapist helps the parents/caregivers to explore the impact on themselves of parenting this child by

thinking about the parent’s/caregivers’ attachment histories


January 2018

46

• the therapist will then help the parents/caregivers to understand the therapeutic process and what their role

will be in the sessions when the child joins them

• when the therapist judges it to be safe and appropriate and the parents/caregivers are ready the child will join

the sessions

• there will continue to be opportunities for the parents/caregivers and therapist to talk about the work, both

before or at the beginning of sessions and through scheduled parent sessions

• when the child is present the therapist will interact with the child in a way that helps them to understand

him/her better

• the therapist will help the child to talk to her parents/caregivers by supporting the child to manage her emotions

and to understand her experience

• therapy will end when the therapist and parents/caregivers think that the child is developing some attachment

security within the family and family members can continue the process of being emotionally available and

connected without the help of the therapist



• Profession/education required: Registered psychotherapist, counsellor, social worker and completion of the 56-

hour Dyadic Developmental Psychotherapy Core Training

• Required materials: Variable

• Length of training: Various levels of training are offered

o It is important to note that attending a Level One training does not enable participants to advertise or

say that they practice Dyadic Developmental Psychotherapy or that their work is dyadic developmental

psychotherapy-informed

o those who have attended a Level Two training and who have regular supervision from a certified Dyadic

Developmental Psychotherapy Consultant or an experienced certified Dyadic Developmental

Psychotherapy Practitioner can say their work is “Dyadic Developmental Psychotherapy -informed” but

are not able to say they provide Dyadic Developmental Psychotherapy.

• Cost of training or membership: Various levels of training that range from $700-1000 USD per person with

additional fees for supervision


• Main findings:

o There have been two related empirical studies comparing the treatment outcome of dyadic

developmental psychotherapy with a control group:

▪ The first study compared a treatment group, which received dyadic developmental

psychotherapy, with a control group, who received other forms of treatment at locations

different from the test site by other providers and found that one year after treatment ended

children who received dyadic developmental psychotherapy had clinically and statistically


January 2018

47

significantly lower scores on the child behaviour checklist and that these scores were all in the

normal range

▪ Children in the control group showed no statistically or clinically significant changes in the

outcome measures.

▪ The second study, (becker-weidman, 2006b, becker-weidman, 2006c) followed this same group

of 64 children and measured the outcome of treatment using the child behaviour checklist

about four years after treatment ended

▪ The results were achieved in an average of twenty-three sessions over eleven months

▪ These findings continued for an average of 3.9 years after treatment ended for children

between the ages of six and fifteen years.

• Limitations:

o limited generalizability of findings due to small sample size

o most treatment evidence is based on the treatment of simple traumas and children with one diagnosis

o clinicians see value in individualizing the treatment for each unique child and family

o the practice of an “evidence-based” treatment requires instead that a treatment package is followed

without deviation in order for the treatment to be standardized which can be very difficult in a therapy

setting

APA references

Becker-Weidman, A., (2011-2012). Dyadic Developmental Psychotherapy: Effective Treatment for Complex Trauma and

Disorders of Attachment. Illinois Child Welfare, 6(1), pp 119-129.

Becker-Weidman, A., & Hughes, D., (2008) Dyadic Developmental Psychotherapy: An evidence-based treatment for

children with complex trauma and disorders of attachment. Child & Family social Work, 13, pp. 329-337.

BeckerWeidman, A., & Hughes, D. (2010). Dyadic Developmental Psychotherapy: an effective and evidencebased

treatment–comments in response to Mercer and Pignotti. Child & Family Social Work, 15(1), 6-11.


January 2018

48

Filming Interactions to Nurture Development (FIND) is an evidence-based parent-child therapy program. This approach

to therapy often takes place weekly for six-weeks or as needed for the client. Training is offered in English but the

program may be offered in various languages depending on the provider. FIND is offered across the US and is currently

being implemented in Alberta serving high-risk families.

Target population

• Age: 6-36 months

• diverse populations including those identified as at-risk, parents/caregivers with intellectual disabilities, fathers,

families involved in the child welfare system

Program details


o to strengthen positive interactions between caregivers and children through supportive guidance and

coaching

o to increase serve and return interaction to boost parent sense of competence, decrease parent stress

and, ultimately, promote positive outcomes for young children

o improve the quality of the parent-child interactions, parent well-being, and decrease reports of

negative child behaviour


o increase parents/caregiver’s ability to interact with children in a caring, responsive way

o support the development of positive relationships and strengthen attachment between parent and child

o support positive relationships and parenting practices that help build and reinforce neural connections

in a child’s brain that support the development of important cognitive, social, and language skills

Program structure

• FIND coaches film families for 10 minutes as they engage in everyday activities in the home, such as playing a

game or having a snack

• short clips are then selected that highlight positive instances of parent-child interaction

• coaches share these clips with the caregiver in weekly structured coaching sessions

• In reviewing clips, coaches facilitate caregivers’ understanding of how engaging in serve and return can promote

the child’s development


• Number of leads/instructors: 1 coach, 1 video editor

• Profession/education required: registered counsellor, psychologist, social worker with required FIND training

and supervision by FIND team

• Required materials: variable

• Length of training: training and certification process begins with a three-day intensive training for FIND coaches

and a two-day intensive training for FIND video editors

o training continues through an ongoing weekly consulting and certification process


January 2018

49

o certification progresses during an implementation, while coaches are working with families and

certification typically takes six months to complete

• Cost of training or membership: total cost for training and certification is approximately $120,000 USD


• Main findings:

o sample included 15 fathers with children ages 6 to 36 months who spoke English or Spanish fluently

o fathers who completed FIND-Father reported lower stress and showed improvements in observed

parenting skills

o fathers who had experienced the most adversity in their own lives reported higher levels of parental

involvement and decreases in their children’s behaviour problems

o FIND-F was associated with improvements in parenting stress, father involvement, and child behaviour

problems.

• Limitations:

o results should be interpreted with caution due to the small sample size

o absence of a control group

o limited generalizability of findings due to lack diversity in the sample

APA references

Fisher, P. A., Frenkel, T. I., Noll, L. K., Berry, M., & Yockelson, M. (2016). Promoting healthy child development via a Two

Generation translational neuroscience framework: The filming interactions to nurture development video

coaching program. Child Development Perspectives, 10(4), 251-256. doi:10.1111/cdep.12195


January 2018

50

Group Attachment Based Intervention (GABI) is an evidence-informed, trauma-informed approach to parent-child

therapy. Often, sessions are 2 hours in length and take place 3 times a week for 26 weeks. Training is offered in

English but the program may be offered in various languages depending on the provider. Currently this approach

is offered across the US.

Target population

• Age: 0-3 years

• this therapeutic approach is designed specifically to support families who have a history of trauma including

multiple adverse experiences including physical abuse, neglect, sexual abuse, multiple foster care placements,

parental substance abuse, incarceration, and domestic and community violence

Program details


o to improve the caregiver-child relationship and support appropriate child development

o to prevent child maltreatment by developing secure parent/child attachment relationships, promoting

infant mental health, and reducing parental stress and social isolation


o multiple groups are offered each week because of the unpredictable nature of people’s daily lives and

schedules, families who need to miss a session have several additional opportunities to attend

o parenting skills to support the development of a secure attachment

Program structure

o the group begins with a 45-min parent/child psychotherapy session held in a group playroom

o there is a parent/child separation where parents/caregivers participate in a parent group while children

engage in a child group for 60 min

o the parent/child reunion occurs; this is the most important segment where parents/caregivers return to their

young children after being separated

o reflective supervision sessions take place immediately after the group ends to hold and process the many

observations and reactions of lead clinicians and trainees


• Number of leads/instructors: 2 lead clinicians and anywhere from two to six graduate students who work

interchangeably as a team

• Profession/education required: licensed psychologist, together with a parent–infant psychotherapist clinician

(possibly a social worker) and four to five social work and psychology practicum students


• Length of training: a 2-day in-person workshop in NYC followed by access a website with written and video

material to facilitate implementation of GABI, video/communication technology to collect data, and receive


January 2018

51

feedback on adherence, two site-visits from GABI trainers to provide individualized consultation (with ongoing

day- to-day support), monthly collection and reporting of implementation and outcome data

• Cost of training or membership: Costs for Canada are unknown


• Main findings:

o 60 mothers and 60 children participated in a randomized clinical trial

o Initial results revealed high levels of neglect, abuse, and household dysfunction in mothers' histories

o 77% reported more than 4 types adverse childhood experiences, with more than 90% reporting two or

more current toxic stressors, including poverty, obesity, domestic and community violence, and

homelessness

o findings did not reflect the effectiveness of this type of intervention and further research is required

• Limitations:

o Limited research is available on this program and this program is currently in clinical trials with the goal

of establishing the efficacy of this treatment model

APA references

Murphy, A., Steele, H., Bate, J., Nikitiades, A., Allman, B., Bonuck, K., ... & Steele, M. (2015). Group attachment based

intervention: trauma-informed care for families with adverse childhood experiences. Family & community

health, 38(3), 268-279.


January 2018

52

The Incredible Years offers a series of interlocking, evidence-based programs for parents, children, and teachers. These

programs and their materials are offered in various languages including Chinese, Danish, Dutch, Finnish, French,

Norwegian, Portuguese, Russian, Spanish, Swedish. Incredible Years programs are currently delivered to multi-cultural

groups in USA, Canada (and Ontario), and internationally.

Incredible Years offers five parenting programs that target key developmental stages. These include IY Baby Program (0-

12 months), IY Toddler Basic Program (1-3 years), IY Preschool Basic (3-6 years), IY School Age Basic (6-12 years), and

Advance Parenting Program (4-12 years) (focuses on parent interpersonal problems such as depression and anger

management). Additionally, there are four adjunct parent programs: Well-Baby Prevention Program, Attentive Parenting

Prevention Program, Autism Spectrum and Language Delays Program, and the School Readiness Program.

There are two child programs using the Dinosaur School Social, Emotional Skills and Problem Solving

Curriculum: “Small Group Dinosaur” Child Treatment Program (ages 4-8 years) and “Classroom Dinosaur” Prevention

Program (ages 3-8 years).

Incredible Years offers two teacher programs including Teacher Classroom Management Program for teachers of

children ages 3-8 years, and Incredible Beginnings Program, for teachers and child care providers of children ages 1-5

years.

Target population


• programs are developed to meet the needs of parents/caregivers and children facing challenges with

aggression, conduct problems, social competency problems, attention deficit hyperactivity disorder,

internalizing problems such as fears, phobias and somatization (conversion of anxiety into physical symptoms),

and children experiencing divorce, abandonment or abuse

Program details


o program objectives vary slightly depending on the specific Incredible Years curriculum

o improve parent-child interactions, building positive relationships and attachment,

o improve parental functioning, less harsh and more nurturing parenting, and increase parental social

support and problem solving

o improve teacher-student relationships, proactive classroom management skills, and strengthen teacher-

parent partnerships

o prevention, reduction, and treatment of early onset conduct behaviours and emotional problems

o promotion of child social competence, emotional regulation, positive attributions, academic readiness,

and problem solving


January 2018

53


o Targeted skills: vary slightly depending on the specific Incredible Years curriculum

o promote emotional and social competence in young children

o prevent, reduce, and treat behaviour and emotional problems in young children

o provide parents/caregivers the skills to build strong relationships with children through child-directed

play interactions, provide praise and incentives to build social and academic competency, set limits and

establish household rules, and to handle misbehaviour

Program structure

• program structure varies greatly depending on the curriculum and more information on each program can be

found at http://www.incredibleyears.com/programs/


• Number of leads/instructors: 1-2 depending on group size

• Profession/education required:

o Master’s degree or comparable higher degree is required to progress from a certified group leader to

coach; a Master’s degree is required for progression to mentor status after completion of the peer

coach certification/accreditation

o group leaders of the Parenting Training programs and the Small Group Therapy Dinosaur Treatment

program may come from a variety of helping professions such as social work, cognitive psychology,

nursing, medicine and education with at least one course in child development and training in social

learning theory

o one of the two leaders conducting a group should have a Master’s degree or higher, or a comparable

educational background

o Teacher Classroom Management training program group leaders may be experienced teachers, school

psychologists, principals, or social workers with school-related experience

o Classroom Dinosaur prevention program is delivered by preschool or primary school teachers possessing

a bachelor’s degree at minimum

• Required materials: A list of prices for all training materials can be found at

www.incredibleyears.com/download/Pricelist.pdf

• Length of training: A large variety of training is offered, please see link for details

http://www.incredibleyears.com/workshop-info/training-descriptions/

• Cost of training or membership: Canada has 3 accredited mentors for training

o the cost to have a trainer at your site is approximately $1,500 – $2000 per day, depending on your

location or which trainer or mentor is sent

o there is a travel day charge to some locations, and your agency reimburses the trainer’s airfare, baggage

charge, lodging, ground travel, and meals

http://www.incredibleyears.com/programs/

http://www.incredibleyears.com/download/Pricelist.pdf

http://www.incredibleyears.com/workshop-info/training-descriptions/


January 2018

54

o the prices for training depend on which training program you attend), and where it is offered (these

prices may vary)


• Main findings:

o research to date includes eight randomized control group trials by the developer and six randomized

control trials by independent investigators of the parenting series with diagnosed children found the

following:

o increases in positive parenting including child-directed play, coaching and praise and reduced use of

criticism and negative commands

o increases in parent use of effective limit-setting by replacing spanking/hitting and harsh discipline with

proactive discipline techniques and increased monitoring

o reductions in parental depression and increases in parental self-confidence

o increases in positive family communication and problem-solving

o reductions in behaviour problems and conduct problems in children’s interactions with

parents/caregivers and increases in children’s positive affect and compliance to parental commands

o improves child behaviour and parenting skills, teacher classroom management strategies, student social

and emotional competence, and teacher-parent involvement

o decrease in behaviour problems

o additional research and ongoing studies can be found at:

http://www.incredibleyears.com/category/research-library/audience-research-library/all-audience-

research-library/

• Limitations:

o despite the wealth of research conducted on this program, methodology of some studies are limited due

to small sample size, limited evidence available concerning the extent to which these results are

maintained over time

APA references

Herman, K. C., Borden, L. A., Reinke, W. M., & Webster-Stratton, C. (2011). The Impact of the Incredible Years Parent,

Child, and Teacher Training Programs on Children’s Co-Occurring Internalizing Symptoms. School Psychology

Quarterly: The Official Journal of the Division of School Psychology, American Psychological Association, 26(3),

189–201. http://doi.org/10.1037/a0025228

Webster-Stratton, C. (2011). Combining Parent and Child Training for Young Children with ADHD. Journal of Clinical Child

and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology,

American Psychological Association, Division 53, 40(2), 191–203. http://doi.org/10.1080/15374416.2011.546044

http://www.incredibleyears.com/category/research-library/audience-research-library/all-audience-research-library/

http://www.incredibleyears.com/category/research-library/audience-research-library/all-audience-research-library/


January 2018

55

Interaction Guidance (IG) (also referred to as Video Interaction Guidance) is an evidence-based parent-child attachment

intervention program that runs for 10-12 sessions across 2-6 months. Interaction guidance is currently offered in

the US and some areas across Canada.

Target population


• families who may have difficulties engaging in treatment due to risk factors (e.g. poverty, substance abuse,

mental illness or other family stressors) Has been modified to better meet needs of high-risk families) and

supports infants with a variety of early regulation disorders including problems with feeding and sleeping, and

excessive crying

Program details


o IG focussed on developing and supporting the parent-infant relationships

o to improve family and child functioning by fostering enjoyment in family relationships and interactions.

o IG uses technology to show parents/caregivers the impact of effective and attuned communication.

Seeing their positive visual image, combined with a benign and attuned relationship with the

professional, allows the parent to make small changes to improve their relationship with their baby


o positive interactions and enhance the caregivers' understanding of infant behaviour and development

o Rather than addressing the mental health of the parent and the child separately, interaction observation

looks at what happens between them—the quality of their relationship

o Builds an understanding with parents/caregivers regarding the impact of active and attuned

communication

o strengths-based approach helps to build parental confidence and allows the parent to reflect on their

relationship with the baby

Program structure

• the facilitator will observe the dyad for 5–10 minutes during an activity, such as feeding, playing with age-

appropriate toys or looking at a book together

• the activity can be as simple as watching the baby and following his/her initiatives, which can prove quite

difficult for some parents/caregivers who feel that they must always educate their baby.

• the guider will edit the footage and choose the most successful moments to show the parent at the following

session; this is called ‘shared review’

• in the shared-review the guider and the parent focus on the good moments


January 2018

56


• Number of leads/instructors: 1 lead therapist but may have a second person trained to edit the videos

• Profession/education required: Registered clinical psychologist, therapist, social worker with a Bachelors and/or

Master’s degrees are preferred, and a nomination from employer or support of an immediate qualified

supervisor



o Level 1 Universal training: Two days’ training looking at baby cues and baby states, attachment,

attunement and sensitive responsiveness, infant brain development and introducing interaction

guidance

o Level 2 Video-enhanced reflective practice: Three days’ training plus 7 hours’ group supervision spread

over 3 months, where participants watch themselves in interaction with parents/caregivers and babies

and then reflect on the best moments of their reflective communication using interaction guidance

principles

o Level 3 Video interaction guidance: Five days’ training plus 15 supervision sessions (individual or pair)

over 12 months

• Cost of training or membership: The cost of training varies depending on the type and level of training

o it is estimated to cost +$4500 USD per person to be fully trained as an interaction guidance facilitator


• Main findings:

o participants in both treatments improved in symptoms, particularly for sleep problems (the most

common reason for referral)

o behaviour problems were more resistant to treatment and tended to increase with age and those

referred specifically for behaviour problems did show improvement

o mother-child interactions and maternal self-esteem improved

o a meta-analysis of 29 video-feedback studies suggests video interaction guidance enhances positive

parenting skills, decreases/alleviates parental stress and is related to a more positive development of

the children

• Limitations:

o lack of a control group or untreated comparison group

o large developmental differences between the youngest and oldest children.

o small sample sizes across some studies

o some studies did not use a randomized design.

APA references

Benoit, D., Madigan, S., Lecce, S., Shea, B., & Goldberg, S. (2001). Atypical maternal behaviour toward feeding-

disordered infants before and after intervention. Infant Mental Health Journal, 22(6), 611-626.


January 2018

57

Fukkink, R.G. (2008) Video feedback in the widescreen: A meta-analysis of family programs Clinical Psychology Review,

28(6), 904–916.

Robert-Tissot, C., Cramer, B., Stern, D. N., Serpa, S. R., Bachmann, J. P., Palacio-Espasa, F., & Mendiguren, G. (1996).

Outcome evaluation in brief mother-infant psychotherapies: Report on 75 cases. Infant Mental Health Journal,

17(2), 97-114.


January 2018

58

Modified Interaction Guidance (MIG) is a version of Interaction Guidance. This program is a play-focused intervention,

focused on training caregivers to respond sensitively to their infants. This program

includes an individually tailored educational component (e.g. information about difficulties regulating emotions or other

specific problems), 90-minute weekly sessions with approximately 15 minutes of videotaped interaction and 75 minutes

of discussion, education and feedback provided for five consecutive weeks up to ten weeks. This program is currently

offered across Canada including Ontario.

Target population

• Age 2-12 years old

• developed to reach families that have been difficult to engage (e.g. burdened by poverty, violence, lack of

education, limited capacity for introspection) and have resisted traditional psychotherapeutic methods

• children with disorganized attachment, insecure attachment, and includes a parent educational component that

is individually tailored to observations in child-parent interactions

Program details


o support the parents’/caregivers’ ability to monitor and accurately perceive a child’s cues and signals

o respond to these infant cues and signals in a sensitive and appropriate manner

o reduce disrupted or atypical parental behaviours


o focus on the interactions that are positive and promote sensitive responsiveness

o identify some of the interactions where the parent missed cues or was unable to calm and comfort the

child

o develop skills to respond more effectively to young children

Program structure

• typical parentchild interactions are filmed during play sessions

• sessions are then reviewed with a clinician with a focus on recognizing when parents/caregivers are responding

to their child’s behaviour cues to highlight and promote their strengths and competencies

• feedback and education is provided surrounding instances when parents/caregivers are missing children’s cues

• between visits, caregivers are asked to practice what they have learned and provide feedback at next meeting

• follow up therapy sessions educate parents/caregivers on how to increase sensitivity to their children’s cues

during play sessions


• Number of leads/instructors: Two instructors


January 2018

59

• Profession/education required: there are no specific qualifications were identified but the MIG research was

conducted with psychologists and psychiatrists specializing in attachment but it is recommended to hold a

bachelor or master degree in counselling, psychology, social work, or marriage & family therapy or equivalent

• Required materials: variable but generally require expensive audio-visual equipment

• Length of training: 6 days of weekly training and 6 weeks of bi-weekly supervision

• Cost of training or membership: costs are variable depending on region but estimates are $325 for training and

$325 for supervision per person


• Main findings:

o a significant decrease in the total display of disrupted caregiver behaviours

o change in classification from disrupted to not- disrupted, after receiving both feedback from the

assessment and the first treatment session

o different patterns of change between caregivers.

o parents who participated in five 90-minute Modified Interaction Guidance therapy sessions

demonstrated significant decreases in disrupted behaviours that are linked to disorganized attachment

o measurable positive changes in parents took place after just one therapy session, and became

statistically significant after three sessions

o a recent meta-analysis of 19 relationship based interventions for social and economically disadvantaged

parents and their infants and toddlers found that programs, like Modified Interaction Guidance, that are

implemented by trained professionals, short in duration, focus on free-play tasks, and provide specific

feedback on individual parent-child dyad interactions are the most effective for promoting children’s

social and emotional development and well-being

• Limitations:

o small sample size and use of samples of convenience limits the generalizability of findings

o differences in timing of assessment for each intervention,

APA references

Benoit, D., Madigan, S., Lecce, S., Shea, B., & Goldberg, S. (2001). Atypical maternal behavior toward feeding-disordered

infants before and after intervention. Infant Mental Health Journal, 22(6) 611-626.

Madigan, S., Hawkins, E., Goldberg, S., & Benoit, D. (2006). Reduction of disrupted caregiver behaviour using modified

interaction guidance. Infant Mental Health Journal, 27(5), 509-527. doi:10.1002/imhj.20102


January 2018

60

Parent-Child Interaction Therapy (PCIT) is an evidence-based attachment intervention program that is structured with

60-90 minute weekly sessions across 14-20 weeks. Parent-Child Interaction Therapy is adapted to the family’s needs and

treatment continues until the parent masters the interaction skills to pre-set criteria and the child's behaviour has

improved to within normal limits. Parent-Child Interaction Therapy is offered as an individual therapy or can be adapted

and offered to small groups of 3-4 families. If this program is run in a small group it is recommend that sessions are 90

minutes in length to allow adequate time for individual coaching of each parent-child dyad while other parents observe,

code, and provide feedback in each session. Currently Parent-Child Interaction Therapy is offered across Canada, and

internationally.

Target population


• children who have been identified to have mental health challenges, children showing behavioural and

emotional problems such as disobedience, aggression, rule breaking, disruptive behaviour, poor attachment

with the caregiver and internalizing feelings

Program details


o treatment focuses on two interactions; the child directed interactions where parents/caregivers engage

with their child in a play situation, and the parent directed interactions which are more clinical sessions,

in which parents/caregivers learn to use specific behaviour management techniques as they play with

their child.

o to receive coaching immediate feedback on parent’s/caregiver’s use of techniques such as differential

social attention and consistency as they practice new relationship enhancement and behavioural

o build close relationships between parents/caregivers and their children using positive attention

strategies by helping parents/caregivers communicate with young children who have limited attention

spans

o educate parents/caregivers about ways to teach to the child without frustration for the parent

o help children feel safe and calm by fostering warmth and security between parents/caregivers and their

children

o improve children’s organizational and social skills such as sharing and cooperation


o parent-child dyads attend treatment sessions together and the parent learns to follow the child's lead in

play

o the parent/caregiver is taught how to decrease the negative aspects of their relationship with their child

and to develop positive communication

o the parent/caregiver is taught and coached to use skills that help the parents/caregivers give positive

attention to the child following positive behaviour and ignore negative behaviour


January 2018

61

o learn and adopt skills to increase positive relationships with their child including providing labeled praise

following positive child behaviour, reflect or paraphrase the child's appropriate talk and/or use

behavioural descriptions to describe the child's positive behaviour

o reduce intrusive interactions that give attention to negative behaviour such as using negative

commands, questions, or criticism

o parent/caregiver is taught how to direct the child's behaviour when it is important that the child obey

their instruction

o parent/caregiver is observed and coached through a one-way mirror at each treatment session

Program structure

• parent-child dyads attend treatment sessions together and the parent/caregiver learns skills to lead the child's

behaviour effectively

• parents/ caregivers play with the children in one room, while the therapist observes and coaches from an

adjacent room equipped with a one-way mirror

• parent’s/caregiver’s skills are observed and recorded during the first five minutes of each session to assess

progress and guide the coaching of the

• the therapist communicates with the adults through an earphone, providing training and guidance

• parents/caregivers are discouraged from using negative language and encouraged to ignore harmless negative

behaviours while showing enthusiasm and giving praise for positive behaviours

• the parent learns to follow through on direct commands by giving labeled praise after every time the child obeys

and beginning a time-out procedure after every time the child disobeys

• behaviours are tracked and charted on a graph at each session to provide the parent with immediate feedback

regarding progress

• parents/caregivers learn skills such as reflecting the child’s language back to him or her to help with

communication, describing out loud what the child is doing to increase the child’s vocabulary, and imitating the

child’s good behaviour to demonstrate approval

• once the parent demonstrates mastery of the procedures, she/he is given homework that gradually increases

the intensity of the situations as the child learns to obey

• treatment does not end until the parent meets pre-set mastery criteria for both phases of treatment and the

child's behaviour is within normal limits on a parent-report measure of disruptive behaviour at home



• Profession/education required: Recommended to have a master’s degree or higher, or an international

equivalent of a master’s degree, in a mental health field or be an independently licensed mental health service

provider (for example, licensed psychologist, licensed marital and family therapist, licensed practicing counselor,

licensed clinical social worker, etc.) or be working under the supervision of a licensed mental health service

provider.


January 2018

62

• Required materials: The typical resources for implementing the program are:

o two connected rooms with a one-way mirror on the adjoining wall (one room for client, other room for

coach) or another method for the therapist to unobtrusively observe the parent

o wireless communications set consisting of a head set with microphone and an ear receiver

o television monitor to tape record sessions for supervision, training, and research purposes


o training in this treatment protocol as well as an established graduate clinical training program, the

equivalent of a master's degree and licensure as a mental health provider is required

o it is recommended that the 40 hours of intensive skills training be followed by completion of two

supervised cases prior to independent practice

o for program supervisors, it is recommended that they complete a minimum of 4 prior cases and

complete a within program trainer training

• Cost of training or membership: Variable depending on level of training and location (e.g. $3,000 USD per person

for a five-day workshop)


• Main findings:

o increases in positive child and parental outcomes

o decreased intensity of disruptive child behaviours

o increases in parental utilization of parent-child interaction therapy parenting skills

o decreases in parental depressive symptoms

o parent-child interaction therapy may be especially helpful for building positive parent-child interactions,

developing positive child-rearing strategies, reducing the likelihood of child physical and verbal abuse,

reducing child behaviour issues (anger, aggression, defiance, etc.), increasing communication and

interaction skills within the family

• Limitations:

o there is strong evidence that Parent-Child Interaction Therapy reduces risk factors for and symptoms of

behavioural, social and emotional challenges, but to our knowledge, no studies have examined whether

Parent-Child Interaction Therapy promotes social and emotional development in children

o very little research has examined whether Parent-Child Interaction Therapy can be adapted for different

cultures

APA references

Chaffin, M., Funderburk, B., Bard, D., Valle, L.A., & Gurwitch, R. (2011). A combined motivation and Parent-Child

Interaction Therapy package reduces child welfare recidivism in a randomized dismantling field trial. Journal of

Consulting and Clinical Psychology, 79, 84-95.


January 2018

63

Eyberg, S .M., Funderburk, B. W., Hembree-Kigin, T., McNeil, C. B., Querido, J., & Hood, K .K. (2001). Parent-child

interaction therapy with behavior problem children: One- and two-year maintenance of treatment effects in the

family. Child & Family Behavior Therapy, 23, 1-20.

Hood, K. K., & Eyberg, S. M. (2003). Outcomes of parent-child interaction therapy: Mothers' reports on maintenance

three to six years after treatment. Journal of Clinical Child and Adolescent Psychology, 32, 419-429.

Kohlhoff, J., & Morgan, S. (2014). Parent-child interaction therapy for toddlers: A pilot study. Child & Family Behaviour

Therapy, 36, 121-139.

McNeil, C. B., Hembree-Kigin, T. L., & SpringerLink (Online service). (2010). Parent-child interaction therapy

(2nd;2; ed.). New York: Springer Verlag.


January 2018

64

Parallel Parent and Child Therapy (PPACT) is an evidence-based attachment-based therapy. Materials and training are

offered in both French and English languages. Parallel Parent and Child Therapy occurs weekly in 60-90 minute

sessions across a minimum of 6 weeks. The narrative stage of Parallel Parent and Child Therapy is relatively brief

(one to six sessions) and can be successful in moving some families forward with the necessary knowledge and

skills to develop successful relationships. The complete therapy is longer term with weekly sessions for about

three to six months. Sessions typically last between 60 and 90minutes, and additional time is required pre- and

post-session for the two therapists to meet. Currently Parallel Parent and Child Therapy is offered across Canada

and in Ontario.

Target population

• Age 4-12 years old

• this form of therapy was developed to meet the needs of mother-child dyads in which there are significant

histories of relational trauma, and maltreatment and children who are experiencing emotional and behavioural

problems where traditional therapy has not led to change and can be adapted for work with older children and

their mothers

Program details



o Parent and Child Therapy (PACT) is based on the premise that the supported looking components of

attachment interventions developed for mother–infant work (e.g. Bakermans-Kranenburg, van

Ijzendoorn & Juffer, 2003; Muir, 1992) can be adapted for work with older children and their mothers.

o supported looking helps to reduce distorted perceptions and pro-videos a basis for clinical intervention

with parents/caregivers and older children.

o supported looking for the mother and child can be a profound and primary aspect of therapy

o in avoidant parent–child relationships, parent and child can be turned toward one another, closing the

gap between them

o in an ambivalent style of relationship (one which alternates between closeness and distance), supported

looking assists the parent to forma consistent and empathic view of their child

o parent and child are provided opportunities to reflect on their relationship and develop a better

understanding of each other, which in turn forms a strong foundation for them to develop a more

secure relationship

Program structure

• there are four stages of the Parallel Parent and Child Therapy intervention including parallel parent child

narrative, preparation to meet as if for the first time, looking before doing, and looking after

o detailed information on each stage of this intervention can be found in Allison, Roeger, Chambers, &

Amos (2006) article on Parallel Parent and Child Therapy


January 2018

65


• Number of leads/instructors: requires two trained PACT psychotherapists, one for the parent (the primary

caregiver, usually the mother) and one for the child

• Profession/education required: accredited psychologists/therapists who have been trained in Parallel Parent and

Child Therapy

• Required materials: access to a playroom with a one-way screen and an observation room with a good sound

system into the playroom

• Length of training: three to four days training in Parallel Parent Child and Parallel Parent and Child Therapy, with

two days additional training six-months later

o Parallel Parent and Child Therapy training also involves the completion of four successful cases under

the supervision of a more experienced clinician.

• Cost of training or membership: Unknown


• Main findings:

o outcomes for six cases of mother and child who were treated using the Parallel Parent and Child

Therapy over a five-year period and found that four of the six cases showed significant improvement in

psychiatric symptoms for the child, the mother or both, as well as improved social and family

functioning

• Limitations:

o Although these outcomes show promise for the Parallel Parent and Child Therapy treatment model,

further studies investigating its effectiveness are required before drawing definite conclusions.

APA references

Allison, S., Roeger, L., Chambers, H., & Amos, J. (2006). Parent and child therapy: An attachment-based intervention for

children with challenging problems. Australian and New Zealand Journal of Family Therapy, 27(2), 68-74.

doi:10.1002/j.1467-8438.2006.tb00700.x

Furber, G., Amos, J., Segal, L., & Kasprzak, A. (2013). Outcomes of therapy in high risk mother-child dyads in which there

is active maltreatment and severely disturbed child behaviors. Journal of Infant, Child, and Adolescent

Psychotherapy, 12(2), 84-99. doi:10.1080/15289168.2013.791166


January 2018

66

Reflective Family Play (RFP) is an Evidence-informed family-wide intervention that takes place weekly across 8-12

weeks. Currently, this program is offered across Canada and in Ontario. Training for this program is offered in English but

the program can be delivered in the language of the therapist.

Target population


• this program supports children who are experiencing a wide variety of relational and developmental difficulties

Program details


o Reflective Family Play blends the Lausanne Family Play paradigm/Lausanne Trilogue Play paradigm

consultation with Watch Wait Wonder.

o Lausanne Family Play paradigm/Lausanne Trilogue Play paradigm provides the family with a structure in

which to play and challenges the co-parents to coordinate.

o Reflective Family Play is a manualized treatment approach for the infant and preschool population

o uses techniques from well-established dyadic treatments grounded in attachment theory and

mentalization-based intervention

o incorporates elements of structural family therapy

o includes adaptations for diverse families including single parents with two or more children


o a play-based therapy and grounded in the evidence-based treatment approach of Watch Wait and

Wonder (WWW) as well as the assessment tool known as the Lausanne Family Play paradigm (LFP)

o developed to address a gap in services and move beyond dyadic treatments to include a family-wide

model

o brings both parents/caregivers and any siblings into the treatment setting to participate in a play-based

family wide intervention

o providing a supportive environment for family play, observation and reflection

o increase cooperative co-parenting by providing an experiential space for parents/caregivers to work

together

o facilitate attunement to their child or children

Program structure

• Lausanne Family Play paradigm/Lausanne Trilogue Play paradigm format of four parts + Watch Wait Wonder

• provided instructions to follow the child’s lead and to reflect on the meaning of the play for all of them

• instructed to use play space freely

• toys are provided to foster creativity

• therapist leaves room and family to signal when done

• the family is asked to play together in four parts:


January 2018

67

o parent plays with child or children, while another parent is “simply present”

o second parent becomes active, and first parent is “simply present”

o the whole family plays together

o parents/caregivers interact while the child or children are “simply present”

• therapist returns to the room, with or without video

• family reflects on what they observed in the play and the transitions

• therapist reflects on observations, following the family’s lead and does not provide own observations



• Profession/education required: registered psychotherapist, social worker or equivalent

• Required materials: requires video/audio recording device, TV for viewing, playroom and age appropriate toys

• Length of training: 2-day training

• Cost of training or membership: prices vary depending on location approximately $560 USD in person, $750 USD

video conference OTN

o this workshop is for psychotherapists working with the 0-6 population and will receive the RFP manual

as part of the workshop registration

o participants will also be eligible to attend a monthly, year-long supervision group to gain advanced

training in RFP


• Main findings:

o two case studies present findings from pilot of 17 families in the infant and preschool program where

Reflective Family Play was the primary treatment and reported positive results

• Limitations:

o there is a strong need for empirical research on the efficacy of this model

o research is needed to examine the decision-making process in selecting which families are most likely to

benefit from a more insight-oriented and whole family approach as opposed to one of the already

established dyadic or prescriptive models currently available

APA references

Philipp, D. A. (2012). Reflective family play: A model for whole family intervention in the infant and preschool clinical

population: Reflective family play. Infant Mental Health Journal, 33(6), 599-608. doi:10.1002/imhj.21342


January 2018

68

Watch, Wait, and Wonder (WWW) is an evidence-based parent-child therapy program that was designed for children 0

to 4 years of age and recommends starting the program when children are around the ages of 4-6 months when an

infant starts to regulate emotions, behaviours and is somewhat mobile. WWW differs from other interventions, which

tend to focus primarily on the more verbal partner – the parent, this program focuses on the parent child relationship.

This program runs weekly for approximately 8-18 sessions. WWW is currently offered across Canada and in Ontario.

Target population

• Age: 0-4 years

• parents/caregivers of children who are experiencing relational and developmental difficulties

Program details


o intended to help the caregiver and children ages 0-4 discover a new way of relating to each other

o to prevent the repeated transmission of insecure attachment patterns from caregiver to child through

the generations

o focuses on strengthening the attachment relationship between the caregiver and child, to improve the

child's self-regulating abilities, self-efficacy, and enhance the caregiver's sensitivity


o specifically, and directly uses the child/infant's spontaneous activity in a free-play format to enhance

maternal sensitivity and responsiveness

o provides a space for the infant/child and parent to work through developmental and relational struggles

through play

o reflective about the child's inner world of initiatives, feelings, thoughts and desires through which the

parent recognizes the separate self of the infant and gains an understanding of her own emotional

responses to her child (i.e. promote mentalisation)

o allow the infant to explore and show his curiosity about the environment through sensorimotor activity

and play

o observe the infant’s spontaneous gestures as a reflection of his innate potential

Program structure

• A feature of the approach is the use of child-led play sessions in which caregivers are encouraged to observe

their infants and allow them to initiate activities

• For half of the session, the parent is asked to:

o get down on the floor with the infant and follow the infant’s lead

o the parent is asked not to initiate any activities him/herself but rather be sure to respond when the

infant initiates

o allow the infant freedom to explore; whatever the infant wants to do is okay as long as it is safe

• parents/caregivers are then asked to talk about their observations during the child’s activity and their

experiences during the session


January 2018

69



• Profession/education required: There were no specific certification requirements listed. Training is suitable for

those who work with young children and their families but they must have some experience with using

psychotherapy/counseling.

• Required materials: playroom, toys that the infant can manipulate and include both construction toys and

representational toys

• Length of training: Training include a 2-day Training [with Mirek Lojkasek, Ph.D., C.Psych.]. Advanced Course is

the follow-up for participants who have completed the Introductory Course and have used the Intervention with

at least one infant/toddler—parent dyad for a minimum of 10 sessions.

• Cost of training or membership: training costs vary depending on the level of certification. Introductory training

begins at approximately $500 per person.


• Main findings:

o participants received either the Watch, Wait, and Wonder intervention or mother-psychodynamic

psychotherapy (PPT), in which the mother and therapist talked while she played with the infant

o Watch, Wait, and Wonder intervention produced significantly greater improvements in attachment,

cognitive development, emotional regulation, and maternal depression

o a second follow-up study found that for both groups, improvements in infant symptoms, parenting

stress, and interaction were maintained or strengthened at six-month follow-up. In addition, the PPT

group gains in cognitive development, emotional regulation, and attachment similar to those exhibited

by the WWW group. At six months, the WWW group still showed better ratings on mothers' comfort in

responding to infant behaviours and ratings of parenting stress.

• Limitations:

o studies were conducted with infants whose attachment was already formed and thus could not evaluate

whether the potential effects of either treatment would have been greater had the intervention

occurred earlier

o the study design did not include a no-treatment comparison group

APA references

Tucker, J. (2006). Using video to enhance the learning in a first attempt at 'watch, wait and wonder'. Infant Observation,

9(2), 125-138. doi:10.1080/13698030600810359

Cohen, N. J., Muir, E., Lojkasek, M., Muir, R., Parker, C. J., Barwick, M., & Brown, M. (1999). Watch, wait, and wonder:

Testing the effectiveness of a new approach to mother–infant psychotherapy. Infant Mental Health Journal,

20(4), 429-451. doi:10.1002/(SICI)1097-0355(199924)20:4<429::AID-IMHJ5>3.0.CO;2-Q

Cohen, N. J., Lojkasek, M., Muir, E., Muir, R., & Parker, C. J. (2002). Six-month follow-up of two mother-infant

psychotherapies: Convergence of therapeutic outcomes. Infant Mental Health Journal, 23(4), 361-380.


January 2018

70

Other approaches and programs for consideration

Aboriginal Home Instruction for Parents of Preschool Youngsters (HIPPY) Canada is a evidence-informed parent

training and education that is structured as a in-home visitation program lead by other trained parents. This program

takes place over 30 weeks and includes a variety of activities and support referral services including partnerships with

Head Start, Mother Goose, and Parents as Teachers programs. Normal delivery is scheduled to roughly coincide with the

public school year. Minimally, HIPPY is a two-year program (three and four-year-old curriculum, or four and five year old

curriculum); however, it is strongly recommended that implementing agencies operate a program that includes all three

years in order to maximize potential outcomes. There are currently 24 HIPPY sites across Canada including 7 Aboriginal

and 17 multicultural sites.

Target population


• offered to a variety of families including Indigenous, new comer family, multicultural families

Program details


o provide mothers with the skills and literacy tools to support their children’s success in school and

beyond

o provides an opportunity to attain social networks that support their inclusion and integration into

Canadian society


o this program uses a variety of program including reading together as a family and talking about the

storybooks to help develop a interest of literacy in the family

o this type of activity on the storybooks to expand literacy skills, HIPPY’s easy-to-use activities nurture

school readiness skills, including; language development perceptual and sensory discrimination logical

thinking and problem-solving

Program structure

• HIPPY consists of 30 weekly activities

• A model program enrolls 60 children the first year and 60 additional children each year

• By year three, a program will deliver all three ages (3-5) curriculums up to 180 children (minimum allowable

annual enrollment is 45 children)

• The HIPPY program is delivered in the homes by women, many of whom were once mothers in the program

• mothers are employed and trained as Home Visitors using a rigorous work-learn training program

• offers past HIPPY participants (mostly mothers) an opportunity for a three-year work-learn position as Home

Visitor with a focus on transitioning them to jobs or higher education after they leave the HIPPY program.


January 2018

71


• Number of leads/instructors: each program site must have one full-time coordinator whose time is fully

dedicated to HIPPY as well as a number of home visitors depending on the enrollment number

• Profession/education required:

o the coordinator's area of expertise may include early childhood education, elementary education, social

work, community development, adult education or any other related field

o home visitors are to be parents in the program or home visitors should be recruited from the targeted

community

• Required materials: overall costs to the community agency are approximately $3,000 per child, per year

o additional costs include storybooks, activity books, basic supplies such as geometric shapes, scissors and

crayons


o HIPPY pre-service training is five days in length and covers all aspects of administering a HIPPY program

and addresses the philosophical and theoretical underpinnings of the program

o home visitors initially receive training in the use of the curriculum during an Initial Site Visit conducted

by a national HIPPY trainer and then receive weekly HIPPY training from their coordinator, which should

also include a minimum of 15 hours of additional professional skill development

• Cost of training or membership: Information not available


• Main findings:

o Limited research is available

o research reported non-significant differences due to a small sample size; however, results indicated positive trends

o HIPPY children, as a group performed better on cognitive measures o results indicated potential advantages for school success including positive social development

• Limitations:

o research to date have not attempted to investigate how parent outcomes are related to child outcomes

as HIPPY programs effects

o future research will not only need to clearly define what is meant by parent involvement, there will also

need to be appropriate measures and methods to assess type and level of involvement and the

influence on child outcomes

o there are limited number of culturally sensitive programs which illustrates the importance of developing

and evaluating tier 2-3 programs for these populations

APA references

Le Mare, L., & Audet, K. (2003). The Vancouver HIPPY Project: preliminary evaluation findings from a multicultural program. Parents making a difference: international research on the Home Instruction for Parents of Preschool Youngsters (HIPPY) Program, Magnes, Jerusalem.


January 2018

72

Inunnquiniq Parenting Program is an evidence-informed parent education group program that has a open-structure (drop-in approach) and is offered year-round. Sessions typically last 2-3 hours with a group size should of approximately 8-10 parents/caregivers. This program uses a drop-in approach that allows parents/caregivers to join any time and engage at any level. Parents/caregivers can then return several months later to join a different module or continue a regular schedule. Parents/caregivers are able to move forward at their own pace. Inunnguiniq Facilitator Training is delivered by Qaujigiartiit in English and Inuktitut periodically throughout the year. Inunnguiniq Parenting Program is the result of 5 years of research and consultation with many organizations and communities. Qaujigiartiit piloted, evaluated, and revised this evidence-based, culturally-responsive parenting program prior to releasing it for use in Nunavut.

Target population


• this program is offered to all parents/care-givers/foster parents/extended family and anyone who cares for

children full- or part-time

• this is not a program for ‘high-risk’ parents, but all individuals who care for children

Program details


o this is a culturally relevant parenting support program that addressed the needs and interests expressed

by parents in our communities

o parents/caregivers will develop an understanding of inunnguiniq, bring cultural beliefs and practices into

their parenting, understand the stages of healthy child development, connect with others in positive and

supportive relationships


o roles of parents in raising and guiding children and reflection on colonial policies which impacted

families in the north

o rebuild the role of extended family and community in child-rearing

o importance of the land in our lives and wellness

o stages of child development

o Inuit perspectives on child-rearing and family relationships

o heart-centred approach to childrearing

o revitalizing Inuit stories and recognizing the power of story in our lives and in the lives of children

o practicing and adopting positive life habits and role modelling

o practical life skills grounded in Inuit Qaujimajatuqangit

o relationships communication skills for spouses, family, and children

o setting expectations for children and ourselves

o budgeting

o exploring ourselves and our actions through reflection

o healthy eating and family nutrition


January 2018

73

Program structure

• each session begins with a central theme that is explored through a range of activities and dialogue over the

course of 2-3 hours


• Number of leads/instructors: 2 trained facilitators and 1 elder

• Profession/education required: information not available in our search

• Required materials: must provide childcare at each session to support parents who wish to attend and each

session must incorporate a food component (a snack break)

o the snack provided must be nutritious and should be country food when availability allows. Recipe ideas

are included in the curriculum.

• Length of training: 5 days/35-hours in length and trainees are presented with a certificate of completion

• Cost of training or membership: Information not available and more information can be found by contacting the

Family Health Research Coordinator at [email protected]


• Main findings:

o parents reported that they enjoyed the program, particularly learning about traditional Inuit

perspectives on childrearing and healthy parenting

o Inunnguiniq pilot programs that regularly involved Elders and the sharing of Inuit parenting practices

and traditional lifestyle had the greatest success

o parents and facilitators found the session on healing had very strong and emotional responses, often

continuing into 1-2 more sessions

• Limitations:

o research to date have not attempted to investigate how parent outcomes are related to child outcomes

o no empirical research is available to date

o there are limited number of culturally sensitive programs which illustrates the importance of developing

and evaluating tier 2-3 programs for these populations

APA references

Qaujigiartiit Health Research Centre (2015). Inunnguiniq Parenting Support Program Final Evaluation Report 2010-2015.

Qaujigiartiit Health Research Centre, Iqaluit, NU.

mailto:[email protected]


January 2018

74

Collaborative Problem Solving is an evidence-informed approach to supporting children and youth in various contexts.

This approach is currently used in a variety of contexts across Canada and in Ontario. The Collaborative Problem Solving

approach helps problem solving occur through a process of collaboration with the child. CPS approach has been

implemented in a variety of outpatient, inpatient, residential, juvenile justice, and school settings, and there have been

multiple informal attempts to evaluate and validate this treatment model.

This approach focusses on the lagging skills and helps adults understand that a child’s maladaptive behaviour is not

intentional, goal oriented, manipulative, or attention-seeking behaviours. Collaborative Problem Solving approach views

children and youth exhibiting difficult behaviours are doing so because they lack the appropriate skills to behave in

healthier ways. This principle recognizes that helping children and youth to develop skills — for example, how to adapt

to change and how to tolerate frustration to support the development of healthier behaviour.


• Main findings:

o research suggests that intake should use best practices in engagement, including training staff who

conduct telephone intake to engage families by identifying barriers, collaboratively problem solving,

and building a treatment alliance

• Limitations:

o there is no research to date that explores the use of CPS in young children 0-6

o across the available research there are discrepancies are in the areas of the efficacy of the model, in

terms of the research methodology and use of medication, evidence of the data, theories of practice,

and the definition of ‘collaborative’

o incongruence is identified in the use of assessment and implementation of the approach for

parents/caregivers and teachers, and relationship challenges between the school, teacher and

parents/caregivers and/or between the teacher and the child, and psychosocial interventions.

APA references

Dickinson, C. A. (2013). Appraisal of Collaborative Problem Solving (CPS) within a Context of Current Waikato Principles

and Practices. Retrieved from Massey University Theses and Dissertations.

Greene, R.W., Albon, J.S., Goring, J.C., Raezer-Blakely, L., Markey, J., Monuteaux, M.C., Henin, A., Edwards, G., & Rabbitt,

S. (2004). Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children with Oppositional-

Defiant Disorder: Initial Findings. Journal of Consulting and Clinical Psychology, 72(6): 1157-1164.


January 2018

75

Report context

This Evidence In-Sight report involved a non-systematic search and summary of the research and grey literature. These

findings are intended to inform the requesting organization, in a timely fashion, rather than providing an exhaustive

search or systematic review. This report reflects the literature and evidence available at the time of writing. As new

evidence emerges, knowledge on evidence-informed practices can evolve. It may be useful to re-examine and update

the evidence over time and/or as new findings emerge.

Evidence In-Sight primarily presents research findings, along with consultations with experts where feasible and

constructive. Since scientific research represents only one type of evidence, we encourage you to combine these

findings with the expertise of practitioners and the experiences of children, youth and families to develop the best

evidence-informed practices for your setting.

While this report may describe best practices or models of evidence-informed programs, Evidence In-Sight does not

include direct recommendations or endorsement of a particular practice or program. Information on programs,

evidence, and contact information will change over time. Please feel free to contact us with any edits or additions at

[email protected]

___________________________________________

Search strategy

A variety of databases and contacts were used to develop this report including but limited to the Aboriginal Portal at

UBC, Ryerson Canadian Best practices portal, California Clearinghouse, National Aboriginal Health Organization (NAHO),

National Registry of Evidence-based Programs and Practices, PracticeWise, PsycInfo, Proquest, and PubMed.

Additionally, grey literature and program managers were consulted to gather information on the programs reviewed in

this report.

Search terms

For the literature review we used the following terms or combination of terms to find literature pertaining to: healthy

development, childhood, early childhood, social, emotional, development, key factors, brain, executive function,

resilience, play, temperament, parenting, caregiving, attachment theory, culture.

For the environmental scan and program review we used the following terms or combination of terms to find literature

pertaining to: early years, mental health, social and emotional development, attachment, behavioural challenges,

prevention programming, primary intervention, targeted intervention, intensive treatment.



January 2018

76

Current Centre products for 0-6 years

Supporting Ontario’s youngest minds: Investing in the mental health of children under 6 (Clinton, Kays-Burden, Carter,

Bhasin, Cairney, Carrey, Janus, Kulkarni, and Williams, 2014)

http://www.excellenceforchildandyouth.ca/resource-hub/supporting-ontarios-youngest-minds-investing-mental-health-

children-under-6

Ontario Centre of Excellence for Child and Youth Mental Health (2017, February). Key messages for healthy

development in early childhood. Evidence In-Sight. Retrieved from

http://www.excellenceforchildandyouth.ca/resourcehub/evidence-in-sight-database

Ontario Centre of Excellence for Child and Youth Mental Health (2016, May). Attachment-based intervention programs

for families of children ages 0-6. Evidence In-Sight. Retrieved from

http://www.excellenceforchildandyouth.ca/resourcehub/evidence-in-sight-database.

http://www.excellenceforchildandyouth.ca/resource-hub/supporting-ontarios-youngest-minds-investing-mental-health-children-under-6

http://www.excellenceforchildandyouth.ca/resource-hub/supporting-ontarios-youngest-minds-investing-mental-health-children-under-6




January 2018

77

References

Barfield, S., Dobson, C., Gaskill, R., & Perry, B. D. (2012). Neurosequential model of therapeutics in a therapeutic

preschool: Implications for work with children with complex neuropsychiatric problems. International Journal of Play

Therapy, 21(1), 30-44.

Bornstein, M. C. (2012). Cultural approaches to parenting. Parenting: Science and Practice, 12(2-3), 212-221.

Brascoupé, S., & Waters C. (2009). Cultural safety: Exploring the applicability of the concept of cultural

safety to Aboriginal health and community wellness. International Journal of Indigenous Health, 5, 6-41.

Center on the Developing Child at Harvard University. (2007). The science of early childhood development (InBrief).

Retrieved from: www.developingchild.harvard.edu

Center on the Developing Child at Harvard University. (2011). Building the brain’s “air traffic control” system: How early

experiences shape the development of executive function: Working paper no. 11. Retrieved from:

www.developingchild.harvard.edu

Center on the Developing Child at Harvard University. (2015). The science of resilience (InBrief). Retrieved from:


Center on the Developing Child at Harvard University. (2016). From best practices to breakthrough impacts: A science-

based approach to building a more promising future for young children and families. Retrieved from:


Cohen, J., Oser, C., & Quigley, K. (2012). Making it happen: Overcoming barriers to providing infant-early childhood mental health. Zero To Three. Available at http://www.zerotothree.org/public-policy/federal-policy/early-

child-mental-health-final-singles.pdf

Conroy, M. A., & Brown, W. H. (2004). Early identification, prevention, and early intervention with young children at risk

for emotional/behavioral disorders: Issues, trends, and a call for action. Behavioral Disorders, 29(3), 224–236.

Cooke, J. E., Stuart-Parrigon, K. L., Movahed-Abtahi, M., Koehn, A. J., & Kerns, K. A. (2016). Children’s emotion

understanding and mother–child attachment: A meta-analysis. Emotion. Advance online publication.

Fox, S. E., Levitt, P., & Nelson III, C. A. (2010). How the timing and quality of early experiences influence the development

of brain architecture. Child Development, 80(1), 28-40.

Graziano, P. A., Slavec, J., Ros, R., Garb, L., Hart, K., & Garcia, A. (2015). Self-regulation assessment among preschoolers

with externalizing behavior problems. Psychological Assessment, 27(4), 1337-1348.

http://www.developingchild.harvard.edu/





January 2018

78

Giallo, R., Cooklin, A., Wade, C., D’Esposito, F., & Nicholson, J. M. (2013). Maternal postnatal mental health and later

emotional–behavioural development of children: The mediating role of parenting behavior. Child: Care, Health and

Development, 40(3), 327-336.

Gilmore, K. (2011). Pretend play and development in early childhood (with implications for the oedipal phase). Journal of

the American Psychoanalytic Association, 59(6), 1157-1182.

Goldstein, S., & Brooks, R. B. (2008). Why study resilience? In Goldstein, S., & Brooks, R. B (Eds.), Handbook of resilience

in children, 1st ed. (pp. 3 -15). New York: Kluwer Academic / Plenum Publishers.

Hanley, G. P., Heal, N. A., Tiger, J. H., & Ingvarsson, E. T. (2007). Evaluation of a classwide teaching program for

developing preschool life skills. Journal of Applied Behavior Analysis, 40(2), 277-300.

Kenney, M. K. (2012). Child, family, and neighborhood associations with parent and peer interactive play during early

childhood. Maternal and Child Health Journal, 16, 88-101.

Liew, J. (2012). Effortful control, executive functions, and education: Bringing self-regulatory and social-emotional

competencies to the table. Child Development Perspectives, 6, 105–111. doi:10.1111/j.1750-8606.2011.00196.x

Lillard, A. S., Lerner, M. D., Hopkins, E. J., Dore, R. A., Smith, E. D., & Palmquist, C. M. (2013). The impact of pretend play

on children’s development: A review of the evidence. Psychological Bulletin, 139(1), 1-34.

Masten, A. S. (2009). Ordinary magic: Lessons from research or resilience on human development. Education Canada,

49(3), 28-32.

Masten, A. S., Cutuli, J. J., Herbers, J. E., & Reed, M.-G. J. (2009). Resilience in development. In Snyder, C. S., & Lopez, S. J.

(Eds.), Oxford handbook of positive psychology, 2nd ed. (pp. 117-131). New York: Oxford University Press.

Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85(1), 6-20.

McElwain, N. L., & Booth-LaForce, C. (2006). Maternal sensitivity to infant distress and nondistress as predictors of

infant-mother attachment security. Journal of Family Psychology, 20, 247–255. doi:10.1037/0893- 3200.20.2.247

Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., … others. (2011). A gradient of

childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences, 108,

2693-2698. doi:10.1073/pnas.1010076108


January 2018

79

Mullin, A. (2012). The ethical and social significance of parenting: A philosophical approach. Parenting, 12, 134-143.

National Scientific Council on the Developing Child. (2004). Young children develop in an environment of

relationships. Working paper no. 1. Retrieved from: http://www.developingchild.net

National Scientific Council on the Developing Child. (2007a). The science of early childhood development: Closing the

gap between what we know and what we do. Retrieved from: www.developingchild.harvard.edu

National Scientific Council on the Developing Child. (2007b). The timing and quality of early experiences combine to

shape brain architecture: Working paper no. 5. Retrieved from: http://www.developingchild.net

National Scientific Council on the Developing Child. (2010). Early experiences can alter gene expression and affect long-

term development: Working paper no. 10. Retrieved from: http://www.developingchild.net

National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen

the foundations of resilience: Working paper no. 13. Retrieved from: http://www.developingchild.harvard.edu

Obradović, J. (2016). Physiological responsivity and executive functioning: Implications for adaptation and resilience in

early childhood. Child Development Perspectives, 10(1), 65-70.

Palm, G. (2014). Attachment theory and fathers: Moving from “being there” to “being with”. Journal of Family Theory &

Review, 6, 282-297.

Ryan, K., Lane, S. J., & Powers, D. (2017). A multidisciplinary model for treating complex trauma in early childhood.

International Journal of Play Therapy, 26(2), 111-123.

Shanker, S. (2013). Calm, alert and happy. Ontario Ministry of Education. Retrieved from:

http://www.edu.gov.on.ca/childcare/Shanker.pdf

Shiner, R. L., Buss, K. A., McClowry, S.G., Putnam, S. P., Saudino, K. J., & Zentner, M. (2012). What is temperament now?

Assessing progress in temperament research on the twenty-fifth anniversary of Goldsmith et al. (1987). Child

Development Perspectives, 6(4), 436-444.

Tarullo, A. R., Obradović, J., & Gunnar, M. R. (2009). Self-control and the developing brain. Zero to Three, 29(3), 31-37.

Tottenham, N. (2014). The importance of early experiences for neuro-affective development. Current Topics in

Behavioral Neurosciences, 16, (109-129). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021037/

http://www.developingchild.net/





http://www.edu.gov.on.ca/childcare/Shanker.pdf


January 2018

80

Ungar, M., Ghazinour, M., & Richter, J. (2013). Annual research review: What is resilience within the social ecology of

human development? The Journal of Child Psychology and Psychiatry, 54(4), 348-366.

Vernon-Feagans, L., Willoughby, M., & Garrett-Peters, P. (2016). Predictors of behavioral regulation in kindergarten:

Household chaos, parenting, and early executive functions. Developmental Psychology, 52(3), 430-441.

White, R. A. (2012). The power of play: A research summary on play and learning. Minnesota Children’s Museum.

Retrieved from: http://www.mcm.org/wp/wp-content/uploads/2015/09/MCMResearchSummary1.pdf

Wright, B., Barry, M., Hughes, E., Trépel, D., Ali, S., Allgar, V., . . . Gilbody, S. (2015). Clinical effectiveness and cost-

effectiveness of parenting interventions for children with severe attachment problems: A systematic review and meta-

analysis. Health Technology Assessment, 19(52), 1-348. doi:10.3310/hta19520

Zilberstein, K. (2014). The use and limitations of attachment theory in child psychotherapy. Psychotherapy, 51(1), 93-

103.

http://www.mcm.org/wp/wp-content/uploads/2015/09/MCMResearchSummary1.pdf


January 2018

81

Appendix A: Contact and additional program information

Please note that this information was updated in December 2017 and may change or vary over time. Please feel free to

contact us with any updates or changes to contact information provided in the table below at

[email protected]

Program name Key contact (for information, training,

resources)

Links Ontario Contact

Coping with

Toddler

Behaviour

(CWTB)

Alison Niccols

Infant-Parent Program

McMaster Children’s Hospital – Chedoke

Site

280 Holbrook Building

Hamilton, Ontario

L8N 3Z5

Tel: 905-521-2100 x77408

http://rfts.ca/cwtb/index.h

tml

Hand in Hand IMHP Chaya Kulkarni

Phone: 416-813-6062

Fax: 416-813-2258

Email: [email protected]

http://www.imhpromotion

.ca

Chaya Kulkarni

FUN Friends JACQUELINE BURKHARDT, FACILITATOR


Phone: 416-795-6823

Website: www.friendstoronto.org

Make the

Connection

0-1 program

1-2 program

Claire Watson - Make the Connection

(MTC) Lead Trainer

Email:

[email protected]

Tel: 416-559-5537

https://psychologyfoundati

on.org/Public/Programs/Fir

st_Three_Years-

Make_the_Connection/MT

C_Training/Public/Program

s/Make_the_Connection/

Make_The_Connection.asp

x?hkey=7aa18ee5-899d-

4763-a01b-19c07b5ddcda

Me, My Baby,

Our World

Rosalie Hall

3020 Lawrence Avenue East

Scarborough, Ontario

M1P 2T7

http://www.rosaliehall.co

m/downloads/mmbow.pdf

http://www.rosaliehall.co


http://rfts.ca/cwtb/index.html

http://rfts.ca/cwtb/index.html

http://www.imhpromotion.ca/

http://www.imhpromotion.ca/

https://psychologyfoundation.org/Public/Programs/First_Three_Years-Make_the_Connection/MTC_Training/Public/Programs/Make_the_Connection/Make_The_Connection.aspx?hkey=7aa18ee5-899d-4763-a01b-19c07b5ddcda









http://www.rosaliehall.com/downloads/mmbow.pdf

http://www.rosaliehall.com/downloads/mmbow.pdf

http://www.rosaliehall.com/downloads/meMyBabyOurWorldSlidePresentation.pdf


January 2018

82

Phone: (416) 438-6880

Fax: (416) 438-2457

E-mail: [email protected]

m/downloads/meMyBaby

OurWorldSlidePresentation

.pdf

Minding the Baby [email protected] http://mtb.yale.edu/trainin

g/summerinstitute.aspx

Mothers in Mind Lisa Sura-Liddell, MSW

Manager, Program Development &

Implementation

Family Violence Services

Child Development Institute

197 Euclid Ave

Toronto, ON M6J 2J8

416-603-1827 ext. 2306

416-603-6655 (fax)

[email protected]

Promoting First

Relationships

(PFR)

Contact:

Jennifer Rees, MSW, Program and Training

Manager, [email protected].

http://pfrprogram.org/trai

ning/community-training/

https://www.childtrends.or

g/programs/promoting-

first-relationships/

Triple P: Positive

Parenting

Program (Various

levels and

programs for

targeted

populations)

Both Tier 2-3

Many contact and programs offered across

Ontario http://www.triplep-

parenting.ca/ont-en/find-help/find-a-

provider/

Supporting

Security:

Attachment-

based

Intervention

Ontario Early Years Centre at The Massey

Centre for Women. For more information

on registering for the program, visit

www.massey.ca or call 416-425-3636.

https://www.sickkids.ca/pd

fs/IMP/20121-

IMHRounds_SupportingSec

urity_112106.pdf






http://pfrprogram.org/training/community-training/

http://pfrprogram.org/training/community-training/

https://www.childtrends.org/programs/promoting-first-relationships/



http://www.triplep-parenting.ca/ont-en/find-help/find-a-provider/



https://www.sickkids.ca/pdfs/IMP/20121-IMHRounds_SupportingSecurity_112106.pdf





January 2018

83


Attachment & Bio

behavioural

Catch-up (ABC)

Please email Dr. Caroline Roben at

[email protected].

https://www.childtrends.or

g/programs/attachment-

and-biobehavioral-catch-

up-abc/

https://www.infantcaregiv

erproject.com/certified-

parent-coaches

Circle of Security

(COS)

https://www.circleofsecurityinternational.c

om/find-a-training

COS-P Facilitator Training with Sonya Vellet

The Spice Factory

Phone: 509-462-2024, Email:

registration@circleofsecurityinternational.

com

121 Hughson Street N

Hamilton Ontario L8R 1G7

Canada

Infant-Parent

Program of

McMaster

Children’s

Hospital at the

Sanford

Neighbourhood

Ontario Early

Years Centre

735 King Street

East, Floor 1-A,

Hamilton,

Ontario

T: 1 (905) 525-

5855

Email:

oeyc@kboysand

girlsclub.com

Trellis Mental

Health and

Development

Services

147 Delhi Street

Guelph Ontario,

N1E 4J3

T: 1(519) 821-

2060

https://www.childtrends.org/programs/attachment-and-biobehavioral-catch-up-abc/








https://www.circleofsecurityinternational.com/find-a-training

https://www.circleofsecurityinternational.com/find-a-training


January 2018

84

Child-centered

play therapy

(CCPT)

Current registered therapists:

Theresa Fraser

Barmpton, ON and Pictou, NS


Website: www.changingsteps.ca/

Hannah Sun-Reid

Coburg, ON


Dyadic

Developmental

Psychotherapy

http://www.attachmentcan.ca/2016_11_A

ttachment_Focused_Family_Therapy.pdf

SIAN PHILLIPS

221 King St E, Kingston, ON K7L 3A7

Phone: (613) 545-3053 KINGSTON

http://ddpnetwork.org/pro

fessionals/find-a-

practitioner- or-therapist/

Filming

Interactions to

Nurture

Development

(FIND)

FIND development team at the University

of Oregon by emailing

[email protected]

Group

Attachment

Based

Intervention

(GABI)

The Center for Attachment Research

The New School for Social Research

Department of Clinical Psychology

80 Fifth Avenue, 6th Floor New York, NY

10011

Phone: (212) 229-5727 x3111 Fax: (212)

989-0846

Email:

Miriam Steele

Howard Steele [email protected]

https://clinicaltrials.gov/ct

2/show/NCT01641744

https://link-springer-

com.proxy.library.carleton.

ca/content/pdf/10.1007%2

F978-1-4614-4848-8.pdf

The Incredible

Years

TIER 2 -- BUT

MAY INCLUDE

TIER 3

COMPONENTS

Anne Kerridge

(613) 738-6990 xx 247 Social Worker;

Clinical Investigator, CHEO Research

Institute Mental Health

[email protected]

http://www.incredibleyear

s.com/about/faqs/

http://ddpnetwork.org/professionals/find-a-practitioner-%20or-therapist/



https://clinicaltrials.gov/ct2/show/NCT01641744







http://www.incredibleyears.com/about/faqs/

http://www.incredibleyears.com/about/faqs/


January 2018

85

Interaction

Guidance (IG)

Also referred to

as VIG video

interaction

guidance

Group with: MIG

and VIG

Training provided by:

Dr. Susan McDonough

University of Michigan's Comprehensive

Center for Depression

T: (734) 936-4400

[email protected]

https://www.videointeracti

onguidance.net

Modified

Interaction

Guidance (MIG)

Dr. Diane Benoit

Department of Infant Mental Health -

Hospital for Sick Children, Toronto

T: (416) 978-2719

Or (416) 813-1500

[email protected]

http://www.reseaudesanteenfant.ca/c/doc

ument_library/get_file?p_l_id=11103&fold

erId=31211&name=DLFE- 1601.pdf

OR

Jean MacKinnon

Aulneau Renewal Centre

228 Hamel Avenue Winnipeg, Manitoba

R2H 0K6

T: (204) 987-7090

[email protected]

http://www.skcp.ca/CEC%20Notices/MIG%

20training%20March%202013%20Winnipe

g.pdf

http://www.imhpromotion

.ca/portals/0/IMHP%20PDF

s/IMPRINT/32IMPReprint-

Benoit.pdf

Blue Hills Child

and Family

Centre

402

Bloomington

Rd., Aurora,

Ontario, L4G

0L9 T: 1 (905)

773-4323

TF: 1 (866) 536-

7608

E-mail:

bluehills@blueh

illscentre.ca St.

Mary's Home

780 rue l'Eglise

St. Ottawa,

Ontario,

K1K 3K7

T: 1 (613) 749-

2491 Email:

info@stmarysho

me.com

Rosalie Hall

Jane Kenny,

MSN RN

Director of

https://www.videointeractionguidance.net/

https://www.videointeractionguidance.net/


January 2018

86

Programs and

Mission

3020 Lawrence

Avenue East

Scarborough,

Ontario,

M1P 2T7

T: 1 (416) 438-

6880 x251 E-

mail:

janekenny@ros

aliehall.com

Parent-Child

Interaction

Therapy (PCIT)

Training Contact:

PCIT International

www.pcit.org/certified-trainers

[email protected]

Reflective Family

Play (RFP)

Diane Phillip Toronto

http://www.hincksdellcrest.org

Watch, Wait,

Wonder

Mirek Lojkasek, Ph.D., C.Psych.

Clinical and Developmental Psychologist

Private Practice

14 Prince Arthur Ave, Suite 314

Toronto, Ontario

Canada

M5R 1A9

Tel: 416-871-2878

Email:

[email protected]

Workshop participants are advised to

purchase the workshop manual which is an

indispensable tool as they begin to practice

WWW.

Blue Hills Child

and Family

Centre

402

Bloomington

Rd. Aurora,

Ontario, L4G

0L9 T: 1 (905)

773-4323

TF: 1 (866) 536-

7608

E-mail:

bluehills@blueh

illscentre.ca

Rosalie Hall

Director of

Programs and

Mission

Other programs/approaches


January 2018

87

Aboriginal Home

Instruction for

Parents of

Preschool

Youngsters

(HIPPY) Canada

Vanier Community Service Centre (2),

Ottawa, ON

Monique Best at 613-744-2892 ext. 1075

or [email protected]

https://www.hippyusa.org/

memanage/pdf/HUSA%20S

tart%20Up%20Manual.pdf

http://hippyottawa.ca/en/

home

Collaborative

Problem Solving

Michael Hone, M. Ed.

613-723-1623×228

Inunnquiniq

Parenting

Program

Lily Amagoalik

Family Health Research Coordinator

Qaujigiartiit Health Research Centre, Iqaluit

email : [email protected]

Tel : 867.975.2523

http://www.qhrc.ca/family

-health-1

https://www.hippyusa.org/memanage/pdf/HUSA%20Start%20Up%20Manual.pdf




http://www.qhrc.ca/family-health-1

http://www.qhrc.ca/family-health-1


January 2018

88

Appendix B: Ottawa Infant and Early Childhood Mental Health Initiative definitions in the

context of this report

Prenatal and Perinatal mental health refers to the mental health of the mother pre-pregnancy, during pregnancy, and

in the postpartum period.

Brain Development begins in pregnancy and undergoes its most rapid period of growth during the first 2000 days. As

such, the first weeks and first months of a child’s life are absolutely critical to brain growth and optimal brain

development.

The environment a child is raised in and their early experiences can have vast effects on later cognitive development.

Childhood adversities, including lack of stimulation and excessive stress can have an irreversible impact on brain

development (Bhutta et al., 2008; Maulik & Darmstadt, 2009; Nores & Barnett, 2010).

Attachment refers to the parent or caregivers’ ability to perceive, interpret and respond promptly to their infant’s needs

as well as the baby's perception of their caregiver’s safety, sensitivity and responsiveness.

Families set the stage for child development and play critical roles in a child’s life (Halle et al., 2013). Relationships are

critical to cognitive and social-emotional growth (Ainsworth, 1979) and children without warm, positive relationships

with caregivers are at increased risk for developing major behavioral and emotional problems (Halle et al., 2013).

Various factors such as poverty, low education and family stress can also compromise the caregiver-child relationship

quality by limiting opportunities for bonding and attachment (Zaslow et al., 2001)

Temperament is a set of personality traits that people are born with. A child’s temperament can shape their outcomes

and influence how others respond to them.

Self Regulation refers to how efficiently and electively children deal with stressors and then recover from them.

Self-regulation and emotion regulation skills provide the foundation for other social and emotional competencies, such

as the development of empathy, stress management skills, and prosocial behaviour. Self- and emotion regulation skills

are strongly impacted by the larger environment, and particularly socio-economic conditions (Blair & Raver, 2015;

Huston & Bentley, 2010).

Resiliency develops over time and is the ability to bounce back from adversity in a positive way.

Resilience is not an innate or fixed trait and is linked to strong executive function, self-regulation, adaptability, positive

self-perception and self-efficacy all of which foster a sense of control over one’s life and a belief that adversity can be

overcome (Masten, et al., 2009)

Documents

Evidence-informed social and emotional development ...€¦ · Defining social and emotional development and mental health in 0-6 years To contextualize the environmental scan (which