Prevention FUNDamentals WELCOME

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Prevention FUNDamentalsWELCOME!!!
Find your Colleagues from your Circuit and have a
Seat!

• 2008 Dependency Summit
• Orlando, Florida
• 28 August 2008

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Prevention FUNDamentals
Workshop Facilitators Judge Daniel Dawson Johana
Hatcher Barbara Foster

• 2008 Dependency Summit
• Orlando, Florida
• 28 August 2008

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Welcome to Prevention FUNDamentals!

• Agenda for the Workshop
• Definitions
• Funding Streams
• No- and Low-Cost Prevention Opportunities
  (Kernels)
• Sharing and Discussion
• Q A

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Test Your Understanding!

• Look over the list of programs.
• Identify which programs are
• Universal Strategies (Primary Prevention)
• Selective Strategies (Secondary Prevention)
• Indicated Strategies (Tertiary Prevention)

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Definition Child Maltreatment

• Child Maltreatment any act or series of acts of
  commission (e.g., physical abuse, sexual abuse or
  psychological abuse) or omission (e.g., failure
  to provide for physical, emotional,
  medical/dental or educational needs inadequate
  supervision or exposure to violent environments)
  by a parent or other caregiver that results in
  harm, potential for harm, or threat of harm to a
  child.
• CDC, 2008

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Definitions Prevention

• Primary Prevention Geared to the general public
  to prevent child abuse, abandonment and neglect
  from occurring.
• Secondary Prevention Geared to families who are
  vulnerable and at risk of child abuse,
  abandonment and neglect.
• Tertiary Prevention Geared to families who have
  been identified as abusive or neglectful.

WHO
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Definitions Prevention Strategies

• Universal Strategies target activities to anyone
  in the general population with the goal of
  preventing child abuse and neglect from ever
  occurring. Universal strategies are available to
  everyone, rather than targeting populations based
  on risk factors or specific characteristics.
  Examples
• Broad-based public awareness campaigns on
  positive discipline
• Developmental screenings for children in primary
  healthcare settings
• Postpartum home visits for all parents of newborns

Impact
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Definitions Prevention Strategies

• Selective Strategies target activities or
  services to a group with specific risk factors
  with the goal of preventing child abuse and
  neglect from occurring in that group. Risk
  factors include parent age, poverty, substance
  abuse, domestic violence, or maternal depression.
  Examples
• Intensive home visitation programs for first time
  low-income mothers
• Parent training for adolescent mothers
• Respite care for parents of children with special
  needs
• Parent support groups for single parents

Impact
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Definitions Prevention Strategies

• Indicated Strategies target activities to a group
  that has experienced abuse or neglect with the
  goal of preventing child abuse and neglect from
  reoccurring in that group. Examples
• Parent training for department of social services
  substantiated parents
• Parent support groups for non-offender parents of
  children who have been sexually abused.

Impact
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Test Your Understanding!

• Look over the list of programs.
• Identify which programs are
• Universal Strategies (Primary Prevention)
• Selective Strategies (Secondary Prevention)
• Indicated Strategies (Tertiary Prevention)

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Federal Legislation

• The Child Abuse Prevention and Treatment Act
  (CAPTA).
• Social Security Act Title IV-B

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CAPTA

• Provides flexible funds for states to improve
  their child protective service systems.
• Requires a state plan to address how the state
  will support one or more program area included in
  the Act.
• Floridas focus is currently case management,
  including the ongoing case monitoring and
  delivery of services and treatment provided to
  children and their families.

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What is CBCAP?

• CBCAP stands for Community-Based Child Abuse
  Prevention. It refers to specific types of child
  abuse prevention programs that exist in every
  state in the U.S.
• Floridas CBCAP program is funded at
  approximately 1.5 million.

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Why were CBCAP programs created?

• The purpose of the CBCAP program is to
• support community-based efforts to develop,
  operate, expand, enhance, and, where appropriate,
  to network, initiatives aimed at the prevention
  of child abuse and neglect,
• support networks of coordinated resources and
  activities to better strengthen and support
  families to reduce the likelihood of child abuse
  and neglect, and  
• foster an understanding, appreciation, and
  knowledge of diverse populations in order to be
  effective in preventing and treating child abuse
  and neglect.

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What is the target population for CBCAP programs?

• CBCAP programs should have some activities
  available to the general population such as
  public awareness and education about preventing
  child abuse and neglect.
• In addition, programs should also target services
  to vulnerable families that are at risk of abuse
  or neglect. These families include
• Parents (all, new, teens, etc.)
• Parents and/or children with disabilities
• Racial and ethnic minorities
• Members of underserved or underrepresented groups
  
• Fathers

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What activities are authorized under CBCAP?

• Comprehensive support for parents
• Promote the development of parenting skills
• Improve family access to formal and informal
  resources
• Support needs of parents with disabilities
  through respite or other activities
• Provide referrals for early health and
  development services
• Promote meaningful parent leadership

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More activities authorized under CBCAP

• CBCAP programs can also
• Finance the development of a continuum of
  preventive services through public-private
  partnerships,
• Finance the start-up, maintenance, expansion, or
  redesign or child abuse prevention programs,
• Maximize funding through leveraging funds
• Finance public education activities that focus on
  the promotion of child abuse prevention.
• Floridas CBCAP program is funded at
  approximately 1.5 million.

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Social Security Act Title IV-B

• Provides the legal basis for child welfare
  services
• Title IV-B Subpart 1
• Charges States to
• protect and promote the welfare of all children
• prevent the neglect, abuse, or exploitation of
  children
• support at-risk families through services which
  allow children, where appropriate, to remain
  safely with their families or return to their
  families in a timely manner
• promote the safety, permanence, and well-being of
  children in foster care and adoptive families
  and
• provide training, professional development and
  support to ensure a well-qualified child welfare
  workforce.
• Title IV-B Subpart 2 Promoting Safe Stable
  Families ?

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Promoting Safe and Stable Families (PSSF)

• Purpose Enable states to develop and establish,
  or expand, and to operate coordinated programs of
  community-based
• Family Support Services
• Family Preservation Services
• Time-Limited Family Reunification Services
• Adoption Promotion and Support Services and
• Community Facilitation.
• Total Funding for Florida is approximately 22
  million.

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PSSF What does it address?

• To prevent child maltreatment from ever
  occurring, including families with risk factors
  through education and the provision of supportive
  family services.
• (2) To assure children's safety within the home
  and preserve intact families in which children
  have been maltreated, when the family's problems
  can be addressed effectively.
• (3) To address the problems of families whose
  children have been placed in foster care so that
  reunification may occur in a safe and stable
  manner in accordance with the Adoption and Safe
  Families Act of 1997 (ASFA).
• (4) To support adoptive families by providing
  support services as necessary so that they can
  make a lifetime commitment to their children.

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Family Support Services

• Designed to
• Increase the strength and stability of families
  (including adoptive, foster, and extended
  families)
• Increase parents' confidence and competence in
  their parenting abilities, to afford children a
  safe, stable and supportive family environment
• Strengthen parental relationships and promote
  healthy marriages, and otherwise to enhance child
  development.

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Family Preservation

• Services for children and families designed to
  help
• families (including adoptive and extended
  families) at
• risk or in crisis!
• Service programs designed to help children
• return to families from which they have been
  removed or
• be placed for adoption, with a legal guardian or
  in some other planned, permanent living
  arrangement
• Pre-placement preventive services programs, such
  as intensive family preservation programs,
  designed to help children at risk of foster care
  placement remain safely with their families

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Types of Family Preservation Services

• Service programs designed to provide follow-up
  care to families whose child has been returned
  after a foster care placement
• Respite care for children to provide temporary
  relief for parents and other caregivers
  (including foster parents)
• Services designed to improve parenting skills (by
  reinforcing parents' confidence in their
  strengths, and helping them to identify where
  improvement is needed and to obtain assistance in
  improving those skills) with respect to matters
  such as child development, family budgeting,
  coping with stress, health, and nutrition

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Time-Limited Reunification Services

• Services and activities provided to a
• child that is removed from the his/her home
• and placed in foster care and to the parents or
• primary caregiver of the child
• to facilitate the reunification of the child
  safely and appropriately within a timely fashion
• only during the 15 month period that begins on
  the date that the child is considered to have
  entered foster care.

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Time-Limited Reunification Services

• Individual, group, and family counseling.
• Inpatient, residential, or outpatient substance
  abuse treatment services.
• Mental health services.
• Assistance to address domestic violence.
• Services designed to provide temporary child care
  and therapeutic services for families, including
  crisis nurseries.
• Transportation to or from any of the services and
  activities just described.

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Adoption Promotion and Support Services

• Services and activities designed to
• encourage more adoptions out of the foster care
  system, when adoptions promote the best interests
  of children
• including such activities as
• pre and post adoptive services and
• designed to expedite the adoption process and
  support adoptive families.

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Community Facilitation

• Working within
• Communities to
• Strengthen and Empower Families and Communities
  to Improve Child Wellbeing

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Evidence-based Kernels

• Fundamental Units of Behavioral Influence

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ExampleKernels in a Prevention Program

• Seattles Social Development Study
• Adults instructed to greet and shake hands of
  five students NOT in their classroom each day.
• Adults instructed to give out caught you being
  good tickets every day.
• Related results 10 years later Increase in
  high school graduation rates Decrease in
  juvenile delinquency, substance abuse rates,
  teen pregnancy

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Kernels Defined and Taxonomy

• An evidence-based kernel is an indivisible
  procedure empirically shown to produce reliable
  effects on behavior, including psychological
  processes (Embry, 2004).
• A kernel may increase or decrease the frequency
  of a behavior.
• It can have its impact by altering antecedent or
  consequent events in the psychological
  environment of the person or it can affect
  behavior by directly manipulating a physiological
  function.
• At any given time, kernels, by definition, target
  a single behavior, whereas programs typically
  target multiple behaviors.
• Kernels can work individually or at cultural
  level.

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Utility of Kernels

• Replicated
• Simple to explain use
• Scalable to populations
• Adaptable and flexible to contexts
• Produce fast results
• Robust to dose and fidelity
• Have multiple syndemic effects
• Can be added to enhance existing efforts

Embry, D.D., Community-Based Prevention Using
Simple, Low-Cost, Evidence-Based Kernels and
Behavior Vaccines. Journal of Community
Psychology, 2004. 32(5) p. 575. A new article
on kernels is being published in Clinical Child
Family Psychology Review, 2008
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Four Types of Kernels
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Example Antecedents
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Example Reinforcement (Consequences)
Money or gambling activity
Citation or punish-ment
Response cost for engaging in action (or not)
Written or verbal praise
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Example Relational Frames
They like hip-hop style.
Support our troops.
Thats a Liberal / Conservative position.
Go Noles!
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Example Physiological Kernels
Fish oil, chocolate other foods
Physical activity
Prescription meds or illegal drugs
Nasal breathing to calm down
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52 Evidence Based Kernels
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Omega 3 Supplements
Costing 20-40 per person per year.

• Randomized control and epidemiological studies
  show
• 50 reduction in chance of depression leading to
  drugs.
• Lower violent tendencies
• Higher IQ, less ADHD, aggression, impulsivity,
  and other disabilities.
• Less asthma.

Freeman, M. P., Hibbeln, J. R., Wisner, K. L.,
Davis, J. M., Mischoulon, D., Peet, M., et al.
(2006). Omega-3 fatty acids evidence basis for
treatment and future research in psychiatry.
Journal of Clinical Psychiatry, 67(12), 1954-1967.
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Prize BowlRewards for Sobriety
Costing 500-1,000 per addicted person per year.

• Randomized control studies show
• 20-70 reduction in use of alcohol, tobacco or
  illegal drugs by receiving prizes for being
  sober and engaging in recovery type activities.
• Reduced involvement in crime and violence
  witnessed by children.
• Reduced violence and drug use bu parents would
  have reduced childrens PTSD, ADHD, oppositional
  defiance and foster care.

Petry, N. M., Tedford, J., Austin, M., Nich, C.,
Carroll, K. M., Rounsaville, B. J. (2004).
Prize reinforcement contingency management for
treating cocaine users How low can we go, and
with whom? Addiction, 99(3), 349-360
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Kangaroo Care
Costing 50-100 per mom for training.

• Randomized control studies show that Kangaroo
  Care (swaddling baby next to adults bare skin)
• Results in moms being less likely to develop
  post-partum depression and better parenting
  skills.
• Would have reduced childs developmental
  problems, including fussiness and difficulty to
  calm.
• Might have reduced chance of shaken baby
  syndrome.

Ferber, S. G., Makhoul, I. R. (2004). The
effect of skin-to-skin contact (kangaroo care)
shortly after birth on the neurobehavioral
responses of the term newborn a randomized,
controlled trial. Pediatrics, 113(4), 858-865
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Turtle Technique
Costing 10-20 per classroom for training.

• Randomized control studies show that errorless
  compliance traininga recently developed,
  success-based approach for teaching children to
  comply with parental requestswithout the use of
  coercive consequences
• Would have reduced abuse
• Would have improved parenting skills
• Would have reduced childs oppositional defiance
  at home and school.

Robin, A., Schneider, M., Dolnick, M. (1976).
The Turtle Technique An extended case study of
self-control in the classroom. Psychology in the
Schools, 13(4), 449-453
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Self-modeling/ Dialogic Storybooks
Costing 3-15 per child.

• Controlled studies show that specially
  constructed story bookfeaturing the child as the
  hero in social or behavior competencies with
  interactive reading
• Improves parenting and safety skills
• Improves achievement
• Improves social competence and resiliency skills
• Improves literacy and reading
• Reduces developmental delays

Billy saw his new sister, Heather. Billy said,
Can we play together. Talk about it What did
Billy say? Good remembering.
Wedel, J. W., Fowler, S. A. (1984). "Read me a
story, Mom" A home-tutoring program to teach
prereading skills to language-delayed children.
Behavior Modification, 8(2), 245.
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Good Behavior Game
Costing 6-20 per child.

• Multiple controlled studies show that the Good
  Behavior Game dramatically affect the following
  lifetime problems, when used in first-grade
• ADHD, special ed placement
• Oppositional defiance conduct disorders
• Tobacco, binge drinking, stimulant drug use
  (e.g., cocaine, meth)
• High-school graduation

Kellam, S., Brown, C. H., Poduska, J., Ialongo,
N., Wang, W., Toyinbo, P., et al. (in press,
2007). Effects of a Universal Classroom Behavior
Management Program in First and Second Grades on
Young Adult Behavioral, Psychiatric, and Social
Outcomes. Drug and Alcohol Dependence,.
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Peer-to-peer Teaching
Costing 2-5 per child.

• Multiple controlled studies show that
  peer-to-peer teaching
• Raises children to grade-level
• Reduces ADHD
• Improves social competence
• Reduces bullying
• Reduces ethnic and racial disparities
• Reduces teacher stress
• Reduces placement for SPED for LD and EMR

Greenwood, C. R., Terry, B., Utley, C. A.,
Montagna, D., al, e. (1993). Achievement,
placement, and services Middle school benefits
of Classwide Peer Tutoring used at the elementary
school. School Psychology Review, 22(3), 497-516.
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Peer-to-peer Notes Positive Home Notes
Costing 0.50-1 per child.

• Multiple controlled studies show that
  peer-to-peer notes and/or positive notes home
• Increases social competence
• Reduces ADHD and problem behavior
• Reduces aggression and violence
• Increases school bonding
• Reduces risk of substance abuse
• Improves relationships with adults

Skinner, C. H., Cashwell, T. H., Skinner, A. L.
(2000). Increasing tootling The effects of a
peer-monitored group contingency program on
students' reports of peers' prosocial behaviors.
Psychology in the Schools, 37(3), 263-270.
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Massage for PTSD/Aggression
Costing about 200 per person

• Multiple controlled studies show that massage
• Improves infant development
• Decreases PTSD like symptoms
• Decreases ADHD, aggression and acting out
• Reduces stress hormones
• Reduces depression
• Reduces cravings for drugs or nicotine

Hernandez-Reif, M., Field, T., Hart, S. (1999).
Smoking cravings are reduced by self-massage.
Preventive Medicine, 28(1), 28-32. Field, T. M.,
Grizzle, N., Scafidi, F., Schanberg, S. (1996).
Massage and relaxation therapies' effect on
depressed adolescent mothers. Adolescence,
31(124), 903-911 Khilnani, S., Field, T.,
Hernandez-Reif, M., Schanberg, S. (2003).
Massage Therapy Improves Mood and Behavior of
Students with Attention-Deficit/Hyperactivity
Disorder. Adolescence, 38(152), 623-638.
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Reward and Reminder
Costing about 200 per licensee
Biglan, A., Ary, D., Koehn, V., Levings, D.,
al, e. (1996). Mobilizing positive reinforcement
in communities to reduce youth access to tobacco.
American Journal of Community Psychology, 24(5),
625-638.
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Hard Drug Prevention Math Matters
What happens if about 50,000 elementary children
are inoculated with the Good Behavior Game tested
at Johns Hopkins, and invented by a teacher.
Here are a few effects.
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Hands-On Exercise
Work as a small group at your table.   Take the
list of evidence based kernels and pick one that 
might be suitable for your home area. Use your
own selection criteria for picking the kernel
(e.g., I could do this in my own job. The
organization that I work with could do this.
Our local libraries have been looking for ways
to help families and this would be something they
could do.) Use whatever works for you and your
table!   Discuss What steps would be needed to
implement the kernel? What benefits would be
expected? What costs, if any, might be
incurred?   Be ready to report out in 10 min.
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Burning Questions and Flaming Answers!
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Prize Bowl and Thank You!

• Judge Daniel Dawson, ctjudd1_at_ocnjcc.org
• Johana Hatcher, Johana_Hatcher_at_dcf.state.fl.us
• Barbara Foster, barbara.foster_at_myflorida.com
• For more on Syndemics and Kernels, see
• http//www.flgov.com/ca_feb_meeting