The Family Interaction Skills Clinic (FISC) provides mental health consultation and training presentations to family advocates and case management staff through collaborative partnerships with the Community Action Partnership of Lancaster and Saunders Counties and the Lincoln Head Start/Early Head Start Programs. Clinical and research efforts focus on early intervention strategies for prevention and identification of child maltreatment as well as other risks to healthy child development. In addition, FISC Child and Family Consultants provide both in-home and clinic-based psychological assessment and treatment services designed to prevent and treat social, emotional, and behavioral difficulties. FISC services include individual, couple, group, and family therapy. FISC consultants also provide behavior management consultation and evaluation services for children in the Head Start Development Center as well as those enrolled in the home based program. Therapists are doctoral students in the Clinical Psychology Training Program at the University of Nebraska - Lincoln who are supervised by Drs. David Hansen and Mary Fran Flood.
Mental Health Consultation for Head Start/Early Head Start Family Advocates
Consultants provide mental health consultation to family advocates for Head Start/Early Head Start families on their caseload. The consultants attend meetings with family advocates, supervisors, and nurse practitioners to discuss social, emotional, and/or behavioral concerns specific to the families and to provide resources for family advocates and their families. In addition, consultants conduct yearly social, emotional, and behavioral screenings for every child enrolled in the Lancaster and Saunders County Head Start/Early Head Start Programs. Consultants also provide depression screens and recommendations for pregnant mothers enrolled in the Early Head Start Program. Additionally, consultants offer several trainings throughout the year on topics relevant to family advocates and enrolled families (e.g., managing difficult behaviors, potty training, normative development in preschoolers, self-care, etc.)
Individual, Couple, Group, and Family Services
Therapists provide provide evidence-based assessment and treatment for children and their families. Child-focused individualized services address behavioral and emotional problems, problems with parent-child communication, and the consequences of child maltreatment and domestic violence whereas parent-focused services address emotional problems including depression, anxiety, anger, and other mental health issues. Family therapy services address couples, parenting, and parent-child relationship issues. All mental health services are free for families enrolled in the Head Start/Early Head Start Program.
Services Provided to the Head Start Development Center
Consultants also provide assessment, treatment, and trainings for children and staff at the Head Start Child Development Center located in Lincoln. Within the center, consultants work in the classroom with Head Start Center teachers to provide hands on behavior management techniques for disruptive behaviors. The consultants conduct behavioral observations twice a year for each child enrolled in the Center as well as in three Saunders County Head Start classrooms using the Behavioral Observation of Preschoolers System-35 (BOPS-35). Consultants also offer a variety of trainings to the Head Start Center Staff (e.g., toileting issues, classroom structure, naptime issues, etc.). Consultants provide training for all new Head Start Center teachers on basic behavior management skills.
Common Services Address:
- Teacher/Child Conflict
- Parent/Child Conflict
- Behavior Management Strategies
- Toileting Issues
- Cognitive Concerns or Delays
- Naptime Difficulties
- Classroom Structure and Daily Routines
- Child Maltreatment Reporting Issues
- Domestic Violence
- Parenting Issues
- Attention-Deficit / Hyperactivity Disorder
- Disruptive Behaviors
- Conduct Disorder
- Oppositional Defiant Disorder
- Anger Management
- Eating Disorders
- Child Abuse and Neglect
Recent Research Projects Include:
Identifying Risk for and Preventing of Child Maltreatment in Early Head Start Families
The study will evaluate of the ability of Early Head Start services to reduce risk factors for and prevent substantiated instances of child maltreatment. Decades of research on child development indicates that children in the very young age group served by Early Head Start are in a critical period where nurturing home environments are especially important and adverse experiences like maltreatment can be especially harmful (Shonkoff & Phillips, 2000). National prevalence data and prevailing theories on risk for child maltreatment indicate that the young children living in poverty that are served by Early Head Start are at increased risk for abuse and neglect (Belsky, 1993; Mersky et al. 2009; U.S. Department of Health and Human Services, 2010). Given knowledge of the risks that maltreatment can pose to development of child competence and the vulnerabilities to maltreatment among the Early Head Start population, information on how to provide services that protect these children from harm is especially important.
The project will examine a broad range of risk factors and their association to child maltreatment through archival data gathered as part of routine services provided to Early Head Start families in a local program, therefore providing helpful information on how high-risk families can be identified. It will examine the manner in which specific components of an Early Head Start program, which are delivered in accordance with national performance standards, lead to reduction of risk factors and prevention of substantiated instances of maltreatment. Further, through a qualitative component, this study will help describe and explain the ways in which the Early Head Start program helps families overcome the struggles and difficulties associated with maltreatment. Therefore, results will provide helpful information for future researchers, practitioners, and policy makers who work to develop and provide early intervention services capable of preventing harm to children and promoting healthy development.
Teacher-Child Interaction Training - Preschool Program (TCIT-Pre)
The Teacher-Child Interaction Training - Preschool Program (TCIT - Pre) is an adaptation of Parent-Child Interaction Therapy (PCIT), an empirically-supported parent training program for children 2 to 7 years of age designed to reduce behavioral, emotional, and/or developmental problems (e.g., Hembree-Kigin & McNeil, 1995; McIntosh, Rizza, & Bliss, 2000). During the first phase of PCIT, known as Child-Directed Interaction (CDI), parents are taught to use positive behavior management skills to strengthen parent-child attachment. These skills are referred to as the PRIDE skills (Praise, Reflection, Imitation, Description, and Enthusiasm). In addition, parents are encouraged to avoid using commands, asking questions, or using criticism. During the second phase of PCIT, referred to as Parent-Directed Interaction (PDI), parents are taught to use appropriate discipline strategies in a consistent manner. Previous research utilizing PCIT has demonstrated effectiveness in improving in the parent-child relationship (Eyberg, Boggs, & Algina, 1995), decreasing child disruptive behaviors (Eisenstadt, Eyberg, McNeil, Newcomb, & Funderburk, 1993), increasing child compliance with parental requests (Eyberg & Robinson, 1982), improving parenting skills (Eyberg, 1995), and reducing parent stress levels (Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998).
However, child disruptive behaviors are rarely limited to the home, and often extend into other contexts as well, including the classroom. For this reason, PCIT has been adapted for use in the preschool classroom under the title Teacher-Child Interaction Training (e.g., Anhalt, McNeil, & Bahl, 1998; McIntosh, Rizza, & Bliss, 2000). Like PCIT, TCIT-Pre includes a child-directed interaction phase (CDI) that focuses on improving the teacher-child relationship with the use of the PRIDE skills, followed by a teacher-direction interaction phase (TDI) where teachers are taught to use appropriate discipline strategies (e.g., clear and firm commands, Time Out) in a consistent manner. Both PCIT and TCIT-Pre involve didactic sessions during which the skills are introduced and role-played, as well as subsequent modeling and coaching sessions to facilitate mastery of the skills.
Previous research has shown generalization effects, such that successful PCIT treatment in the home is associated with reduced conduct problems in the classroom (McNeil, Eyberg, Eisenstadt, Newcomb, & Funderburk, 1991). A single subject case-study design also demonstrated significant improvements in compliance and decreases in disruptive behaviors in one child following TCIT-Pre (McIntosh, Rizza, & Bliss, 2000). To date, however, research has yet to investigate the effectiveness of TCIT-Pre on improving the behavior of multiple children in a classroom.
TCIT-Pre was originally implemented in Nebraska through the Family Interaction Skills Clinic in 2000. Graduate students have conducted TCIT-Pre in several Head Start classrooms throughout Lancaster County since 2000. The latest version of the TCIT-Pre manual is a fairly strict adaptation of PCIT, with the exception of additional classroom components.
TCIT-Pre is likely to be particularly beneficial to children from low-income households, where high rates of behavioral and emotional problems are evident (e.g., Aber, Jones, & Cohen, 2000; Evans, 2004). For this reason, it is believed that programs that are focused on fostering healthy development in low-income children, such as Head Start, are likely to benefit greatly from the utilization of TCIT-Pre. A research component has also been added and has been continuously revised to adequately address the needs of teachers as well as meet the requirements of rigorous outcome research.
Behavioral Observation of Preschoolers System - 35 items (BOPS-35)
The BOPS is a 35-item live behavioral observation coding system designed to capture prosocial and disruptive behaviors in preschool-aged children. The BOPS is administered over a 15-minute observational period which is separated into 30-second intervals (i.e., a 25-second observation interval and a five-second recording).
The coding system consists of five scales (Cooperation with Adults, Peer Interactions, Independent and Self-Regulating Behaviors, Challenging Behaviors, and Atypical Behaviors), two domains (Prosocial Behaviors and Disruptive Behaviors), and an overall composite score. The Prosocial Behaviors domain measures a broad spectrum of behaviors in children, including the target child’s ability to: (a) establish and maintain positive relationships with others; (b) demonstrate developmentally appropriate behaviors during classroom activities; (c) function independently; and (d) demonstrate positive social and emotional adjustment. The Prosocial Behaviors domain is comprised of three scales: Cooperation with Adults, Peer Interactions, and Independent and Self-Regulating Behaviors. The second domain, Disruptive Behaviors, summarizes behaviors from the Challenging and Atypical Behavior scales. The Disruptive Behaviors domain measures negative and inappropriate behaviors that impede classroom functioning and children’s ability to learn and develop prosocial behaviors, positive relationships with others, and other important skills relevant to future school readiness and adjustment.
Improving Assessment Tools for Identifying Risk Factors for Child Maltreatment
- The Behavioral Emotional, and Social Screener (BESS) is delivered to all consenting Early Head Start and Head Start children in Lancaster and Saunders County upon entry to the program and then again annually. The measure is designed to assess children's social and emotional development along with possible risk for child maltreatment. Research using this measure has sought to assess and improve it's clinical utility, reliability, and validity.
- Based on review of the existing literature and clinical experience in the Child Maltreatment lab, the Assessment of Family Needs survey (AFN; Veed et al. 2008) was developed. This instrument is designed to assess specific areas of need for families so that they can be targeted for preventative treatment. Use of the AFN results in a numerical rating of risk, which allows for a family's overall risk to be tracked over the course of time and treatment. The AFN uses a standardized form and directions for completion, and therefore lends itself to use in research on child maltreatment.
Development of a group treatment for parental depression, a known risk factor for child maltreatment:
- A group treatment for depression has been developed my members of the Child Maltreatment Lab to address the mental health needs of Early Head Start and Head Start parents. A manual has been developed for the group, which outlines a 14-session treatment based on cognitive-behavioral strategies.
Outcome research examining the impact of FISC and Early Head Start/Head Start services on reducing the risk of child maltreatment:
- Research efforts have assessed for the presence of risk factors for child maltreatment across a broad range of contexts, systematically tracked these variables throughout children's participation in the program, and assessed for the ability of intervention services to reduce risk. Recent investigations have examined the differential predictive validity of various types of risk factors, barriers to delivery of preventative services, and the impact of preventative services.
- While previous evaluations of these services have produced promising results, a major limitation has been reliance on indirect measures of child maltreatment (e.g., reports from parents or Head Start/Early Head Start service providers). Research efforts currently in development stages aim to utilize official Nebraska State Family Court records as a direct measure of child maltreatment. Through use of official records of child maltreatment incidents that have resulted in family court action, we hope to further our understanding of our ability to ameliorate risk and increase protective factors for child maltreatment and to longitudinally track the long-term effects of these efforts.
Child and Family Consultants
210 O Street
Lincoln, NE 68508
LAP Office: (402) 471-4515, Extension 126
FISC Message Line: (402) 472-8795
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