Building Systems for Effective Early Intervention and Support for Parents:Extending the Lets Start Program to Aboriginal Families & communities

Gary Robinson, Yomei Jones, Anita D’Aprano, Kate McGuinness, Roger

Tipungwuti, Sven Silburn, Steve Zubrick, Bill Tyler, Carolin Stock, Carmen Cubillo.

Menzies School of Health Research

What is Let’s Start?

• Trial of a targetted intervention for Indigenous parents and 4-6 y.o. children at risk

o Funded by FaHCSIA, CRCAH, NTG, ARC

• Funding extended to 2012 by FaHCSIA under FSP & NT Emergency Response

• Sites to 2009: Malak, Palmerston, Nguiu, Milikapiti, Pirlangimpi, Palumpa, Jabiru

• Further trials of a redesigned program: pilots from July 2010, implementation in partner sites from 2011

Trained Indigenous group leaders

Work in Groups

• Interactive: children playing with parents; parents in control, leaders assist, manage transitions

• Child: peer play, feelings, stop-think-do, etc.

• Parents: observe, discuss parenting, child behaviour, strategies, family of origin etc.

Working with differences

Parent & child responsiveness

Works with her dad …

Repairing relationships, supporting families

Evaluation Sample

Total Referrals Included in Evaluation Sample N = 225

Participated in ≥ 1 Sessions = 48

Participated in ≥ 1 Sessions = 15

Participated in ≥ 1 Sessions = 47

Completed ≥ 4 Sessions = 36

Completed ≥ 4 Sessions = 40

Completed ≥ 4 Sessions = 10

Tiwi Indigenous = 77 Urban Indigenous = 49 Non Indigenous = 99

Problems at referral

0% 20% 40% 60%

Good

Average

Academic Rating Poor

Aggressive Oppositional

Hyperactive

Phobias

Withdrawal

Worries

Distractible

Problematic Relationships

Developmental Delay

Cognitive

Language

Emotional

Below median Parents' NP

Total Sample

Tiwi Indigenous

Urban Indigenous

Non-Indigenous

Findings

• Engagement strategies need to be tailored for different contexts to improve participation and retention

• Important differences: urban Aboriginal kids• Improved parenting & reduced stress: large effect size K6

measure of parents’ psychological distress• Reduced behavioural problems in primary and preschool children:

o Moderate-large effect sizes at program end, larger effects at 6 months, program outcomes not only sustained but increase

• Dose-response effect: the more people attend the better the outcomes

• Variable response to treatment according to gender and Aboriginality: need to revise aspects of intervention strategy

• The challenge of developing the evidence base is to contextualize process and research strategies while retaining fidelity: structure, intensity & quality

Service learning

• Evidence-based programs for remote centres, “hubs”:o It is possible to support evidence-based

interventions in diverse contextso By developing local partnerships,

“integration” with health & education services

o With centrally provided professional training, support & supervision

Directions

• Develop SEWB protocols for CQI• Screening & assessments (d’Aprano)• Identify referral pathways for SEWB• Redesigning Let’s Start: Parents talk &

Interact: a focus of parent mental health and parent-child interaction for 4-8s

• Imagining my child: early years intervention to strengthen attachment for 0-4s

• Parenting support from birth to young adulthood

Building systems for delivery of professionally supported programs

Training & capacity-building

Research & evaluation Program delivery

Assesment, referral & intake;datagathering & analysis;verification of quality, feedback.

Community setup: leadership; capacity assessments; agreement between agencies; teambuilding; training; location & resources

Ongoing professional support for community team to guide practices of engagement with families and maintain practice standards

Models for integration: CQI & systems of practice

Wellbeing and early intervention program

1. Imagining my child 0-4 year olds

2. Let’s Start 4-8 y.o.

3. Adult and child wellbeing services

Program intake &/or ffurther referral.

Community child health care

Well child checks, healthy under 5s: audit of services according to CQI cycle developed for SEWB, behavioural development & parenting

Menzies CRCATSIHOne21Seventy

1. Review and trial of audit protocols and guidelines: queries about behaviour, social-emotional development & family support.

2. Pilot of assessment and referral to early intervention programs.

Evaluation, feedback & practice supportOne21seventy: Continuous quality improvement audit and feedback cycle

Let’s Start evaluation program: evaluation and clinical supportDevelopmental screening and assessment pilotsImagining my child: An early intervention to assess and to support early mother-child attachment AEDI:: community level developmental status data on NT children

Research and evaluation outputs

• Evaluation Report: Robinson, G., Zubrick, S. R., Silburn, S., Tyler, W., Jones, Y., D’Aprano, A., Cubillo, C., McGuinness, K., Bell, M., Stock, C., 2009, “Let’s Start: Exploring Together. An Early Intervention program for Northern Territory Children and Families. Final Evaluation Report”, Darwin: School for Social and Policy Research, Institute of Advanced Studies, Charles Darwin University.

• http://www.crcah.org.au/communication/downloads/lets-start-evaluation-report-2010.pdf

• Let’s Start: Parents talk & Interact. Manual and guidelines - a program for Aboriginal parents and communities (June 2010)

• Let’s Start working with kids: capacity assessment, training and community engagement (June 2010)

• Imagining my child: An early intervention trial (2011)• Systems for integrated child and family support: Protocols &

instruments for SEWB in primary health care (2010/2011)