what is let’s start?
DESCRIPTION
Building Systems for Effective Early Intervention and Support for Parents: Extending the Lets Start Program to Aboriginal Families & communities. Gary Robinson, Yomei Jones, Anita D’Aprano, Kate McGuinness, Roger Tipungwuti, Sven Silburn, Steve Zubrick, Bill Tyler, Carolin Stock, Carmen Cubillo. - PowerPoint PPT PresentationTRANSCRIPT
Building Systems for Effective Early Intervention and Support for Parents:Extending the Lets Start Program to Aboriginal Families & communities
Gary Robinson, Yomei Jones, Anita D’Aprano, Kate McGuinness, Roger
Tipungwuti, Sven Silburn, Steve Zubrick, Bill Tyler, Carolin Stock, Carmen Cubillo.
Menzies School of Health Research
What is Let’s Start?
• Trial of a targetted intervention for Indigenous parents and 4-6 y.o. children at risk
o Funded by FaHCSIA, CRCAH, NTG, ARC
• Funding extended to 2012 by FaHCSIA under FSP & NT Emergency Response
• Sites to 2009: Malak, Palmerston, Nguiu, Milikapiti, Pirlangimpi, Palumpa, Jabiru
• Further trials of a redesigned program: pilots from July 2010, implementation in partner sites from 2011
Trained Indigenous group leaders
Work in Groups
• Interactive: children playing with parents; parents in control, leaders assist, manage transitions
• Child: peer play, feelings, stop-think-do, etc.
• Parents: observe, discuss parenting, child behaviour, strategies, family of origin etc.
Working with differences
Parent & child responsiveness
Works with her dad …
Repairing relationships, supporting families
Evaluation Sample
Total Referrals Included in Evaluation Sample N = 225
Participated in ≥ 1 Sessions = 48
Participated in ≥ 1 Sessions = 15
Participated in ≥ 1 Sessions = 47
Completed ≥ 4 Sessions = 36
Completed ≥ 4 Sessions = 40
Completed ≥ 4 Sessions = 10
Tiwi Indigenous = 77 Urban Indigenous = 49 Non Indigenous = 99
Problems at referral
0% 20% 40% 60%
Good
Average
Academic Rating Poor
Aggressive Oppositional
Hyperactive
Phobias
Withdrawal
Worries
Distractible
Problematic Relationships
Developmental Delay
Cognitive
Language
Emotional
Below median Parents' NP
Total Sample
Tiwi Indigenous
Urban Indigenous
Non-Indigenous
Findings
• Engagement strategies need to be tailored for different contexts to improve participation and retention
• Important differences: urban Aboriginal kids• Improved parenting & reduced stress: large effect size K6
measure of parents’ psychological distress• Reduced behavioural problems in primary and preschool children:
o Moderate-large effect sizes at program end, larger effects at 6 months, program outcomes not only sustained but increase
• Dose-response effect: the more people attend the better the outcomes
• Variable response to treatment according to gender and Aboriginality: need to revise aspects of intervention strategy
• The challenge of developing the evidence base is to contextualize process and research strategies while retaining fidelity: structure, intensity & quality
Service learning
• Evidence-based programs for remote centres, “hubs”:o It is possible to support evidence-based
interventions in diverse contextso By developing local partnerships,
“integration” with health & education services
o With centrally provided professional training, support & supervision
Directions
• Develop SEWB protocols for CQI• Screening & assessments (d’Aprano)• Identify referral pathways for SEWB• Redesigning Let’s Start: Parents talk &
Interact: a focus of parent mental health and parent-child interaction for 4-8s
• Imagining my child: early years intervention to strengthen attachment for 0-4s
• Parenting support from birth to young adulthood
Building systems for delivery of professionally supported programs
Training & capacity-building
Research & evaluation Program delivery
Assesment, referral & intake;datagathering & analysis;verification of quality, feedback.
Community setup: leadership; capacity assessments; agreement between agencies; teambuilding; training; location & resources
Ongoing professional support for community team to guide practices of engagement with families and maintain practice standards
Models for integration: CQI & systems of practice
Wellbeing and early intervention program
1. Imagining my child 0-4 year olds
2. Let’s Start 4-8 y.o.
3. Adult and child wellbeing services
Program intake &/or ffurther referral.
Community child health care
Well child checks, healthy under 5s: audit of services according to CQI cycle developed for SEWB, behavioural development & parenting
Menzies CRCATSIHOne21Seventy
1. Review and trial of audit protocols and guidelines: queries about behaviour, social-emotional development & family support.
2. Pilot of assessment and referral to early intervention programs.
Evaluation, feedback & practice supportOne21seventy: Continuous quality improvement audit and feedback cycle
Let’s Start evaluation program: evaluation and clinical supportDevelopmental screening and assessment pilotsImagining my child: An early intervention to assess and to support early mother-child attachment AEDI:: community level developmental status data on NT children
Research and evaluation outputs
• Evaluation Report: Robinson, G., Zubrick, S. R., Silburn, S., Tyler, W., Jones, Y., D’Aprano, A., Cubillo, C., McGuinness, K., Bell, M., Stock, C., 2009, “Let’s Start: Exploring Together. An Early Intervention program for Northern Territory Children and Families. Final Evaluation Report”, Darwin: School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University.
• http://www.crcah.org.au/communication/downloads/lets-start-evaluation-report-2010.pdf
• Let’s Start: Parents talk & Interact. Manual and guidelines - a program for Aboriginal parents and communities (June 2010)
• Let’s Start working with kids: capacity assessment, training and community engagement (June 2010)
• Imagining my child: An early intervention trial (2011)• Systems for integrated child and family support: Protocols &
instruments for SEWB in primary health care (2010/2011)