Evidence-informed social and emotional development ...€¦ · Defining social and emotional...
Transcript of Evidence-informed social and emotional development ...€¦ · Defining social and emotional...
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
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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
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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
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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).
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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
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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).
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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.
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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
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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).
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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
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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).
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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,
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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).
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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
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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.
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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
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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
• Age: 0-5 years old
• families identified at risk through primary screening, child welfare, early intervention, or child protective services
Program details
• Core program objectives:
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
• Targeted skills:
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)
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• 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
Program implementation
• 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
Summary of the research
• 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.
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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
• Core program objectives:
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
• Targeted skills:
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)
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• 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
Program implementation
• 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.
Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
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Program implementation
• 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)
Summary of the research
• 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
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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
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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
• Core program objectives:
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
• Targeted skills:
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
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Program implementation
• 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)
Summary of the research
• 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.
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• 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
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Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• 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
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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
Summary of the research
• 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
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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
• Age: 0-4 years old
• mothers who have experienced family violence, childhood abuse, neglect or sexual assault, and have children
under the age of four
Program details
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: 1
• Profession/education required: clinicians including registered nurses, advanced practice nurses, social workers,
psychologists, or other mental health clinicians
• 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
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• 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
Summary of the research
No research was available to date
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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
• Age: 0-3 years old
• 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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: 1
• Profession/education required: clinicians including registered nurses, advanced practice nurses, social workers,
psychologists, or other mental health clinicians
• Required materials: video tape device, TV
• Length of training: 15 weeks
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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
Summary of the research
• 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.
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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
• Core program objectives:
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
• Targeted skills:
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
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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.
Program implementation
• Varies depending on type of program: Further information can be found at http://www.triplep-
parenting.ca/ont-en/triple-p/?cdsid=b126e41461fc3ff0883329aa4c9a2640
Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• 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
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• Cost of training or membership Information: information not available
Summary of the research
No published research available to date
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Tier 3 level programs
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
• Age: 0-5 years old
• high risk parents/caregivers and alternate caregivers of infants and toddlers
Program details
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: one parent coach
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• Profession/education required: clinicians including registered nurses, advanced practice nurses, social workers,
psychologists, or other mental health clinicians
• 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
Summary of the research
• 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.
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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
• Age: 1-4 years old
• families who are at risk due to mental health challenges, history of trauma, involvement in child protection
Program details
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: 1
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• 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
Summary of the research
• 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
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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
Social and emotional development programs
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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
• Age: 3-10 years old
• children experiencing social, emotional, behavioural and relational disorders.
Program details
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: 1
• 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
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Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
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• 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
Program implementation
• Number of leads/instructors: 1
• 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
Summary of the research
• 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
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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.
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• 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
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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
Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• 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
• Required materials: variable
• 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
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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
Summary of the research
• 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.
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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
• Age: 0-12 years old
• 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
• Core program objectives:
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
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• Targeted skills:
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/
Program implementation
• 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
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o the prices for training depend on which training program you attend), and where it is offered (these
prices may vary)
Summary of the research
• 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
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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
• Age: 0-8 years old
• 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
• Core program objectives:
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
• Targeted skills:
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
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Program implementation
• 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
• Required materials: variable
• Length of training:
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
Summary of the research
• 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.
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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.
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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
• Core program objectives:
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
• Targeted skills:
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
Program implementation
• Number of leads/instructors: Two instructors
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• 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
Summary of the research
• 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
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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
• Age: 2-7 years old
• 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
• Core program objectives:
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
• Targeted skills:
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
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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
Program implementation
• Number of leads/instructors: 1
• 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.
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• 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
• Length of training:
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)
Summary of the research
• 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.
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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.
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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
• Core program objectives:
• Targeted skills:
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
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Program implementation
• 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
Summary of the research
• 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
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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
• Age: 0-5 years old
• this program supports children who are experiencing a wide variety of relational and developmental difficulties
Program details
• Core program objectives:
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
• Targeted skills:
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:
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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
Program implementation
• Number of leads/instructors: 1
• 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
Summary of the research
• 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
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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
• Core program objectives:
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
• Targeted skills:
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
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Program implementation
• Number of leads/instructors: 1
• 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.
Summary of the research
• 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.
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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
• Age: 3-5 years old
• offered to a variety of families including Indigenous, new comer family, multicultural families
Program details
• Core program objectives:
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
• Targeted skills:
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.
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Program implementation
• 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
• Length of training:
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
Summary of the research
• 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.
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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
• Age: 0-18 years old
• 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
• Core program objectives:
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
• Targeted skills:
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
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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
Program implementation
• 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]
Summary of the research
• 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.
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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.
Summary of the research
• 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.
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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
___________________________________________
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.
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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.
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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:
www.developingchild.harvard.edu
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:
www.developingchild.harvard.edu
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.
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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
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Gilmore, K. (2011). Pretend play and development in early childhood (with implications for the oedipal phase). Journal of
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Hanley, G. P., Heal, N. A., Tiger, J. H., & Ingvarsson, E. T. (2007). Evaluation of a classwide teaching program for
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Kenney, M. K. (2012). Child, family, and neighborhood associations with parent and peer interactive play during early
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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,
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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
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
Email: [email protected]
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:
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
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Phone: (416) 438-6880
Fax: (416) 438-2457
E-mail: [email protected]
m/downloads/meMyBaby
OurWorldSlidePresentation
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)
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
Social and emotional development programs
January 2018
83
Tier 3 level programs
Attachment & Bio
behavioural
Catch-up (ABC)
Please email Dr. Caroline Roben at
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
Social and emotional development programs
January 2018
84
Child-centered
play therapy
(CCPT)
Current registered therapists:
Theresa Fraser
Barmpton, ON and Pictou, NS
Email: [email protected]
Website: www.changingsteps.ca/
Hannah Sun-Reid
Coburg, ON
Email: [email protected]
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
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
http://www.incredibleyear
s.com/about/faqs/
Social and emotional development programs
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
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
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
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
Social and emotional development programs
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
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:
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
Social and emotional development programs
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
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
Social and emotional development programs
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)