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A Commentary on

“Building Adult Capabilities to Improve Child Outcomes: A Theory of Change” from

The Center on the Developing Child at Harvard University

By Shelley Calissendorff, Founder and Executive Director,

Smile At Your Baby!

June 11, 2013

 

 

With widespread, improved parent/infant bonding and attachment, Smile At Your Baby! (SAYB) believes there will be fewer instances of Reactive Attachment Disorder (RAD) as well as a reduction in so many other social, mental, and emotional issues including (but not limited to): child abuse/neglect, the need for children to enter foster care, bullying, animal abuse, obesity, teenage pregnancy, high school drop-outs, substance abuse, violence, crime prison and even early death.

 

Through our BABY BIT program, SAYB is working to reduce the occurrence of early childhood trauma/toxic stress/ACEs.  While we agree with the recent “Building Adult Capabilities to Improve Child Outcomes: A Theory of Change” video produced and released by the Center on the Developing Child at Harvard University, that the best way to improve parenting skills is through “Active Skill Building,” including coaching, training and practice, we also feel that since “Active Skill Building” is not yet widely available to all who need it (not even close), that BABY BITS can help in the interim and/or as an additional tool. Making progress in this movement need not be an all or nothing proposition.  It needn’t be, “Active Skill Building,” OR dissemination of well researched “advice and information.” 

 

Not all parents have access to transportation or childcare, or have reliable Internet access.  Many parents will not participate in parenting education due to their perceived social stigma or taboo against admitting to having parenting needs or problems that cannot be solved without assistance [Curran ’89, Levant ’87, Mertensmeyer & Thornburg ’98, Powell et al ‘90].  But MOST of them DO have a cell phone.  According to research published in 2013 by The Pew Research Center, 82% of low-income American’s own cell phones, and among young adults age 18-24, 95% own a cell phone. In at least 39 U.S. States, recipients of food stamps or other government assistance program benefits can now choose to receive a free or very low cost cell phone instead of the traditional land telephone line. 

 

SAYB sincerely believes that by NOT taking advantage of the accessibility and discretion that cell phones provide, we are not doing everything possible to improve outcomes for our children. This venue is untapped for parenting education--at least when it comes to social/emotional/mental/behavior needs.

[Text4Baby (which is sponsored by Johnson & Johnson) sends text messages 3 times a week on nutrition, safety and vaccination issues.  Smile At Your Baby! does NOT broach  those issues at all.]

 

I would like to invite Dr. Jack Shonkoff, and the Center on the Developing Child to embrace and endorse Smile At Your Baby!’s BABY BIT program and include it as a part of the solution to improving child outcomes. 

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Resilience is so very important!  But, please, let us not forget, or overlook prevention!  I could quote experts galore on why prevention is so critical, but I really don't think I have to with this group of people.  We all already know that prevention is less expensive then treatment/rehabilitation later in life.  It almost seems as if there is a movement inside of a movement here...we all want to reduce the impact that ACEs make on society, but those of us promoting prevention are in the minority it would appear.  We need both.  But, I personally would very much like to see MORE attention and enthusiasm directed toward prevention.  Let us practice what we preach!  :D  Thoughts?  ~ Shelley

Shelley,

 

That's great you heard back from Harvard!

 

I totally agree that prevention is key. I just found this in a document I was reading (and this excerpt is from Harvard!) which echoes the same sentiment:

"Research overwhelmingly points to the benefits of supporting children and families at an early age to prevent maltreatment and its negative effects on brain development before they occur. In addition, cost-benefit analyses demonstrate the stronger return on investments that result from strengthening families, supporting development, and preventing maltreatment during childhood and adolescence rather than funding treatment programs later in life (Center on the Developing Child at Harvard University, 2007)."

https://www.childwelfare.gov/pubs/braindevtrauma.pdf

The concept of "resilience" is, too easily confused in my opinion, and puts the focus back on the victim -- it's something they need to have or "work on" so they can better endure abuse; completely wrong focus. 

 

I hope you soldier on at trying to get BabyBits out there. I think it's a wonderful tool!

Harvard's response to my commentary above.

Dear Shelley,
Thank you for sharing your thoughts relating to our new video. We certainly don't mean to disparage meaningful efforts to reach parents and caregivers in a variety of ways — clearly different people respond to receiving information in different ways. That said, there's a great deal of evidence showing very little impact on child outcomes of programs that simply provide didactic information about parenting, so the emphasis of our video was to show why we think a better approach may be active skill-building. As noted, it's a theory of change, not a proven intervention. Clearly you have a theory of change for your intervention as well. It may turn out that, for some caregivers, receiving timely reminders by text message may in fact serve as a virtual mentor or coach — it will be very interesting to see what happens as you evaluate SAYB for its effectiveness on parenting behaviors and child outcomes.
In response to your request for an endorsement, I'm afraid that Center policy does not permit us to endorse any particular product or service.
Thanks again for sharing your thoughts.
Al Race
Deputy Director
Director, Communications and Public Engagement
Center on the Developing Child 
Harvard University 
www.developingchild.harvard.edu

Thank you Chris!  I will watch the video!  

And, yes, Harvard is FOR prevention, they just want the focus to be on hands-on, face-to-face training rather than with what they have labeled BABY BITS to be, a didactic method.  As I mentioned in my commentary, Smile At Your Baby! agrees that hands-on and face-to-face is, and will be, likely more effective--that does NOT mean however, that there is no place for BABY BITS.  BABY BITS could actually be MORE effective for those parents who have no transportation, can't afford childcare, who don't have reliable Internet access and for those who are embarrassed to attend parenting classes.

We WILL soldier on!  Don't you worry about that!  :D

Smiles, Shelley

  • Story of Moving Upstream “I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I jump into the cold waters. I fight against the strong current and force my way to the struggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank and revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. I jump into the cold waters. I fight against the strong current, and swim forcefully to the struggling woman. I grab hold and gradually pull her to shore. I lift her out onto the bank beside the man and work to revive her with artificial respiration. Just when she begins to breathe, I hear another cry for help. I jump into the cold waters. Fighting again against the strong current, I force my way to the struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay him out on the bank and try to revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. Near exhaustion, it occurs to me that I'm so busy jumping in, pulling them to shore, applying artificial respiration that I have no time to see who is upstream pushing them all in....” (Adapted from a story told by Irving Zola as cited in McKinlay, John B. "A case for refocusing upstream: The political economy of illness." In Conrad and Kern, 2nd edition, 1986, The Sociology of Health and Illness: Critical Perspectives. pp. 484-498.) Quoted on Page 5
  • I like to give this classic public health primary prevention story a twist that focuses the primary prevention parable into one that is specifically perpetration prevention-oriented. Since sexual violence is not a crime or situation of the victim "falling into the river" but being "pushed into the river" I tell it that the "rescuer" goes upstream to the head of the river to figure out who is pushing the people in and why. This "rescuer" deals with the perpetrators by holding them accountable and ensuring that they receive treatment and attention to stop the harmful behavior of pushing people into the river to drown. (Alisa Klein)"Suppose you are standing next to a river, and you see someone drowning as she floats downstream. You jump into the river and pull her ashore. As soon as you've done that, you see another person in trouble, again floating downstream, and you rescue him as well. Every time you've saved one person, you see another, and another. After you've dragged another drowning body out of the river, you're thoroughly exhausted and you know you don't have the energy to save one more person, so instead you decide you must go upstream to find out what is causing these people to end up in the river. You want to address this problem at its source. You get upstream, and see a bridge. Upon careful inspection, you find that there is a well-concealed, yet sizeable hole in this bridge that is causing people to fall in. What do you do? You do what makes the most sense - you work to repair the bridge. Primary prevention means "going upstream" and repairing the bridge before more people fall through this hole. Too often we just focus on the tangible aftermath of a problem. We just keep pulling people out of the river - we set up systems to support people directly affected by sexual violence. While these systems of support are crucial, we also need to cultivate complementary systems that get to the core of the violence, stopping it from ever happening in the first place. We need to become proactive, go upstream to that bridge, study it, determine what resources we need to repair it, and start doing the long and hard work of primary prevention. For sexual violence, it means examining and changing individual attitudes that lead to patterns of relating that create norms that shape the institutions in our society that allow sexual violence to thrive. Addressing these underlying factors is all the more difficult because they are intertwined with the identity of our society. Rigid gender roles, male entitlement, and glorification of disrespect play major roles in our society in the same way that the bridge is central to the culture of its nearby communities." The key thing about this version that I've found useful is the metaphor of a "well-concealed, yet sizeable hole" in the bridge to represent the factors in our society that help support sexual violence and yet seem/are so commonplace. So I guess this version might be more geared toward trying to get those "big picture" factors across to folks, whereas other versions of this story - where you go upstream and find someone pushing people in - might work better for exposing factors that are at a more individual level. In my expanded version of this story, there actually is a group of privileged folks who live near the bridge (the "Bridgies") who receive a greater proportion of the toll revenue from the bridge and have a far greater knowledge of the bridge structure itself. As such, Bridgies have a strong interest in extolling the virtues of the bridge and promoting its use (which sometimes includes minimizing the danger of the hole) so as to keep their "superiority" intact. Holding the Bridges accountable to come clean and repair the bridge then becomes a major goal. (Brad Perry, Virginia Sexual and Domestic Violence Action Alliance ) Excerpted from http://www.vahealth.org/civp/sexualviolence/Moving%20Upstream.pdf
    • Our organization assigns a different duty to the rescuer, and furnishes him with some interesting "supplies." Here's our twist: When Alisa's rescuer arrives upstream he finds it is far from evident who is doing the pushing. After all, being "in the river" means the victim has already been terrorized into lifetime silence. They're not available to point out offenders. Dr. Carla Van Dam's new book proposes useful categories of offender as Groomers and Grabbers. The clumsy Grabbers get spotted and their pushing is stopped. The clever Groomers don't get spotted, and their pushing continues. Our Secondary Prevention approach is inspired by the "Van Dam Plan" and focuses on reducing that splash-count. It equips the rescuer with supplies of inconspicuous life preservers the children wear to assure survival in case they are pushed, and with foolproof single-use "magic gloves" the adults have to wear. The gloves light up when a push occurs, but they cost $300 a pair. Lacking budget, the rescuer has mostly fake ten-cent gloves which don't light up but look exactly like the ones that do. Quite a few, however, are genuine and really work. New gloves are issued every day, so the undetectable Groomers are forced to play Russian roulette with their pushing. It is such a high-stakes game for them that the Groomers use their cunning to find benign-sounding excuses for dropping-out. (Let's hope they voluntarily "drop-in" to one of Alisa's progressive treatment clinics on the way.) Magic gloves? We have 'em. But you can't just buy the ten-cent version, otherwise who would even believe in them? (David Allburn, Safe Harbor Resources)

Actually, the Annie E. Casey Foundation has quite a few programs that work with communities to do true  child abuse prevention, including parent education, preventing teen pregnancy and building healthy communities so that children, who may be born into families that are very healthy, don't have to live in violent neighborhoods.

I think that many of our county and state child protective service systems traditionally wait until a child suffers for a while before intervening. However, there's a movement to change that. One of the child welfare agencies on the cutting edge of transforming to a trauma-informed agency is in San Diego County.

-- J.

Shelley, now that my book is published I finally have time get involved with ACES Too High.  And, so enjoy reading your posts, of course.  Could not agree more with your point that society's focus on true prevention runs a distant second to remediation after the fact of childhood betrayal.   Organizations like the Annie B. Casey Foundation tout that their focus is child abuse prevention. However, what that means is that the child has already been abused, so we will swoop in as rescuing angels to "save" that child whose innocence has already been shattered.   True PREVENTION means the child never suffers at all. 

 

The mission of the America's Angel Campaign accepts nothing less ~  To establish the well-being of America's children as our nation's highest priority, ensuring their birthright to be safe and nurtured in their own homes and homeland. 

This message needs to infiltrate the media and create critical mass that embraces the only moral choice, TRUE prevention. 

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