Introduction to

Handle with Care:

with 4 Key Building Blocks

October 6th, 2017

Presenters: Sherri Armstrong and Laurie McPherson

PREVENTION MATTERS 2017

About us…

Sherri Armstrong BPE • Sherri has a background in early

childhood development, disabilities and behavior.

• Consultant in Alberta

Laurie McPherson RPN, MSc

• Laurie has a background in mental health,

mental health promotion, sociology and family social sciences.

• Consultant in Manitoba

Faculty/Presenter Disclosure

• Presenters: Laurie McPherson and Sherri Armstrong

• Relationships with commercial interests: – None

CFPC COI: Slide 1

Disclosure of Commercial Support

• Prevention Matters has received financial support from: – Community Action Plan for Children

in the form of an educational grant.

• This program has received in-kind support from the Saskatchewan Prevention Institute in the form of logistical support.

• Potential for conflict(s) of interest: – No conflicts of interest

Mitigating Potential Bias

- Does not apply

CFPC COI: Slide 2

Aim of this Workshop

• Introduction to Handle with Care

• Overview of Handle with Care

• Share evaluation findings

• Share parent/caregiver perspectives & feedback

• Interactive sampling of several Handle with Care activities

• Challenges & lessons learned

• Where to find out more about Handle with Care

Every child is a wonderful, beautifully unique being, full of potential and possibility. Parents and caregivers play a critical role in laying the foundation for a child’s healthy and happy future.

Image ©Laurie McPherson

Impact of Parenting on Children’s Mental Health • Prevention programs promoting nurturing and stable relationships

have significant potential to reduce the negative impacts of poverty and other conditions that negatively impact healthy childhood development (Morris et al., 2017).

• “Children with sensitive and nurturing caregivers in early childhood exhibit fewer behavioral and mental health problems, and are more likely to be prosocial and succeed in school” (National Research Council &

Institute of Medicine, 2009).

• Family environments that are warm, involved and responsive contribute to children’s social and emotional development and positive mental health (Mullan & Higgins, 2014).

• A key characteristic of best practice programs that support positive early childhood outcomes is the focus on helping adult parents/caregivers strengthen their skills so they can support the healthy development of the children in their care (Center on

the Developing Child at Harvard University, 2016).

“I’m Googling How To Raise My

Child Which Is Probably Not The

Best Idea”

“Millennial Dads Turn to Digital in Their Moments of Need”

“Parenting before Google. How did anyone actually do that?”

What is Handle with Care?

• Handle with Care is a set of simple interactive strategies to help parents and caregivers, including those who work in early childhood settings, to promote the mental health of young children from birth to 6 years.

• Handle with Care uses a strengths-based approach that assumes every parent and caregiver has problem-solving skills, potential resources, and wants what’s best for the children in their lives.

Four original HWC Sites

Consultations with communities across Canada – here’s what the community asked for: • Fun, interactive content

• Include a variety of activities: stories, discussions, crafts, books, games, and videos

• Flexibility in delivery: small groups & individual

• Culturally safe and relevant

• Based on simple concepts with big impact

• Training for facilitators not too costly or time consuming

• Focus on positive mental health concepts that are relevant to all parents (universal)

HWC Program Development

• Public Health Agency of Canada funding secured 2010-2015 from Innovation Strategy funding for enhancing mental health of families dealing with risk factors for mental health

• Led by Hincks-Dellcrest Centre (now operating in partnership with SickKids)

• Project and evaluation included four sites across Canada – Yukon, Manitoba, Ontario, Prince Edward Island

• Program was developed from the adaptation of original HWC aimed at Early Childhood Educators developed in 2007

• Adapted, piloted, revised, implemented and evaluated

Handle with Care - Building Blocks

Building Block 1

Building Block 3

Building Block 2

Relationships

with Others

Building Trust and

Attachment

Building and

Enhancing Self-esteem

Expressing Emotions

Building Block 4

Key Messages of Handle with Care

• Young children’s mental health is critically important in order for them to flourish, thrive and grow into healthy adults.

• The well-being of parents and

caregivers is key to children's

mental health and well-being.

• It’s never too late to build a

healthy and trusting relationship with

your child.

How the program is organized

Overview of the Program

Choice of 10 activities in each of the 4 Building Blocks

Variety in the types of activities:

original stories

discussions

crafts

interactive games

children’s books

self-reflection activities

DVDs/videos

What makes Handle with Care unique?

• Opportunity for self-reflection – not prescriptive

• Interactive learning with a variety of methods

• Flexible delivery (8 sessions/4 sessions/individual)

• Self-care focus

• Strength-based

• Fits for all

parents and

caregivers

• Training itself is

capacity building

for facilitators

FLEXIBLE MODELS OF DELIVERY

PHASE II PHASE III

8 Group Sessions

8 Group Sessions

4 Group Sessions 4 One-on-One Sessions

Current Phase

Handle with Care - Building Blocks

Building Block 1

Building Block 3

Building Block 2

Relationships

with Others

Building Trust and

Attachment

Building and

Enhancing Self-esteem

Expressing Emotions

Building Block 4

Building Trust and Attachment Building Block 1 Activity: Attachment Mobile

Attachment Mobile Story https://www.youtube.com/watch?time_continue=6&v=zExk9y18Zcs

Image www.riverdreamer.com

What activities could you do to add attachment beads on to a mobile for a:

Toddler

Preschooler

Elementary School

Youth

Bringing it together:

A strong attachment relationship is built on many small positive interactions and connections made throughout our day as parents/caregivers; this healthy attachment relationship also contributes to a child’s positive self-esteem.

Scheduled 10 Minute Break

9:30 – 9:40

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QUANTITATIVE AND

QUALITATIVE RESEARCH FINDINGS

Participants 349 parents/caregivers (Aboriginal People, new immigrants,

chronically disadvantaged) Communities at risk for mental health issues in three Canadian

provinces (PEI, Ontario, Manitoba) and one territory (Yukon)

Method for Evaluating the Handle with Care Program Efficacy

Pe

xa

ls.c

om

Immediate

Intervention Pretest Posttest

4-months

Follow-up

Control/Delayed

Intervention Pretest1 --- Pretest2 Posttest

4-months

Follow-up

Design

Intervention

Intervention

DESIGN

ASSESSMENT TOOLS (PARENT MEASURES)

Knowledge and Beliefs of Child Development Questionnaire

Mental Health Continuum Questionnaire

Major Depression Inventory

Parenting Sense of Competence Scale

Self-care Questionnaire

Interviews / Focus Groups

Mental Health

Parents and caregivers had significant reduction

in symptoms associated with negative mental

health (languishing).

Parents and caregivers had more positive

feelings about themselves, people around them

and the environment (flourishing).

Parenting Sense of Competence

Gained confidence in their parenting

practices.

Increased positive feelings about their

relationships with their children or children in

their care.

“I had to kinda take a step back and really acknowledge the feeling words...and let them understand ...this is frustration...and stopping and talking with them instead of blowing up...” “When she makes me mad, instead of just yelling or getting angry, I stop and think about how it’s going to make her feel depending on what I say.”

Expressing Emotions (BB3): (empathy)

KEY CHANGES IN PARENT PRACTICES

KEY CHANGES IN PARENT PRACTICES

"I am…spending more time trying to identify the problem with my children. And I’m also spending more time… trying to recognize their emotional needs.”

Building Trust and Attachment (BB1) 72 sources, 119 references

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“Giving her the tools to manage her own emotions. So, by helping her manage hers, I, in turn, manage mine. And she also gets the benefit of my example ... to see me struggle and take a deep breath so that she can understand ... it’s not just children that experience the struggle.”

Expressing Emotions (BB3): (empathy) 149 sources, 318 references

KEY CHANGES IN PARENT PRACTICES

3 Important Elements of HWC

1) Self-Care

2) Self-reflection

3) Role of the Facilitator

Self-care and wellness

practices improved

significantly in the

parents and caregivers

and continued to improve

over the life of the

project.

Handle with Care Outcome

Self-care

57 sources and 100 reference “Self-Care”

73 sources and 151 references “Importance of Self-Care, taking breaks node”

“...taking more time for myself is helping my parenting in a positive way.” “I have learned that in order to take care of my child I have to take care of me.” “...it is a big thing that I’m starting to take care of myself more; can’t really take care of him or my other one if I’m not taking care of myself.”

VIKI2WIN / ISTOCK

Self-Care Activity

Self-care assessment tool to develop awareness and monitor progress

Activity:

At your table or in pairs, brainstorm and share several self-care activities to promote wellness in the following areas: 1. Music and Movement 2. Mind and Hand Games 3. Things that Nourish 4. Reflection and Gratitude

Handle with Care - Building Blocks

Building Block 1

Building Block 3

Building Block 2

Relationships

with Others

Building Trust and

Attachment

Building and

Enhancing Self-esteem

Expressing Emotions

Building Block 4

Building and Enhancing Self-Esteem Building Block 2

Activity: Temperament Tidbits Temperament Traits Activity level: quiet..............................active Rhythmicity: regular/predictable…….irregular/unpredictable First Reactions: jump right in……………….sit back at first Sensitivity to Stimulation: usually not sensitive……very sensitive Emotional Response: mild/low key……………….strong/intense Mood: usually happy………………more unhappy Distractibility: hardly notices things……very distractible Attention Span/Persistence: easily stops………………….won’t let go Adaptability: adapts quickly……………..slow to adapt

Choose one of the chairs here that best fits with your temperament and share why you made that choice.

NEXT – think about a chair that you feel best describes the temperament of a child in your life – share with your partner/group about your choice.

Building Block 2 - Enhancing Self-Esteem

Temperament

If there is time: - Talk about how children’s temperaments impact how they express emotions. - Discuss strategies parents and caregivers can use when children’s temperaments differ from their own.

Bringing it together:

Understanding children’s temperament as well as our own is an important step towards building a strong and trusting relationship.

Handle with Care - Building Blocks

Building Block 1

Building Block 3

Building Block 2

Relationships

with Others

Building Trust and

Attachment

Building and

Enhancing Self-esteem

Expressing Emotions

Building Block 4

Building Block 3 Expressing Emotions

Activity: Breathe and Stretch Imagine that you have a nice smooth stone in your hand Complete the following sentences in a small group:

When I am anxious, I feel…..

When you have the “stone”, complete the sentence and then pass to the next person. You can say pass if you are not comfortable. When the stone has gone around the entire circle sit down.

There are techniques that we can use with children (and ourselves) to help them calm their bodies and minds such as breathing exercises and children’s yoga. Breathing Exercises: Blowing Out Birthday Candles Blowing Up Imaginary Balloon Hot Soup

Bringing it home: How calming strategies can help children work through different emotions and lead to emotion-regulation.

Expressing Emotions

Handle with Care - Building Blocks

Building Block 1

Building Block 3

Building Block 2

Relationships

with Others

Building Trust and

Attachment

Building and

Enhancing Self-esteem

Expressing Emotions

Building Block 4

Activity - Family Nest

Reflect upon traits and values that you believe are important in your family or that you would like to be important in your family. http://innersasa.blogspot.ca/2012/04/painting-rocks.html

Building Block 4 – Relationships with Others

Aim is to support participants to help children acknowledge and celebrate shared values within family or group. Participants reflect on what traits/values are important to them and record the on stones in a family nest. Participants keep the nest on display so that you can use it and review values.

Bringing It Together 1. Appreciating family values can improve secure relationships. 2. Respecting and accepting helps you express your emotions in a positive way. 3. Positive self-esteem can be a foundation for healthy relationships. 4. Safe and secure emotional environment enables kids to express emotions. 5. How all of the Building Blocks interweave to promote children mental health and wellbeing of parents and caregivers.

Lessons learned/challenges

• Parents with young children now seem less interested in attending

group programs, even fun ones!

• Facilitators need to focus their efforts on facilitating a process of

reflection with parents/caregivers from a strengths-based perspective;

many are more accustomed to a “teaching” model

• When the program is facilitated as intended – participants can

experience quite profound and meaningful insights from very simple

activities

• While the program can be delivered flexibly – our data is telling us

that the 8 week delivery model leads to greater benefit for the

participants

• While the program is aimed at parents of children birth to 6, many

parents are able to transfer their learnings and skills to other

relationships within their family or with friends

Agencies with Trained Facilitators

Wide representation of agencies who have trained

facilitators including:

• Parent-Child Coalitions and partners

• Early Learning Centres

• Family Centres in Schools

• Family Resource Centres in community

• Women’s Health Clinic

• Women’s Shelters

• Child & Family Services Agencies

• Pregnancy & Family Support Services

• Canadian Mental Health Association

• Aboriginal Head Start and Aboriginal Health & Wellness

Parent reflection

“I think that you sometimes doubt your parenting abilities…that you’re doing the right thing all the time, and I felt by the end of it (HWC program) that it kind of just made me feel better about the parent that I was…made me realize that I am doing a lot of the things that are in there.”

Facilitator reflection

“They were very comfortable with each other. They were a very trusting group even though we had a lot of variety in personality, socioeconomic background, and education it was amazing how they were learning from each other in a way that you wouldn't expect.”

We would like to thank the Public Health Agency of

Canada for their funding and support of all three phases

of the Handle with Care Project.

Handle with Care is led by the

Now operating in partnership with

References: A healthy, productive Canada: A determinant of health approach (2009). Report of the Senate Subcommittee

Population Health Series – Senate Standing Committee on Social Affairs, Science and Technology, Subcommittee on

Population Health. CN: YC17-402/3-01E-PDF

Center on the Developing Child at Harvard University (2016). From Best Practices to Breakthrough Impacts: A Science-Based

Approach to Building a More Promising Future for Young Children and Families. Retrieved from

www.developingchild.harvard.edu.

Handle with Care: A Guide for Families and Caregivers: Promoting the mental health of young children everyday (2014).

Toronto, ON: Hincks-Dellcrest Centre.

Jane-Llopis, E. (2006). From evidence to practice: mental health promotion effectiveness. Australian e- Journal for the

advancement of Mental Health 5 (1) www.auseinet.com/journal/vol5iss1/jane-llopiseditorial.

Keyes, C. (2007). Promoting mental health as flourishing. American Psychologist, 95- 108.

McCain, M.N., Mustard, J.F., & Shanker, S. (2007). Early Years Study 2: Putting science into action. Toronto: Council for Early

Childhood Education.

McCain, M.N., Mustard, J.F (2002). Early Years Study. Toronto: Council for Early Childhood Education.

Morris, A. S., Robinson, L. R., Hays-Grudo, J., Claussen, A. H., Hartwig, S. A., & Treat, A. E. (2017). Targeting Parenting in

Early Childhood: A Public Health Approach to Improve Outcomes for Children Living in Poverty. Child Development, 88(2), 388–

397. http://doi.org/10.1111/cdev.12743

Mullan, K., & Higgins, D. (2014). A safe and supportive family environment for children: Key components and links to child

outcomes. (Occasional Paper No. 52). Canberra: Department of Social Services. Retrieved from www.dss.gov.au/about-the-

department/publications-articles/research-publications/occasional-paper-series

National Collaborating Centre for Determinants of Health (2017). Foundations: definitions and concepts to frame population

mental health promotion for children and youth. Canada: National Collaborating Centres for Public Health.

National Longitudinal Survey of Children and Youth (2008). Ottawa, ON: Canadian Research Data.

O'Connell ME, Boat T, Warner KE. (2009). National Research Council (US) and Institute of Medicine (US) Committee on the

Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and

Promising Interventions.

Reading, C., & Wien, F. (2014). Health inequalities and social determinants of Aboriginal people’s health. National Collaborating

Centre for Aboriginal Health, Prince George, BC.

Schwean, J., & Rodger, S. (2013). Children First: It’s time to change mental health promotion, prevention, and treatment

informed by public health and resiliency approaches. Canadian Journal of School Psychology, March , 28, 136-166.

Tamminen, T., & Puura, K. (2015). Infant/early years mental health. In A. Thapar, D.S. Pine, J.F., Leckman, S. Scott, M.J.

Snowling, & E. Taylor, Rutter’s Child and Adolescent Psychiatry Sixth Edition, West Sussex, UK: Wiley (pp. 79-92).

Webster-Stratton, C. Parenting Practices Scale. www.incredibleyears.com

Willinsky, C., & Anderson, A. (2013). Analysis of best practices in mental health promotion across the lifespan Centre for

Addiction and Mental Health.

More information: Visit Please visit the Handle with Care Website for further

information on the program and training opportunities

• Website www.handlewithcarecanada.org

• Email handlewithcare@hincksdellcrest.org

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Laurie McPherson LaurieMcPhersonConsulting@shaw.ca

Sherri Armstrong abhwcsherri@gmail.com