Strengthening Caregiver Practices that Build Infant Social-Emotional and Social Communication Competencies

Strengthening Caregiver Practicesthat Build InfantSocial-EmotionalandSocialCommunicationCompetencies

KathleenM.Baggett,Ph.D.Associate Professor&Director ofEarly Childhood Social-Emotional Health PromotionResearchMarkChaffin CenterforHealthy DevelopmentDivisionofHealth PromotionandBehavior,School ofPublicHealthGeorgiaStateUniversity

Prepared fortheNationalInstituteofNursingResearch Summit ontheScienceofCaregivingAugust8,2017Bethesda,MDContact:[email protected]

Infant-Net/Baby-NetResearchTeam

KathleenM.Baggett,Ph.D.,GeorgiaStateUniversityEdwardG.FeilBetsyDavisLisaSheeberSusanH.LandryUrsulaJohnson

KathleenM.BaggettEdwardG.Feil,Ph.D.,OregonResearchInstituteBetsyDavis,Ph.D.,OregonResearchInstituteLisaSheeber,Ph.D.,OregonResearchInstituteSusanH.Landry,Ph.D.,UniversityofTexas,HoustonUrsulaJohnson,Ph.D.,UniversityofTexas,Houston

Grant Participants Design1-NIMHR34MH073756 (2006-2008)2-NICHDR01HD1R01HD064870(2010-2014)

40 low-incomemothersandthieir infants159lowincomemothersandtheirinfants

RCT

2-CDCR18CE001705(2009-2012) 13HealthyFamilieshometheirmotherinfantcaseloads Implement.

3- USDE, IESR324A100041 (2010-2013)4- NICHDR21HD06287(2010-2012)

19 EarlyHeadStartteachersand infants21 CommunityChildCareteachers andinfants

FeasibilityPilot

5-HRSAR40MC26822RCT(2014-2017) 36 Low incomemothersandtheirinfantsexitinginnerurbanNICUs

RCT

ADecadeofResearch:AcknowledgmentsandDisclosure

*Disclosure:Thisinformationorcontentandconclusionsarethoseoftheauthorandshouldnotbeconstruedastheofficialpositionorpolicyof,norshouldanyendorsementsbeinferredbyanyoftheentitiesabove.Dr.BaggettisadeveloperoftheInfantNet/Baby-Netprogram.

Epigenetictoxicstresscontributesto earlyinfantvulnerability,whichchallengescaregivingandleadstopracticesthatfurthercompromisehealthanddevelopentoutcomesacrossthelifecourse

• Prematurityandlowbirthweight• Neurodevelopmentalandbehavioralchallenges• Developmentaldelays

EvidenceBasedIntervention 20YearLag

https://www.whatisepigenetics.com/what-is-epigenetics/

CommunityImplementation

ResearchGap

KeyOpportunities

Ø Deployinterventionswiththestrongestevidenceofeffectivenessforimprovingcaregivingpracticesdemonstratedtopromoteinfantsocial-emotionalandsocial- communicationcompetencies

Ø Makethemaccessibletoallcaregivers-especiallythemostvulnerable

Ø Rigorouslyevaluateandrefinethemtobringthemtoscalewhilemaximizingengagementforallcaregivers- especiallythemostvulnerable

Baby-Net(ePALS)isamobileweb-basedadaptationoftheevidence-basedPlay&LearningStrategiesHomeVisitingProgram

Baby-Netgoalsareto:

Strengthencaregivingpractices thatbuildinfantsocial-emotionalhealthanddevelopment

Improveaccess forvulnerablecaregiversandinfantsto:• Skills-basedintervention:Practice– Observe– Reflect–BuildInteractionSkills• 24-hourmobileaccess• Supportivecoachingrelationship

Weeklypost-sessionremotecoachingcallsengageparentsinco-viewingtheirownvideostonotice,celebrate andplanforsuccess

SequencedInterventionStructure

ProgramFeatures• Securelogin• Discovery:Video-basedteachingofnewcontent• Check-InQuestionswithimmediatecorrectivefeedback• SessionReview• GuidedActionPlan• Self-CreatedVideoofparent-infantinteractionskillpractice• RemotePractice-BasedCoachCall• Administrativereportstomonitorparticipantprogress• Secureemail,textforcoach-participantcommunication

SessionStructure

Step1Discover

Step2CheckIn

Step3GuidedActionPlan

Step4Video

Creation

Step5CoachCall

10-12WeeklySkill-BasedSessions

1-2Caregiverlearningmotivation7Linkingwords&actions3Recognizingsignals 8Readingwithbaby4 Sensitiveresponding 91-2Alternatecaregiversessions5 Maintainingfocus 10Beingyourowncoach6Introducingforengagement

SampleDemographics

Mothers• =/<130%fedpoverty• 66%<$20,000/year• 42%Non-White• 38%Hispanic• 46%highschool/less• MeanPDSS>clinicalcut

OtherCaregivers/Providers• Communitychildcareproviders• Earlyinterventioncenterbasedteachers• HealthyFamilieshomevisitors

Infants• Meanage=4months• NICU;VLBW• Identifieddisability• Developmentaldelays• Childmaltreatmentrisk

Results

Results

Conclusions• Programcompletionratesformothersandchildcareproviderswerehigh• EffectsoftheInternet,remotecoachingadaptationofthePALSprogramareencouraging• Considerationsforscalability:• GiventhecontinueddigitaldivideforcomputerInternetaccess,futureeffortsshouldfocusonmoreubiquitoustechnologiessuchassmartphonedelivery• Futureeffortsshouldincludebriefon-linemulti-gatingscreeningproceduresthatassistfamiliesandchildcareprovidersinaccessingtieredinterventionbestmatchedtotheirneed• Opportunitiesforintentionalimbeddingofcaregivermentalhealthfocusedintervention:e.g.,reducingmaternaldepression