ROUGHLY EDITED COPY

2015 EHDI CONFERENCE

Bringing the Parent-Child Relationship Lens to Our Work Using the Early Relational Assessment

March 9, 2015, 2:00 P.M.

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This is being provided in a rough-draft format. Remote CART, Communication Access Realtime Translation, is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

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Welcome to EHDI!

"Bringing the Parent-Child Relationship Lens to Our Work Using the Early Relational Assessment."

REBECCA MARTIN: Hi, everybody, thanks for coming. We're going to get started in about three minutes, so if you're not staying for the next presentation, we'd ask you to continue your conversation out in the hallway, so we can get the room cleaned up. Thank you.

REBECCA MARTIN: Okay, so I think we're going to get and get started. First off, would it be okay to dim the lights a little bit? Can we do a check to see if you can still see the interpreters if we dim the lights a little bit for the videos? Can everybody see it? Okay. Because I do have videos that I want to be able to show.

Okay. Perfect. Okay. Thanks. So my name is Rebecca, and I'm from Wisconsin, and today, I'm talking to you guys about the parent-child relationship and the Early Relational Assessment that we've been doing in Wisconsin. I have my infant mental health endorsement and I've been working in the field of infant mental health for officially seven years and unofficially probably my whole career so I'm excited to talk to you about the emerging findings that we're seeing in Wisconsin.

So today, we're going to talk about why do parent-child relationships matter to EHDI, how is EHDI-Wisconsin evaluating these relationships, what patterns do we see, and we are we going next?

So in thinking about how to present this, I came across this quote from Marti Erickson -- she's a great woman out of Minnesota -- that says, "Understanding parent-child attachment must become a lens through which we consider all decisions that touch the lives of children. This is not a political issue. This is a universal human issue." I just found that statement so profound. I think that sometimes we get caught up in not wanting to talk about parent-child relationships. I was a little bit nervous about presenting this information to you today, and when I found that quote, I thought, that's it. She's a good one, if you ever want to look up information about her.

So why do parent-child relationships matter to EHDI? They matter during the crucial time period, and it can impact this relationship and its development.

Another piece of it is that the communication and in fact all development develops in the context of primary relationships. During this time, I'm mostly going to say the word "mom," but I am in no means excluding the other people, but "mom" is easier to say.

So how are we evaluating these relationships in Wisconsin? We're using the ERA or the Early Relational Assessment, and it's a video snapshot in the moment of this parent and this child. So parents have the opportunity to participate in our research project. And the video attempts to capture the child's experience as a parent, the parent's experience as a child and the quality or tone of the relationship.

Also, it's going to say -- I will take questions as I'm talking and reserve the right to field them to the end, but I want to make sure that someone's not understanding something that we can clarify it.

So the ERA can be used to develop profiles of the parent-child relationship so in terms of with the birth to 3 program and early intervention Part C program, to program evaluation outcome studies and that's what we're doing with it so far in Wisconsin. So what we have today that we're going to be talking about is our baseline assessment, baseline information that we've been gathering for the last about nine years, since 2009, if that math works out to 2015.

The other thing I should say, the information is not used to compare groups of people, so we're not going to be talking about this group of kids who are Deaf or hard of hearing compared to this group. So, for example, at Wisconsin EHDI, we're looking at children who are Deaf or hard of hearing, and in other cases, we're using it for a particular population where the parents had significant trauma history, so it's not to compare groups of people. It's looking from the people that you're focusing on.

So just a little bit of nitty-gritty about it, developed by Roseanne, involves five-minute video segments and there's a free-play session, a structured pass that depending on the age of the child so for a newborn, it's changing the baby's diaper. For a 1-year-old, it's stacking blocks, and for a 2-year-old -- I'm sorry, I switched that around. For a 1-year-old, it's finding a monkey under a cup and the 2-year-old is stacking blocks and there are scenarios that parents and kids find themselves in on a daily basis.

So after you do the videotaping of the parent and child interaction, we take you back and we rate it, and the rating process is pretty intense. I'll sometimes look at a video all day and then go back to it another day. We're looking at 65 individual parents, so 29 parental, 28 child items and 8 didactic items, each in terms of rating and strength and I've been watching them seven years now so I've watched a lot of them and scoring them and using them for a variety of purposes.

So in Wisconsin, the ERA is part of the assessment of early intervention outcomes which is part of NECAP which you might have heard about out of Colorado and we've completed 25, but 23 are presented today because I didn't have time to put them in my presentation. We have a varying degree of sharing, including kiddos who have co-occurring conditions and 14 to 37 months of age. It is purely a relationship assessment, looking at the parent and child, but some nuanced pieces of the rating system where you might look at is something developmentally appropriate but it's not a developmental system.

So it looks to what the parent brings to the relationship, how the parent experiences the child. What the child brings to the relationship and how the child experiencing the parent, and how they are as a dyad. So think of this as a spectrum. So mom smiles, in an ideal situation, baby smiles back, mom smiles back, and you as a coo, a brightened touch, a pattern, a lovely pattern between the parent and child. So what does the parent bring to that child? Mom smiled. Did baby respond? Baby smiled. And then they do something else. That's the ideal situation. So the baby doesn't smile back or baby smiles and mom doesn't smile back. So you're looking at each piece of that relationship, that it all goes together, so they're each bringing something to it and with the ERA you have this lovely kind of evaluation of both pieces of that relationship and how it looks together too.

So some of the patterns that we're seeing along these parent-child relationships, so we're going to look at the parent side of things, so there are 29 parent items. So the first place we're looking at, and I should say, there are a lot of really positive things coming out, so in general, kids are not completely disregulated. They're really persistent. They have good attention spans. The moms in this case, most of the moms, although dads have participated. And the moms are not really emotional, they don't have a lot of emotional ability, so we're not looking at parents who are really emotionally disturbed. So there's a lot of positive things coming out, and today we're talking about the things that we're having a little bit more of concerns coming out. Not to say that there aren't strengths happening. There certainly are. But today I thought we'd talk about some of the patterns that are emerging that are more concerning and where we need to go to move that needle and what the outcomes are what we expect.

So one of the parent items is quantity of verbalization. So the amount of words the parents are saying. As you can see here, you're doing pretty well. So almost 80% of the parents in the study are doing pretty well as far as area of strength for the number of words that they're saying.

And then there are a couple of others who are not. So a little over 10% have it as an area of concern where they're not saying a whole lot to the kids, and I say the word "saying," but it could be sign language as well.

And then we get to this piece. So we have verbalization is happening and the quality is where we're really seeing some problems. So if you think back even to today's plenary session, right? In those big studies where kids in poverty hear 200 words a day and kids out of poverty hear 2,000. What are they hearing? Get your shoes on or, let's go to the park. It's sunny outside. Not just parents saying specific words, but what are they saying and what kind of quality of verbalization are they saying? So you can see it's kind of half and half. Half the parents are still doing pretty well, for quality verbalizations and half aren't.

To the next piece, really interesting, especially thinking about social and emotional development and communication development of kids which is what we think about in EHDI, is the parents' scores on social initiative, so social initiative being, you know, here's this block, let's play something, doing -- giving the child an opportunity to respond to something. So with social initiative, you're starting that interactive behavior, right? So I'm going to smile at you. That's a social initiative. So I'm going to hand you a toy. That's a social initiative. Parents are struggling with this one. 50/50. 50% of the parents are doing okay and 50% are not. It's that parent and then the child. So if the parent isn't giving the child a lot to respond, to you have this mismatch in that relationship.

And then this is the piece that I find to be really concerning. So in the ERA, we look at mood. So mood being a representation of how a parent might be feeling. So in this case, it's the category that we're looking at is a parent's characteristic mood, cheerful, animated, a joy to be around, and I do have the instrument with me, if you want to see those, you can contact me. This is where you see for the first time that the parents are dropping, that more of this are having them as an area of concern than are having it as an area of strength. So if a parent is not super happy and animated, what's baby going to be doing? So we have social initiative and they're not having a whole lot of fun. So looking at what might be happening in these parent-child relationships.

And then the other piece of it is resourcefulness creativity, so what are they doing with that child? Let's turn this shoe into a boat. Let's do something more creative with your play. So scaffolding something that the child can build upon. So we're not saying that parents are really able to do that in the population that we've looked at so far. And this is really concerning.

So I thought I'd show you -- this family in particular, agreed to let me use their video for educational purposes. These are real people. This is real life. And I'll show you three one-minute segments of their five-minute video. So keep in mind this is just one part of the segment of a parent and a little guy here.

Woo! (Away from mic).

Oh!

Oh, my gosh! Oh!

(Toy noise)

REBECCA MARTIN: And then she said, what does the duck say, and -- thinking about those items that I talked about where parents were struggling, did you notice anything, sort of her resourcefulness or creativity? She had five minutes. She was not just rated on this one minute, and the family's ratings were what we were seeing, and I picked that video as well. This is exemplifying some of the things that we're seeing. Yeah, Lori.

AUDIENCE MEMBER: (Away from mic).

REBECCA MARTIN: No, they're a standardized set of toys, and this is a free play, so moms are told to play as they normally will, as they normally do. I'm in the home for sometimes an hour, even though I'm only recording three five-minute segments, and I've been in the home for at least 20 minutes before they start doing the free-play, and they are given the toys and told to play as they normally do. Yeah.

AUDIENCE MEMBER: (Away from mic).

REBECCA MARTIN: No, just play. Oh, sure. His question was, are you given any -- are they given any prompts about speech or anything or is it just play, and my answer is, no, it's really just play, and we talk about it's kind of looking at how things normally go for you, and I do talk to mom after I'm done taping, how did that go for you, is that normal or not normal for how things normally go and I never get the answer of "no, it's totally different" or "I normally don't sit on the floor with them." I get -- did somebody have a hand up?

AUDIENCE MEMBER: (Away from mic).

REBECCA MARTIN: Yeah, so I take those videos -- exactly. Exactly. I take the video back to my office. Sure. Yeah. So the question was whether I was using the videotape to then evaluate the relationship assessment and -- I forget the rest of the question. And if it's a natural kind of scenario. So yeah, after I did the videotaping, I take the videotape back to my office and I spend sometimes days rating it. So for the parent part of it, there's 29 variables that I'm looking at. So 29 items. And each item has really specific criteria. So -- in some places, I'm literally counting items of times that mom looks at the child, the number of social initiatives. Does she move her body? It's that spectrum that everything that parent is bringing to the table and really looking at what she's -- what she's doing. And in most of the item, she gets credit for something she does whether the child responds or not. So if she's really doing a good job at something, but kiddo is kind of -- she can still get some credit for that and she may not get as high of a score because it didn't elicit as high of a score. I hate to use the term "credit," but I can't think of another one. Anything else?