the achievement gap initiative at harvard university … · the achievement gap initiative at...
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The Achievement Gap InitiativeThe Achievement Gap Initiative
at Harvard Universityat Harvard University
19 June 200719 June 2007
William R. Beardslee, MDWilliam R. Beardslee, MD
Department of PsychiatryDepartment of Psychiatry
ChildrenChildren’’s Hospital Bostons Hospital Boston
Harvard Medical SchoolHarvard Medical School
Key PrincipleKey Principle
Aligning resources to enable families to accomplish
the tasks that support children in learning in
school should guide our development and
deployment of programs to narrow the
achievement gap from a family perspective.
Aligning resources to enable families to accomplish
the tasks that support children in learning in
school should guide our development and
deployment of programs to narrow the
achievement gap from a family perspective.
In 1990, we believed that parental influence
diminished as peer influence increased in
adolescence…
…today, we understand that parents are as critical during adolescence as they were in
childhood, even as peer influence
increases.
Reprinted by permission of Robert Wm. Blum, MD, MPH, PhDJohns Hopkins Bloomberg School of Public Health (2005)
In 1990, we believed that parental influence
diminished as peer influence increased in
adolescence…
…today, we understand that parents are as critical during adolescence as they were in
childhood, even as peer influence
increases.
Reprinted by permission of Robert Wm. Blum, MD, MPH, PhDJohns Hopkins Bloomberg School of Public Health (2005)
Risks for DepressionRisks for Depression
Specific:� Extensive family history
of depression, especially parents
� Prior history of depression
� Depressogenic cognitive style
� Bereavement
Specific:� Extensive family history
of depression, especially parents
� Prior history of depression
� Depressogenic cognitive style
� Bereavement
General (Risks for many disorders)
� Exposure to trauma
� Poverty
� Social isolation
� Job loss
� Unemployment
� Family breakup
� Loss of community
� Dislocation / immigration
� Historical trauma
General (Risks for many disorders)
� Exposure to trauma
� Poverty
� Social isolation
� Job loss
� Unemployment
� Family breakup
� Loss of community
� Dislocation / immigration
� Historical trauma
Depression’s Impact:Four Levels
Depression’s Impact:Four Levels
1. Individual with diagnosis
2. Family of individual
3. Caregiver / Care System
4. Community – School, Friends, Neighborhood
1. Individual with diagnosis
2. Family of individual
3. Caregiver / Care System
4. Community – School, Friends, Neighborhood
Component StudiesComponent Studies
1979 - 1985: Risk Assessment - Children of Parents with Mood
Disorders
1983 - 1987: Resiliency Studies and Intervention Development
1989 - 1991: Pilot Comparison of Public Health Interventions
1991 - 2000: Randomized Trial Comparing Psychoeducational
Family Interventions for Depression
1997 - 1999: Family CORE in Dorchester
1998: Narrative Reconstruction
2000: Efficacy to Effectiveness
1979 - 1985: Risk Assessment - Children of Parents with Mood
Disorders
1983 - 1987: Resiliency Studies and Intervention Development
1989 - 1991: Pilot Comparison of Public Health Interventions
1991 - 2000: Randomized Trial Comparing Psychoeducational
Family Interventions for Depression
1997 - 1999: Family CORE in Dorchester
1998: Narrative Reconstruction
2000: Efficacy to Effectiveness
Seven Different Implementations of Family Depression Approach
Seven Different Implementations of Family Depression Approach
1. Randomized trial pilot – Dorchester for single parent families of color
2. Development of a program for Latino families
3. Large scale country wide implementation – Finland
4. Head Start – Program for parental adversity / depression
5. Blackfeet Nation – Head Start
6. Costa Rica
7. Collaboration with other investigators in new preventive interventions
1. Randomized trial pilot – Dorchester for single parent families of color
2. Development of a program for Latino families
3. Large scale country wide implementation – Finland
4. Head Start – Program for parental adversity / depression
5. Blackfeet Nation – Head Start
6. Costa Rica
7. Collaboration with other investigators in new preventive interventions
Characteristics of Resilient YouthCharacteristics of Resilient Youth
� Activities - Intense Involvement in Age Appropriate
Developmental Challenges - in School, Work, Community,
Religion, and Culture
� Relationships - Deep Commitment to Interpersonal Relationships
- Family, Peers, and Adults Outside the Family
� Self-Understanding - Self-Reflection and Understanding in Action
� Activities - Intense Involvement in Age Appropriate
Developmental Challenges - in School, Work, Community,
Religion, and Culture
� Relationships - Deep Commitment to Interpersonal Relationships
- Family, Peers, and Adults Outside the Family
� Self-Understanding - Self-Reflection and Understanding in Action
Resilience in ParentsResilience in Parents
� Commitment to parenting
� Openness to self-reflection
� Commitment to family connections and growth of
shared understanding
� Commitment to parenting
� Openness to self-reflection
� Commitment to family connections and growth of
shared understanding
Criteria for Intervention Development
Criteria for Intervention Development
1. Compatible with a range of theoretical orientations and to be
used by a wide range of health care practitioners
2. Strong cognitive orientation
3. Inclusion of a family as a whole
4. Integration of the different experiences of a family, that is,
parents and child(ren)
5. Developmental perspective
1. Compatible with a range of theoretical orientations and to be
used by a wide range of health care practitioners
2. Strong cognitive orientation
3. Inclusion of a family as a whole
4. Integration of the different experiences of a family, that is,
parents and child(ren)
5. Developmental perspective
Core Elements of the InterventionCore Elements of the Intervention
1. Assessment of all family members
2. Presentation of psychoeducational material (e.g., affective disorder, child risk, and child resilience)
3. Linkage of psychoeducational material to the family’s life experience
4. Decreasing feelings of guilt and blame in the children
5. Helping the children develop relationships (inside and outside the family) to facilitate independent functioning in school and in activities outside the home
1. Assessment of all family members
2. Presentation of psychoeducational material (e.g., affective disorder, child risk, and child resilience)
3. Linkage of psychoeducational material to the family’s life experience
4. Decreasing feelings of guilt and blame in the children
5. Helping the children develop relationships (inside and outside the family) to facilitate independent functioning in school and in activities outside the home
Latino AdaptationLatino Adaptation
� Familismo
� Allocentric orientation
� Kinds of separation in immigrant families
� Differing involvement of parents and children in
the mainstream culture
� Familismo
� Allocentric orientation
� Kinds of separation in immigrant families
� Differing involvement of parents and children in
the mainstream culture
What helps parents cope with depression?
What helps parents cope with depression?
� Focus on the children
� Visualizations. Envisioning a better future
� Prayer, songs, religion, church community, spiritual healing
� Support groups
� Helping others, sharing information
� Focusing in the present: “viviendo de dia a dia” (living day to day)
� Not giving up: “seguir la lucha”
� Alternative medicine
� Humor: “al mal tiempo buena cara” “yo no lloro, yo me rio”
� Focus on the children
� Visualizations. Envisioning a better future
� Prayer, songs, religion, church community, spiritual healing
� Support groups
� Helping others, sharing information
� Focusing in the present: “viviendo de dia a dia” (living day to day)
� Not giving up: “seguir la lucha”
� Alternative medicine
� Humor: “al mal tiempo buena cara” “yo no lloro, yo me rio”
Head Start Family Connections Project Partners
Head Start Family Connections Project Partners
Boston ABCD
Dimock Health Center
Ruggles-Gilday Day Care Center
Federal Head Start Bureau
Boston ABCD
Dimock Health Center
Ruggles-Gilday Day Care Center
Federal Head Start Bureau
The Family Connections Approach
The Family Connections Approach
1. Emphasize the positive ways that all parents can enhance
their parenting & their interactions with Head Start
2. Foster engagement with Head Start among depressed
parents
3. Incorporate a program for getting appropriate treatment
4. Enhance parents’ & children’s classroom interactions
through consultation, teaching and support for Head Start
staff.
1. Emphasize the positive ways that all parents can enhance
their parenting & their interactions with Head Start
2. Foster engagement with Head Start among depressed
parents
3. Incorporate a program for getting appropriate treatment
4. Enhance parents’ & children’s classroom interactions
through consultation, teaching and support for Head Start
staff.
Family Connections Partnership Family Connections Partnership
� Training & support for staff
� Partnerships for referral & networking
� Consultation/intervention in the classroom
� Stress support groups for parents
� Expanded home visitation & consultation
� Preventive relational friendship building for children
� Example: sessions that relate to mental health with an emphasis on depression
� Training & support for staff
� Partnerships for referral & networking
� Consultation/intervention in the classroom
� Stress support groups for parents
� Expanded home visitation & consultation
� Preventive relational friendship building for children
� Example: sessions that relate to mental health with an emphasis on depression
“Of all the forms of inequality,
injustice in health care
is the most shocking and inhumane.”
“Of all the forms of inequality,
injustice in health care
is the most shocking and inhumane.”
Reverend Martin Luther King, Jr.Reverend Martin Luther King, Jr.
ReferencesReferences
1. Beardslee, W.R., Gladstone, T.R.G., Wright, E.J., & Cooper, A.B. A family-based approach to the prevention of depressive symptoms in children at risk: Evidence of parental and child change. Pediatrics, August 2003, 112(2), e119-e131.
2. Podorefsky, D.L., McDonald-Dowdell, M., & Beardslee, W.R. Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child andAdolescent Psychiatry, August 2001, 40:8: 879-886.
3. Beardslee, W.R. When a parent is depressed: How to protect yourchildren from the effects of depression in the family. Originally published in hardcover under the title, Out of the darkened room: When a parent is depressed: Protecting the children and strengthening the family, by Little, Brown and Company, June 2002. First paperback edition, December 2003.
1. Beardslee, W.R., Gladstone, T.R.G., Wright, E.J., & Cooper, A.B. A family-based approach to the prevention of depressive symptoms in children at risk: Evidence of parental and child change. Pediatrics, August 2003, 112(2), e119-e131.
2. Podorefsky, D.L., McDonald-Dowdell, M., & Beardslee, W.R. Adaptation of preventive interventions for a low-income, culturally diverse community. Journal of the American Academy of Child andAdolescent Psychiatry, August 2001, 40:8: 879-886.
3. Beardslee, W.R. When a parent is depressed: How to protect yourchildren from the effects of depression in the family. Originally published in hardcover under the title, Out of the darkened room: When a parent is depressed: Protecting the children and strengthening the family, by Little, Brown and Company, June 2002. First paperback edition, December 2003.
ReferencesReferences
4. Beardslee, WR. National Registry of Evidence-based Programs and Practices. Intervention Summary: Clinician-Based Cognitive Psychoeducational Intervention for Families. [On line] http:www://nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=88]
5. Beardslee, W.R., & Knitzer, J. Strengths-based family mental health services: A family systems approach. In: K. Maton, C. Schellenbach, B. Leadbeater, & A. Solarz (eds.). Investing in children, youth, families, and communities: Strengths-based research and policy. Washington, DC: American Psychological Association, 2003, 157-171.
4. Beardslee, WR. National Registry of Evidence-based Programs and Practices. Intervention Summary: Clinician-Based Cognitive Psychoeducational Intervention for Families. [On line] http:www://nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=88]
5. Beardslee, W.R., & Knitzer, J. Strengths-based family mental health services: A family systems approach. In: K. Maton, C. Schellenbach, B. Leadbeater, & A. Solarz (eds.). Investing in children, youth, families, and communities: Strengths-based research and policy. Washington, DC: American Psychological Association, 2003, 157-171.