 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on the role of the family and community in prevention and treatment. We're going to define what family and community really are because when we're talking about this, who are the players involved? Who are the stakeholders that we're really talking about? And the short version is everybody. And we're going to explore skills and strengths to help prevent medical, emotional, and behavioral disorders. And throughout the presentation, sometimes it's I've abbreviated it M E B medical emotional and behavioral disorders. So if you see that, that's what it means. The committee, the opiate commission that the president requested or whatever the report. One of their recommendations was that evidence based prevention programs for schools and tools and for teachers and parents to enhance youth knowledge of the dangers of drug use, as well as early intervention strategies for children with environmental and risk factors be implemented. Well, that's great. That sounds wonderful. But how are we going to do it? What interventions are we going to use and how are we going to work that into the already present demands on teachers and parents and everybody else? So we're going to look at that. Some of the risk factors they identified and we went over this last week, but I'll just recap for those who weren't there trauma, those who are in foster care, those who've experienced adverse childhood experiences, which includes substance misuse, not even addiction, but substance misuse in the household, divorce, an incarcerated parent or mental illness within the household. And it doesn't have to be a severe and persistent mental illness like schizophrenia. So that really boils down to about 70% of children in school or children period really need some level or would benefit from some level of early intervention strategies because they've been exposed to environmental and individual risk factors and developmental disorders is another one that's a risk factor. So what are family and community? Community we can really think of as like our neighborhood, you know, the really small community where junior goes out and plays and interacts with the kids in the neighborhood more or less, you know, depending on where you live. We live out in the country where everybody has, you know, five or more acres in our neighborhood. So, you know, those generally people who move into those types of neighborhoods are less interested in block parties. So depending on the neighborhood will influence the types of interventions that you're able to do. I mean in neighborhoods where there's a clubhouse, obviously it's going to be easier to facilitate stuff than in neighborhoods where, you know, you've got 15 farms or something schools are another thing that another place that we can consider community. It may not be in your neighborhood, but a school is where youth spend a majority of their time each week. Social service organizations that are available in the community that go out and do presentations that sometimes come into the schools and do school based counseling. They qualify businesses. What kinds of things can businesses do to promote positive interactions and promote health and wellness behaviors? One of the things and it's a little bit off topic, but Pizza Hut does this book reading thing where you read the child reads five books a week and they get their teacher to sign off on it and they get a free personal pan pizza. I know for my kids that motivated a whole lot of reading. So what can we do that will engage children that will get them excited and I'm not saying give them food for everything, but that was one way to kind of tap in kids like video games. So maybe giving them time at an arcade or you know, I don't know, but businesses can think about what types of fun things they can offer or rewards they can offer and how they can promote health and wellness. Not only in the in the youth, but in the adult people in the community. Sometimes bookstores will have presentations like little wellness presentations. There are a lot of different things we'll talk about local media can be responsible for doing segments on health and wellness and healthy communication and more so than just identifying that there's a problem and saying there's a treatment center over here, but actually doing segments that give practical tools for people to use. What can you do to help yourself get in shape? What can you do to deal with conflict? What can you do to survive the holidays? The national media can go along with that and that includes if you will, your actors, actresses, your media, your movies, your sitcoms, those sorts of things. What types of things can those venues promote? If you remember, I mean, I think back to when I was little and we had the after school specials, you know, you may think they were hokey, but a lot of people watched them and they did communicate a message. You may not be able to engage somebody for an entire after school special now, but when we think about what kind of messages the television shows are communicating now, you know, this is where we can really or Hollywood could actually make a positive impact to discourage bullying, even on the news to discourage name calling and some of the conflictual interactions that that seem to be pretty, pretty harsh. The internet is another place that is the community. I mean, people spend a significant amount of time on the internet. So how can we use the internet to reach out to people? And I'll give you a couple of hints. Advertising you have those annoying pop-up ads, but you do tend to look at them. Online chat rooms, online forums and support rooms like I've talked about before, but also organizations that are interested or that can provide this kind of information helpful tips can sponsor videos, can sponsor YouTube channels that are popular with a particular demographic. I know there are certain YouTube YouTubers that my son watches religiously. So if I were trying to reach his particular demographic, then I would see about sponsoring or supporting those particular things and even getting some ads on YouTube, but it's a little hit or miss about which ones they'll they will display next to which YouTube programs. But if you contact the program directly and say, Hey, I would like to sponsor your program and do a 30 second ad, you know, you're going to get a much more targeted audience and politicians. I mean, that's kind of the meta concept of community, but politicians have a huge impact on where funding goes and on what the priorities are. So if we want to improve the priority on health and wellness in the school system, then we need the politicians to get on board and provide some money for it as well as provide a little less emphasis on testing scores. And it's all about the test right now. The family is considered the biological mother and you know, I put mom out there. I am one, but when the baby is in utero, we're we're it. So we want to look at prevention through healthy pregnancies. The biological family, but not everybody is still in contact or wants to be in contact with their biological family. So we need to extend our notion of family to significant others that are not blood related. So who is it that you call your family and you know, some youth and even some older people that I've worked with will identify their family very differently than their blood relatives. So asking clients who is in your family, but those people we want to get involved. If you think back to broth and Brenner's model, you know, you're thinking of the the meso system and you're thinking of all of the different influences. And if you've got healthy family, however you define it, if you've got a healthy school system, if you've got a healthy local community, then you're probably going to have a positive influence on the individual that's at the core of that community. So what are we doing now? Now we know why we're doing it and who we're trying to get to buy into this preconception. We want to prevent high risk pregnancies. Some of the risks are poor maternal nutrition and anemia. So making sure that people have access to food stamps, wick, those sorts of things. That's already pretty much done, but we want to make sure that people who need it know how to access it and can access it. And there are some caveats and there are some gotchas that I know prevent some pregnant women from being able to access it even when they truly need it. So it would be nice to take a look at that system. That's on a much larger scale. Maternal smoking, alcohol and drug use can all have significant impacts on the fetus. We know that alcohol can cause fetal alcohol spectrum disorders. Drug use can contribute to behavioral and neurological issues and maternal smoking is strongly linked with low birth weight and certain behavioral neurological problems. Exposure to neurotoxic substances and this includes like lead. We don't have lead paint anymore for this reason. And it's also recommended that pregnant women limit their intake of certain fish when they're pregnant because the levels of mercury are higher than what a fetus should be exposed to. Important to educate pregnant mothers about this. Maternal depression and this is when she's pregnant not just after after delivery, but postpartum depression as well as depression during the pregnancy period has been correlated with lower child IQ. Adrenal fatigue and anywhere from Addison's disease to just plum exhaustion. If you've got a mom who's barely getting by and she's drinking caffeine, you know, by the gallon. Number one, the caffeine is not good for the baby. But number two, it creates a situation where the body might feel it's too taxed and it make increases the risk of preterm delivery. Low birth weight. We want to do everything we can to get the birth weight up on the babies. Low maternal weight. And this is another one where the community as well as the family can kind of pitch in a lot of moms don't really worry about it. They know they're going to gain some weight when they're pregnant, but then there's a certain segment those with eating disorders and body dysmorphic disorder, especially who have difficulty when they start putting on the pregnancy weight. And so they may refuse to eat in order to support both mom and baby, which creates a high risk pregnancy can have damaging effects on the fetus. So we want to make sure that mom is putting on enough weight. Most of us put on too much. I know I did with both of my kids. Multiple previous preterm deliveries and actually multiple is exaggerated. They say once you have a preterm delivery, you're most likely going to have preterm deliveries after that. I was lucky with mine. Generally each baby after that is cooks stays in less time and is more preemie than the one before it. I was lucky. My daughter came out six weeks later than her brother did. So score for me. But one previous preterm delivery creates the designation of a high risk pregnancy. Another interesting one periodontal disease. Now this is one I didn't know about. So if you're working with a mom who is pregnant or thinking about getting pregnant, making sure that she has access to dental care to prevent periodontal disease, which has been linked to preterm delivery and physical and emotional stress can cause preterm delivery. It can also have some adverse effects on the fetus, but they put that in there. The CDC put that in there as something that you want to minimize in pregnant women. Now that doesn't mean you're run of the mill stress. You go to work. You have a bad day. You're stuck in traffic. There are stressors that happen and that doesn't have a negative effect on the fetus. What we're talking about is extreme physical or emotional stress. During the fetal development period, it's important to recognize and we're still kind of on healthy pregnancies. Preterm births have increased from 8 to 12 and a half percent over the past 20 years. Now granted, we are able to keep babies alive that are born much earlier now than we could 30 years ago, so that's good, but even controlling for all that preterm births are going up. So why is this? Well, they don't really know. Great. We want to make sure that women are getting adequate nutrition and that's not just making sure they have wick. That means making sure they know what adequate nutrition healthy nutrition is. So they may need to speak with a nutritionist. Libraries can have a shelf full of books that talks about prenatal nutrition. Doctors can have handouts that summarize prenatal nutrition because it can get overwhelming when you're looking at it and there's a lot of conflicting information. So ideally it would come from the OBGYN, but anyway, we can get this information into the hands of pregnant women would be good. Preventing exhaustion, making sure that pregnant women are able to get enough sleep that they're not working 12, 15 hour days standing on their feet. Some people that's what they have to do to make ends meet. So how can we help them with this? Identify and control bacterial vaginosis. This is a bacterial condition that sometimes is looked at as an STD because it can be gotten from sex with multiple partners, but there's a lot of other ways and a lot of women get really would you start talking about this because they think of it as an STD, but you can get bacterial vaginosis when you have an imbalance in the good bacteria, the lactobacilli bacteria. And it's important to recognize that that can be caused by using antibacterial soap to wash. So there are a lot of reasons. There are a lot of things that can cause bacterial vaginosis, but it is highly correlated with preterm birth and mothers with bacterial vaginosis are usually put on antibiotics either until it goes away or until they deliver mother baby prenatal treatment programs. Now that Medicaid can be billed for residential services, this is going to potentially be awesome because getting mom and baby in or mother in when she's still pregnant and being able to keep baby after the delivery is huge. I ran a mother baby unit when I was in Florida and it was just beautiful to be able to work with mom through the pregnancy, however long we were lucky enough to have her through the delivery and then for six months postpartum and it was an awesome experience to be able to work with these women, but it prevented a lot of problems and a lot of women will avoid going to treatment if they think they're going to be separated from their infant once they're they deliver or if they've got other kids at home and we were able to accommodate mothers that had multiple children, they would have their own room and they could have children that were under the age of five in the program with them and then they would go to daycare or whatever during or school during the day. So this is huge now because these women will have Medicaid most of the time because they have dependent children or some sort of insurance. The ability to open more mother baby prenatal treatment programs is going to go way up and this isn't just for substance abuse. This can be for major depressive disorder or bipolar disorder. Perry and postpartum depression changes in sleep, appetite, weight, energy level and physical discomfort during pregnancy and postpartum can cause significant emotional strain. If you've been pregnant, you know you have those days where you don't sleep at all because junior is kicking you in the abdomen all night or you just can't get comfortable especially once you get into that third trimester. So it's important to work with moms and help them understand how to take care of themselves because a lot of women will still push through even though they're not sleeping well, which can contribute to problems with the pregnancy. So once the baby's out and we've got a little swaddle bundle of joy, this is the trust mistrust period and during this period is when the child forms their initial attachment relationships. The mother infant attachment relationship is a well established influence on the infant's eventual successful development. If this goes awry, the kids probably going to be at much greater risk of having problems. So one of the things that they look at during this period is maternal sensitivity in creating infant attachment and what that means sensitivity. I don't like that word, but it's the best one they came up with is the mom actually understanding what baby needs being sensitive to what this cry means what that cry means instead of just okay here stick a pacifier and a bottle in his mouth the mom actually being aware and responsive to the child's needs and a lot of moms. Aren't you know that they just either didn't have the training they didn't come from that background or they're emotionally unable to really differentiate right now because they're dealing with postpartum depression or anxiety or something. So they're not a as able to be as responsive will use that word instead of sensitivity home visiting is an intensive intervention that targets successful pregnancies and infant development. So you know with my son he was born at 29 weeks. So he was itty-bitty buddy when he came home from the hospital. We were enrolled in the early intervention program and this is really important to know about most pediatricians know about it. So it's not a surprise to them but the early intervention program is available for any child that either is at risk of developmental disability or has demonstrated a developmental disability. So since Sean was so creamy they I mean literally the day we got out of the hospital we had an assessment set up and then we started having home visits and he had OT and PT and then a home visit therapist that would come in and work with us. But it provides assistance with physical delays cognitive communication social emotional and even self-help in older children. So there's lots of examples of other services. A lot of times it's paid for by Medicaid Part D I believe so you can read over this but it's important to recognize that if you have a mom who has a baby and a lot of our moms that came through the program ended up having children that had developmental delays or seem to have so they got evaluated by the early intervention program and in most cases it didn't cost them anything and it provided a lot of additional services to the parents and it relieved a lot of stress. I know for me it did having experts being like you know it's all good he's going to figure this out. Florida has the early steps program. This is the one we were enrolled in so you know I'm more familiar with it but it brings services into the child's life than fitting rather than fitting the child into services. So they were really attentive to the fact that you know I was working and in school and my husband was working and they worked around our schedule they brought like I said we had in home therapists come in in addition to the other therapists that we went out with. But there's a special certification for counselors that work with early intervention services. It's a really fun program to be involved with from from a professional standpoint to so those are things we can do during the early period to help mom and baby bond help mom become more responsive. And prevent some problems that may happen later during early childhood and childhood the child is working on developing autonomy their ability to control their own body they go through the no phase and initiative you know can they do something and succeed and what happens if they do something and they fail how do they deal with that. During this period aggressive social behavior often starts to emerge when you see hitting and biting and you know temper tantrums and lots of externalizing behavior. So a key risk factor for the progression of externalizing disorders is whether we can get this externalizing behavior under control during the early childhood period. So instead of hitting Sammy when he takes your toy how can you deal with that. Harsh and inconsistent parenting practices contribute to aggressive social behavior. Children learn what they live if you you know a child hits another child and you walk up to him and pop him on the button say don't hit excuse me what what. So you want to make sure that the parenting practices make sense to the child and looking at positive involvement in positive reinforcement of desirable behavior. So when they're doing well remembering to say awesome job Sam or you did really well at the playground today. That contributes to cooperative and pro-social behavior. It's also important to help parents learn and you know I would struggle with this sometimes to remember it's not just about the know it's about especially with young children or you know whatever it's about positive redirection so if you're not going to do this what are you going to do and teaching parents how to figure out what a reasonable alternative is is helpful and they can practice this even before they have kids. We use it with our foster animals. If they're having difficulty chewing on something they're not supposed to instead of just taking it away and going no you can't chew on that. We take it away say no you can't chew on that here chew on this this is appropriate same thing with when the cat scratch on things so you can help parents from before juniors even born start learning how to identify positive and use positive redirection. Programs that target child maltreatment have the potential to prevent multiple medical emotional and behavioral disorders and promote healthy development across several domains of functioning. So we really want to look at who's at risk of child maltreatment and how can we prevent. Child maltreatment and that can be intervening in a family that has already had child maltreatment issues. And it can be providing education to parents who are at higher risk for child maltreatment such as teenage mothers and single teenage mothers. Family poverty is associated with increased parental depression increased spousal and parent child conflict and ineffective parenting. So let's think about this for a second. Increased parental depression well if there's they're impoverished they are having difficulty getting their basic needs met they're stressed about how to you know pay the rent there's going to be a lot of stress anxiety it's going to get exhausting and can contribute to depression. So to that end we want to look at how can we alleviate depression how can we network the family with social services so they're making sure they get their basic needs met. Increased spousal and parent child conflict when you're stressed about things it tends to be more difficult to be patient so helping parents and children helping families develop distress tolerance skills anger management skills and effective use of communication that you know I in an ideal world would be available in community programs and people would go to them in reality people don't go to community community programs a lot so you got to figure out how can you get this to people in small enough sound bites you know over the Internet or in on TV on something they're watching so they can hear it and some of it sinks in and ineffective parenting. A lot of that has to do with the parents especially in an impoverished environment. Maybe working multiple jobs so they're exhausted when they come home and they're not as attuned to what juniors doing so they're not as consistent and we know that consistency is the key. We're not saying they're bad parents but what we're looking at in in most cases of this ineffective parenting it's parents that are either harsh or inconsistent or both. So then we move into early adolescence young people are developing the concept of industry and identity who am I what can I do what am I good at what do I contribute to the world. This is the period during which the prevalence of substance use delinquency and depression begin to rise psychological and behavioral problems tend to be interrelated so risk factors include family conflict in poverty this one keeps coming up so guess what this is one of the areas we need to intervene Increase in the rates of teasing and harassment in middle school although elementary schools are getting pretty rough now. Significant physical changes everybody goes through that awkward stage during this early early adolescence we're talking middle school and maybe early high school social changes including the transition from elementary to middle school there's a whole lot going on during this period and if children don't have a supportive environment to you know deal with it then they're going to find other ways to deal through stifling through depression through acting out externalizing. There's increased concern about peer acceptance so they may be more likely to give in on something and do things they're not supposed to increase demand for autonomy in early adolescence youth really want to start spreading their wings a little bit they want to be able to go out on their own and not be supervised and so it can become sort of a battle ground for the parents who are trying to make sure that they're young fledged safely from the nest and the young who are ready to just kind of open their wings and see what happens. Inadequate parental monitoring during this time it's not just you know mom and dad not necessarily being there but juniors not around as much juniors going over for visits with friends having sleepovers going out on you know scouting trips or whatever so there's less parental monitoring and depending on how good the chaperones are on some of these other outings. Adolescents may get away with more stuff if you will deviant peer group formation so going towards that unhealthy group and aggressive social behavior contributes to social rejection and deviant peer group formation so junior never learned distress tolerance and coping skills and still externalizes a lot they're probably not going to be as accepted into the mainstream of middle middle and early high school that crowd they're probably going to go more to the fringes and experience more social rejection. So we want to teach and encourage parents teachers and after school care workers after school care workers are a huge niche here because a lot of youth go to after school care and this is where you're not worried about the testing this is where youth I mean they need to let their hair down and get some energy out but they can also participate in teen building activities and do some fun stuff. But these groups of people need to use praise and rewards to reinforce desirable behavior and replace criticism and physical punishment with mild and consistent negative consequences for undesirable behavior like time out or a brief loss of privileges. So you know you need to go sit down you can't play right now. We also want to teach and this isn't on the slide but we want to encourage parents teachers and after school care workers to be aware of signs of problems in youth that may need to be addressed such as ADHD or FASD or cognitive disabilities which may be contributing to their externalizing or inappropriate behaviors because if Junior can't help it then Junior is going to keep doing it and going to is going to get frustrating. So we need to help this group of people understand that you know children are going to respond in a certain way to meet a need. So if that need gets met if they develop another tool then they won't have to act out that way. So helping them learn how to do what you expect them to do whatever the desirable behavior is and if they can't do that especially if they keep making the same error then considering is it is the child even able to do what I'm expecting them to do and if not what do we need to do to intervene and increasing positive involvement of adults with children such as playing with them reading to them and listening to them. So not just you know throwing them out on the playground and go go go play you know I'll sit here and make sure nobody breaks breaks their neck but other than that I'm disconnected you know actually getting out playing hide and go seek or pushing somebody on a swing or talking to a child really increases that positive involvement and increases children's positive view of adults early childhood interventions there are parent training programs best practices that can help with creating positive parent child interactions. These programs revolve around increasing effective emotional communication skills being able to say how you feel without having to externalize using time out instead of physical punishment and emphasizing parental consistency or parenting consistency. So let's look at this first one. The incredible years program includes parent teacher and social skills training components. The parent training program shows parents brief videotaped vignettes of interactions as examples of positive interactions the value of praise and reward and the use of time out and other mild negative consequences. So this is a video thing. It's not a lecture. So they're seeing it's been extensively evaluated and treating children with conduct disorder. So this is one that can be really helpful. Not only for parents but also for teachers and after scale after school care workers to learn these skills through observation. Another one is triple P the positive parenting program which focuses on the general population not just individual families and has selected components tailored to at-risk groups such as young single mothers or children with behavioral problems. The program includes five levels of parenting guidance based on family needs and preferences. The universal level provides information by a mass media like we were talking about about effective parenting and solutions to common child rearing problems. So those little 60 second commercial snippets that you know CBS used to do and stuff could be used to deliver this kind of information. Remember I said we want to have it in digestible chunks that people can hear sometimes repeatedly before they act it actually sinks in but they can get it and they can get a tool from it. The second level provides brief advice to parents for dealing with specific concerns such as toileting bedtime problems and parents are typically reached through contact with their primary healthcare provider such as a pediatrician but not always you know the nurse at the pediatricians office may provide educational sessions or the pediatrician might have videos on his or her website that communicates this information so parents don't have to come to the office but can get it via you know tuning into that to that pediatricians website. The third level provides skills training for parents who are having problems with aggressive or uncooperative children and the fourth level provides up to 12 one-hour sessions on parenting skills for parents whose children have multiple behavioral problems particularly aggressive behavior. So this requires the parent to be able to be present for 12 sessions. But if they're working with a child if they have a child with multiple behavioral problems one of them being aggressive behavior a lot of times you'll see more compliance because parents are at their wits end and they're just like I need to know what to do to you know get junior to calm down. The final level enhanced triple P provides skills and support to deal with parental depression, marital discord and other family challenges. So remember we keep talking about family discord being a risk factor even from pregnancy. So this final level of triple P starts to address that and identify interventions to use to help with postpartum depression or just regularly occurring depression in mom or dad or caregivers I should say. So this is a really awesome program and this entire presentation is based largely on family school and community interventions here. So you can read more about these after the class preventative interventions for divorcing families have also been shown to be really effective. The new beginnings program was designed to strengthen parenting and improving warmth and discipline increase father child contact as and non parental adult support and reduce divorce stressors. So this is a great program obviously if you've got a child who's experiencing divorce and it can be implemented in a variety of different ways but this is one that does require parental commitment to the program. So you know how you're able to disseminate that whether it's home visits or after school activities or something you know that may be hit or miss school based the CDC task force on community preventative services recommends the use of universal school based programs for preventing violence and improving behaviors in school. All right that's great wonderful but schools are really not focused on behavior modification right now and behavioral enhancement except for to prevent it from distracting from academic work. So getting some of these programs in is a challenge and I would love to see the community and the PTA and you know at large and the parents in the schools be able to affect the school system and get some of these programs in there. One of the programs is called the good behavior game which is an elementary school universal intervention program and it targets classroom behaviors and basically the classroom is divided in half and they get the participants in each team are able to earn points for their team by being on task and there are rewards at the end of the day and at the end of the week for the team that has the most on task people which promotes some social pressure and it promotes kids trying to you know do what they need to do. Unfortunately good behavior game in order to even begin to implement it costs about $3,500 so it's a little expensive to get started like most evidence based practices but it can be effective and it is something a teacher could easily implement fast track is a comprehensive long term multi-level intervention for students at high risk of antisocial behavior. It's a evidence based practice but I couldn't find much information on it except for the fact that it costs about $10,000 to get started guiding good choices is one that I'm familiar with. We used to use in the facility that I worked at and it got a lot of really positive feedback from the parents and participants and the outcomes were really stellar most of the time. So guiding good choices it costs about $2,500 to get started with so is another one that's expensive. But if your school system or your local community mental health agency wants to look into that. All they need to do is go to the website for guiding good choices. It's a five session program it does require parents to show up for five two hour sessions. That's where the problem lies and five consecutive ones so it can't be like willy-nilly hit or miss. However, if you can get parental buy-in and get them to do it just for five weeks. It does have a significant impact. The Seattle social development project was designed to reduce risk build protective strengths in schools, families and children themselves. This project the long term follow-up revealed multiple positive effects on mental health functioning in school and work and even sexual health 15 years after the intervention ended. Now I went to the Seattle social development project's website and there really wasn't a lot of information about what they did and several of their links that were would give more information were defunct. So if you want to look around on the Internet you may find some more information but that was one that was mentioned in the book that did have good results. I'm hoping they end up publishing more early headstart is a federally funded extension of the headstart program which targets low income pregnant women and families with infants and toddlers. Those participating in early headstart showed improvements on the mental development index of the Bailey scales which is what they use to assess child and infant development. That's the the basic is kind of like the beck inventories for children. They showed larger vocabularies lower levels of aggressive behavior higher levels of sustained attention greater engagement with parents and less negativity towards parents. A lot of school systems already employ early headstart. So this is something we want to make sure that funding keeps going for and you know some school systems also accept volunteers for this program. Interestingly though families with four or five of the following risk factors did not benefit from early headstart. If the family had if the parents had no high school education it was a single parent household it was a teen parent if they were receiving public assistance or not employed or in school now they said four or five. Now I'm looking at those going if I had four out of those five risk factors I'd be hard pressed to not be really stressed and anxious and maybe depressed too. So remembering that poverty which if they don't have a high school education if they are receiving public assistance and or not employed or in school is an indicator of poverty poverty is in associated with increased parental depression increased spousal and child parent conflict and ineffective parenting. So what I took away from that was the head early headstart program is really awesome if the child's home life is moderately functional. If there is a lot of conflict and parental depression at home then it doesn't matter how much enrichment you do for the four hours that junior is in early headstart the other 20 hours are going to weigh down on the effectiveness of that so we need to make sure to have interventions for the families of these children in addition to just early headstart. Preschool the CDC recommends publicly funded center-based comprehensive early childhood development programs for low income three to five year olds. Let's make sure they're getting the enrichment they need preschool education has the positive effects of increasing language skills literacy and general cognitive ability. I know my son really didn't talk a lot until he started preschool and that was because he didn't have to you know I he would motion to something I'd get it for him. I didn't force him to talk at home and he got his needs met once he went to preschool. He had to articulate his needs and express himself and he became quite expressive high risk preschool prevention programs are available and not widely though. So again with the opening of the Medicaid doors I'm hoping that some money will go in this area to supplement home visiting parent training and preschool education. This helps improve family functioning child social emotional functioning and cognitive functioning. So again what child learns during that four hours or six hours there in preschool is great but then we want to see it reinforced at home. Interventions directed towards children's early cognitive development are associated with long term improvements in multiple mental emotional and behavioral problems. Around Florida many libraries have wings or areas of the library that are devoted to young children and they have computer kiosks that are set up that have cognitive enhancement enhancing programs on them to help them learn their ABCs or whatever. But they also have places they can lay on big bean bags and read child appropriate books and parents can feel safe with the children in that area and it's not necessarily one of those you got to be you know use your library voice because we recognize that children are going to get a little excited. So libraries are a great place for early cognitive development enhancement in addition to preschools and after school care for those children who are in early head start head start or kindergarten. One little note child outcomes due to reducing poverty remains limited and again I would assume and I don't know this to be true that just reducing poverty doesn't necessarily improve the family environment if there's already depression anxiety and conflict. So we need to not only reduce poverty but also improve family functioning in order to improve child outcomes. Several preschool classroom curricula are designed to improve teachers behavior management of classrooms by reducing child behavior program problems and strengthening children's social skills or executive functioning or both the promoting alternative thinking strategies curriculum teaches elementary and preschool children about emotion self control and problem solving. It is shown been shown to be really really effective. So when you work that in I mean yeah that's great wonderfully preschool doesn't have to have academic meet academic standards every year. So in preschool and head start and early head start these things can be taught to help children identify be able to articulate their emotions and develop appropriate methods of dealing with their feelings. The community members influence legislation and we can influence community members at large can influence the school by volunteering at the school participating in the PTA advocating for children so they can have access to school based counseling health curricula promoting practical health and wellness behaviors not just you know general these are the parts of the body but how do you stay healthy home economics courses teaching basic life skills how do you cook how do you shop how do you balance your checkbook and school life balance programs and or school life balance and I emphasize this because I know so many of my children's friends that are in public school will come home from school and they spend the next 5 hours doing homework and you know sometimes they don't even get to make it to their extracurriculars because they've got so much homework to do so there's not really a balance there at school leave for school at 630 in the morning and they study till 9 at night and you know that's their life and we always warn adults from doing that with work going to work coming home eating going to sleep getting up and going back to work it's not healthy it's not healthy for the kids either so we want to advocate for basically less homework less busy mundane work you know there's a lot of stuff they can probably get done in the classroom and school nutrition programs we want to keep those going to make sure that children have access to healthy foods and you know however you define healthy I thought the pizzas that we got when we were in high school in school were just fine. We can also as a community members model healthy behaviors as it relates to smoking alcohol and drug use stress management proper nutrition good sleep habits and effective communication children learn when they're in Walmart looking at people or wherever you shop when they're watching TV when they're with their family when they're in church they learn. So we as community members can model these healthier behaviors so children can pick them up. Agencies and organizations can make prevention and early venture intervention services affordable and available and sometimes they got to be creative but that's what they get grants for some says prevention week could be highlighted in your community and that could be a center piece so to speak in order to launch initiatives to help the community itself be stronger and healthier and we're going to get to a program that builds off of that in just a second home visiting community based multi component interventions that provide services such as family support which this can be also done some sometimes churches synagogues houses of worship whatever type you go to the leader will maintain a list of people who are willing to help and people who need help and that family support can come in really handy if you've got a child in the hospital or you know a sick child or you just need some respite time or whatever. We can also make sure preschool education is available childcare affordable good childcare is available community development and that means not only just talking about the people that are there but developing the infrastructure so it brings business and brings jobs so we have less poverty media interventions can be promoted by the community through local news local channels intensive family preservation services can be available for families that have existing maltreatment issues and social skills development interventions can be shared along the way from the pediatricians office to after school care to daycare you know there's a lot of places where the providers have the time to provide handouts or to do some training so they could work with children slightly differently in a way that would model appropriate coping skills. The school community interventions add several elements including in-service training of school staff on how to work with kids who are struggling how to identify externalizing behaviors and deal with them as well as to how how to identify problems that may need referral for further assessment and intervention. Local task forces can develop policies conduct schoolwide fairs seek funds for the school and conduct field trips for parents and children so again the community doesn't have to necessarily be parents can form a task force to help enrich the school system and parent training workshops can be made available online so people don't have to get childcare or in person. Communities that care is a prevention system designed to reduce adolescent delinquency provides processes for communities through a community prevention board to identify their prevention priorities and develop a profile of community risk and protective factors. The logic model involves community level training and technical assistance for adoption of science based prevention frameworks creation of a plan for changing outcomes through using evidence based programs and implementation and evaluation. I love this program because it recognizes that each community has its own unique needs and challenges and encourages communities to create a task force to get together and go OK what's going on in our community and how can we address it. The media and the Internet are emerging as a means to reach local communities beyond schools and families and their extensive use by today's young people makes development of evidence based promotion and prevention interventions using these venues attractive. So how can we develop an evidence based practice using YouTube for example. That's what we want to start looking at studies of the impact of electronic media such as TV and computer assisted interventions on other health related behaviors have found positive effects in cognitive behavioral and mood management skills mental health interventions and smoking cessation in the UK. They actually have two computerized cognitive behavioral interventions for depression and panic phobia disorders that have been approved by the National Institute of Health and Clinical Excellence. So those are completely self run self help type computer based intervention programs. The ecological approach to family intervention and treatment a.k.a. ecofit consists of a parenting information program provided through a family resource center along with parent child homework interaction. So homework's going and then the parent and child have to work together to encourage effective family management. It's based on empirically based model of child adolescent problem behavior. It's family centered addressing adult leadership and support in the change process. Mom and dad got to buy into it. It's assessment driven identifying intervention needs in that family as well as in that community addresses client motivation as a core component. We got to get buy in from everybody not just mom and dad but also junior to and utilizes a health maintenance model delivered in service settings that involve children and families. So real quickly let's talk about targeting problem behaviors aggression violence and substance abuse. Many of the target risk factors of prevention interventions are interrelated. So what we're looking at is addressing both aggressive and withdrawn behaviors because when they occur together they impart a much higher risk of depression failure at school and violence and substance abuse than just aggressive behavior alone. Both risk factors are independently linked to concurrent and successive problems in concentration attention and poor achievement and depression is also associated with poor achievement. Externalizing behavior across different social fields and deviant peer group contact in middle school will predict later juvenile arrest drug use and higher levels of risky sexual behavior. So we really need to address that externalizing behavior when they're knee high to a grasshopper and help them learn how to deal with those angry or unhelp unhelpful feelings. Many of the targeted risk factors can be addressed using social skills training and cognitive components that alter perception and attributions basic CBT change behaviors and improve social relationships interpersonal effectiveness skills if you want to go to dbt and promote non response to provocative situations that doesn't mean avoiding all conflict because you can't avoid all conflict that means having the skills and tools to deal with conflict and if you are in a provocative situation not to get provoked and externalize universal interventions are designed to affect school structure improve classroom management and improve students relationships self awareness and decision making skills. So the interventions that we've talked about can come from the media from you know watching the news and you know newscasters even though kids don't necessarily watch the news they hear it is on and if they're doing a lot of bickering name calling bullying kids are going to pick up on that and you know let's teach what we want kids to do and let's model it. The TV the themes of different programs that are on TV can impart healthy coping skills or unhealthy and athletes a lot of youth look up to athletes so they can serve as great role models the Internet you can use ads you can support websites and different things on the Internet that target your population so you you're getting your message out directly to them and you can have websites available that they can get more information podcasts teachers are also part of the interventions and they can have curricula that they use but they can also model healthy coping skills and positive redirection physicians after school providers parents school based counselors and staff at churches synagogues mosques and other houses of worship can all play apart in getting this information out getting these interventions out risk factors that seem to be cross cutting that we still want to make sure we're keeping a focus on lack of maternal bonding during that infancy period parental depression family discord and externalizing behaviors. All righty are there any questions. Okay you're able to unmute yourself now so if you want to have a discussion type question I'm here and I've got my headphones on if you are ready to go take your quiz and be done with your day you are good and I will see you tomorrow or the next day. So just let me know where you're at you enjoy this podcast please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at all see us dot com slash counselor toolbox. This episode has been brought to you in part by all see us dot com providing 24 7 multimedia continuing education and pre-certification training to counselors therapists and nurses since 2006 use coupon code counselor toolbox to get a 20% discount off your order this month.