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Integrating specialized mental health services into child welfare settings
Mary Dozier Carole Shauffer
University of Delaware San Francisco
Research support
• NIMH R01 52135
• NIMH K02 74347
• NIMH Network grant (Gunnar PI)
Dissemination support
• Foundations (Casey, Skillman, Stewart, Pierce)
• Youth Law Center
Attachment and Biobehavioral Catch-up
• 10 session intervention delivered in foster parents’ homes
• Targets issues identified empirically as challenging
• Videofeedback central– Critical issues
• Identifying times when parents are motivated• Strength based• Talented interventionists
Targets several key issues
1. Babies in foster care especially need nurturing care
a. Babies in foster care often push caregivers away
b. Caregivers’ own issues often get in the way of their providing nurturing care
2. Babies in foster care need help developing self-regulatory capabilities
Issue 1a: Babies in foster care behave in ways that push caregivers away
Sequential analyses reveal that child’s behavior reliably elicits complementary behavior from parent
Targeting issue 1a: Re-interpreting children’s cues
• Child needs you even though he or she may not appear to need you
Issue 1b: Caregivers’ own issues get in the way
Targeting Issue 1b: Caregivers’ own issues get in the way
• Over-ride issues
• Become aware of “voices from the past”
Issue 2: Foster children have difficulty regulating behavior and physiology
Behavior
Problem behaviors
Deficits in inhibitory control
Physiology
Atypical production of cortisol
Cortisol production
Preschoolers and infants/toddlers differ from comparison children
Among preschoolers in foster care:• Many have low levels in the morning• Some have high levels at one or more times
(Fisher et al., Dozier et al.)
Among infants in foster care:• Many have high levels at one or more times
(Dozier et al.)
Wake-up and bedtime cortisol levels of infants and preschoolers in foster care
0
0.2
0.4
0.6
0.8
1
1.2
wake-up bedtime
Time of day
cort
isol u
g/d
l
InfantsPreschoolers
Targeting issue 2: Help young children regulate behavior and physiology
•Following the child’s lead in play;
attending to child’s signals
(Barnard, 1998; Van den Boom, 1994)
Targeting issue 2: Help young children regulate behavior and physiology
•Touching, holding child (Field, 1994)
Targeting issue 2: Help young children regulate behavior and physiology
•Facilitating expression of emotions (Izard, 2003)
Efficacy data
Randomized clinical trial
150 children randomly assigned to:
Attachment and Biobehavioral Catch-up
Educational intervention
Attachment quality among Attachment and Biobehavioral Catch-up and control
intervention children
0
10
20
30
40
50
60
70
Percentage with secure attachment
Attachment andBiobehavioral Catch-up
(n=41)
Control intervention(n=45)
NICHD Early Child Care(n=1131)
Group
Problem behaviors among children in Attachment and Biobehavioral Catch-up and treatment control children
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0 - 18 months 18 - 36 months
Attachment and Biobehavioral Catch-up
Treatment control
*
Cortisol production among children in Attachment and Biobehavioral Catch-up and treatment control groups
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
AM PMTime of Day
Co
rtis
ol u
g/d
l
Attachment and Biobehavioral Catch-up
Treatment control
Cortisol production among children in Attachment and Biobehavioral Catch-up, treatment control, and non-foster
comparison groups
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
AM PMTime of Day
Co
rtis
ol u
g/d
l
Attachment and Biobehavioral Catch-up
Treatment control
Comparison
*
Attachment and Biobehavioral Catch-up
Effective, efficient prevention program
There’s a need for it
“If you build it, they will come” (Field of Dreams)
Why Sell The Program
The Need
Who are the decision makers?
• Child Welfare Administrators• Political Figures• Community leaders• Foundations• Advocates• Staff
Reasonable time frames
• Change takes time– but
• Times change
• Permanency for Youth• Teens leaving care• Education
The Time for Babies is Now
