Kansas ABC program making tales of success in first year

11 Apr Kansas ABC program making tales of success in first year

Hutchinson Community Foundation a partner in science-based early childhood initiative

By Wendy Skellenger | Hutchinson Community Foundation

 

Bobbie Cooprider knows you can read a house by watching the child.

Through observing the child, Cooprider says, one can gain a sense of the household’s normal routines and family dynamics. One can also gain a sense of what may cause the child stress.

And for the past year, identifying stress triggers in children 6 to 24 months of age ­– the prolonged “toxic” kind that doesn’t quickly recede like the stresses classified as “positive” and “tolerable” by the National Scientific Council on the Developing Child – has been the focus for Cooprider, the Reno County coordinator of the Attachment and Biobehavioral Catch-Up (ABC) program, a statewide early childhood intervention initiative administered locally by Horizons Mental Health Center.

The $2.4 million grant-funded three-year pilot program began last spring at five test sites encompassing 35 Kansas counties as part of Project NeuroNurture, an effort led by United Methodist Health Ministry Fund aimed at encouraging science-based early childhood programs such as ABC. In addition to United Methodist Health Ministry Fund, the REACH Healthcare Foundation, Kansas Health Foundation, Wyandotte Health Foundation and Hutchinson Community Foundation are funding partners on the initiative.

Driven by a desire to get ahead of the ongoing problems seen in children assessed for kindergarten readiness and compelled by the growing research on toxic stress and the developing brain, Project NeuroNurture launched ABC.

“That’s where we started in the ABC project, recognizing that this might be a true prevention component that we can do,” said Katie Schoenhoff, program officer with United Methodist Health Ministry Fund and overseer of the project in Kansas.

Hutchinson Community Foundation was moved to partially fund the Reno County project because of its leadership in early childhood initiatives for nearly two decades.

“Our vision since entering the early childhood conversation locally has been to ensure a seamless system of inclusive services to help young children and families thrive in Reno County,” said program officer Kari Mailloux. “Though we already have strong home-visitation programs, we were compelled to invest in the ABC program because of its short-term, evidence-based format and the fact that the program complements and works alongside existing home-visitation programs for wraparound support for families.”

And as the free 10-week home-visitation program nears the end of its first year, lives are already changing.

The science

Behind the idea of the ABC program lies scientific research that concludes prolonged exposure to toxic stress and the resultant hormone cortisol early in life can lead to brain shrinkage, cognitive deficits, infections and chronic health problems later in life, according to the Centers for Disease Control and Prevention’s report “The Effects of Childhood Stress on Health Across the Lifespan.”

Normally, the body releases cortisol in the mornings as a kind of wake-up call and the level tapers dramatically as the day wears on and bedtime approaches. For babies who may be exposed to the kinds of ongoing stressors Cooprider looks for, such as parental neglect or frightening play, that cortisol level can remain elevated.

“When cortisol levels are deregulated, children are constantly in a state of elevated stress which can lead to toxic stress,” said Amy Mendenhall, a University of Kansas associate professor and principal investigator for the ABC project.

Society can be left with the bill for the impact on the welfare, health and criminal justice systems when those stressed out kids become adults, according to James Heckman, a University of Chicago economist, Nobel Laureate and leading proponent of early childhood intervention programs.

And intertwined with the findings on toxic stress and its effects on the developing child is the growing recognition of the conclusions drawn from the landmark mid-1990s CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study.

One of the largest investigations of its kind conducted from 1995 to ’97 involving more than 17,000 subjects, the study looked at the effects of childhood abuse and neglect on later health.

In addition to the widely known impact of abuse and other childhood obstacles on adult mental health and behaviors, the study’s unique findings suggested biological links between those adverse childhood experiences – such as physical, verbal and sexual abuse; mentally ill parents; addicted parents; and parental death – and an array of adult-onset physical health problems, such as chronic obstructive pulmonary disease, ischemic heart disease, liver disease and cancer.

In response to the growing emphasis on recognizing the effects of ACEs on students, Hutchinson USD 308 recently joined other districts across the nation in becoming “trauma informed,” an initiative that stems from the ACE study.

Among the CDC’s recommendations for helping prevent or offset ACEs are early childhood-screening, parent-training and home-visitation programs.

And that’s where ABC comes in.

Reading the signals

When Cooprider, who spent four years working with the Child Advocacy Center, was approached last May to coordinate the local program, the training began.

Developed by researchers at the University of Delaware, ABC aims to strengthen bonds and nurturing practices for infant caregivers through home visitations from parent-coaches, such as Cooprider. Research suggests that children strongly attached to at least one caregiver better self-regulate and weather adverse experiences and arrive better ready for the social demands of kindergarten.

All parent-coaches in Kansas have undergone training from the University of Delaware, but the training, Cooprider said, is very much hands on.

The learning involves recruiting families to participate – who may already be involved in other programs, such as Parents as Teachers or Early Head Start – videotaping the sessions and meeting with supervisors each week to review the sessions and how to properly record them. Cooprider is working toward her certification.

The scope of what Mendenhall describes as a “rigorously tested” highly rated program “proven to be an extremely effective parenting/caregiver intervention that helps regulate children’s cortisol levels” varies with each family depending on their needs, but it follows a general outline.

At first during the one-hour weekly sessions, Cooprider focuses on the strengths, the things she sees caregivers doing right. But as the video rolls through each session, she also observes parents’ behaviors in specific areas:

1. Following the lead: “Basically, if a child comes up to you and they have a ball and they hand it to you, you do what the child wants you to do,” Cooprider said.
2. Nurturance: For instance, if the child falls down, Cooprider said, it’s important to offer the child comfort and reassurance rather than expecting the child to dust himself off and move on.
3. Frightening and intrusive behaviors: This can involve aggressive play that parents may intend as innocent but can frighten, frustrate or agitate the child. Cooprider recalled a mother who was “just going to town tickling her child” but observed the child didn’t seem to enjoy it. “It’s part of our ABC program to notice the signals of when they don’t like to be tickled because if you do it too much, it dysregulates them. So before they’re 3, you want to make sure they don’t do that.”

Meanwhile, the KU researchers randomly select participating ABC families for cortisol testing and collect saliva samples in the first week of the program, again at the end of the program and six months after the program’s end, Mendenhall said. Over time, they hope to see levels normalize.

“It is not that you want to see low levels of cortisol, rather, you want to see regulated cortisol patterns. … We are not necessarily looking at specific cortisol levels but rather we are looking at whether or not children are going to bed at night with significantly lower levels of cortisol than when they woke up,” she said.

The program relies on in-the-moment commentary as the parent-coach observes parent-child interaction. However, according to Cooprider, once a sufficient rapport exists between coach and caregiver, the video can be a useful tool in revealing problematic behaviors to skeptical parents.

Cooprider said the 19 families she’s worked with so far have come from all socio-economic backgrounds.

Of the families who’ve completed the program, Cooprider said all have improved. Moreover, she said, the course helps with other skills, recalling how, in one case, the program’s emphasis on following the lead benefited a child’s language development.

“We’re helping with a lot of their skills; they just don’t realize it,” she said. “Not only do children change but children change because the parents change. So when the parent calms down and takes the time to interact with their child in these ways that we’re encouraging, everything just trickles down and calms down. It’s a domino effect. I see a lot of behaviors calming, the house calming.”

Though raw and not yet fully analyzed, the data collected so far for KU review, Mendenhall said, points to strengthened parent-child interactions, parent-child play and parenting attitudes.

A 40-point improvement

Schoenhoff and her colleagues brought the hopes of early childhood investment and what the program could potentially accomplish for K-12 education to four Senate and House education committee hearings recently in Topeka.

The feedback from lawmakers, according to Schoenhoff, was encouraging, the response bolstered, in part, by the program’s scientific component.

In addition to receiving an overview of the program, Schoenhoff said, lawmakers heard tales of success.

In one case reported from a northwest Kansas site, a mother was on the brink of signing away her parental rights.

“During our visits, the first thing I noticed was that Mom began to ‘Follow the Lead’ with her child and enjoy it. By the 5th visit, Mom did something that I had never seen, she reached out, picked up her child and offered nurturance,” according to the Jan. 25 testimony.

The mother went on to participate in other parenting services, the testimony said, and the child made a 40-point improvement in the second edition of the Ages and Stages Questionnaire, a social-screening test.

In another case, a single mom who struggled with nurturing her child and committing to the course, finally started making small strides. Eventually, the mother enrolled in another parenting program and obtained a job, an action the testimony attributed to the confidence she developed while in the ABC program.

Strengthening a bond

With her 21-month-old daughter, Harper, using a pair of short legs to propel her to first one object of interest then another in the living room of her east Hutchinson home on a Friday afternoon in mid-March, Jessica Suarez sat nearby on the floor folding laundry and extolling the virtues of ABC.

She’s a believer.

In fact, she’s such an advocate of the program that she recommended it to her next-door neighbor. And having completed the 10-week course with Harper’s father, Dustin Belote, Suarez said she’d recommend it to anybody.

Her family’s involvement grew out of their participation in the Parents as Teachers home-visitation program. Their instructor informed them of a new course for parents being led by Cooprider.

The first-time mother was more than willing to give it a try.

“‘Sure! I would love to have my bond with my daughter a little bit stronger if I could!’ ” she recalled thinking. “I really couldn’t wait to get this thing started. I’m a new mom. I was all about learning new things and how to basically raise my daughter in a proper way.”

Aside from helping with a young cousin and working with her mother in the church nursery, Suarez didn’t have much experience with kids. And though Belote came from a family with a younger sibling and cousins, Suarez said, it couldn’t prepare him for fatherhood.

“He’s very good with kids, but when it came to his own, it almost seemed like he was lost,” she said.

But ABC helped them forge a new path, according to Suarez.

Like many parents, Suarez and Belote walk the high wire of work schedules and home life. Suarez works part time at two restaurants but said she’s mostly a stay-at-home mom. Belote, meanwhile, apprentices as a diesel mechanic in McPherson. Parenting, then, often becomes about working in shifts, which can mean limited quality time with baby, especially for Belote.

As a result, when Suarez’s work schedule changed, it left Harper in Belote’s care “and it took him awhile to get her comfortable with him … she wasn’t used to him around.”

However, through Cooprider’s guidance and the program’s homework exercises – a booklet with assignments that Suarez continues to find useful as a problem-solving reference – the family rapport flourished.

“They have their own little bond. She’ll seem like she’s a mommy’s girl, but when you see them play, you can definitely tell she’s going to be a daddy’s girl when she gets older,” Suarez said.

As for Suarez, she described herself as a worrier, but learning to follow her daughter’s lead in activities, nurturing her if she stumbles and becoming more aware of her signals – all those things that Cooprider focuses on during sessions – has helped her to relax as a mother.

And she’s seen changes in Harper too. The toddler, she said, seems to be more adventurous and controlling of her environment and, as a result, more sociable.

“I really think this program, if it becomes a known thing, it can help a lot of parents,” she said. “I love the bond that we have.”

Wendy Skellenger is the communications officer at Hutchinson Community Foundation. Email: wendy@hutchcf.org.