Maria Conceio do Rosrio Child and Adolescent Psychiatry

Maria Conceição do Rosário Child and Adolescent Psychiatry Unit (UPIA) Department of Psychiatry UNIFESP

Mother Support Program (MSP) to improve cognitive, social and communication skills of pre-school children, to improve the mother’s quality of life and to decrease the level of domestic violence Coordinator: Prof. Maria Conceição do Rosário, M. D. , Ph. D. Early Childhood Attention Program (PAPI) Child and Adolescent Psychiatry Unit (UPIA) Department of Psychiatry at the Federal University of São Paulo (UNIFESP) www. programaprimeirainfancia. com. br

Psychiatry/ Psychology Maria C. Rosario Mônica Scattolin Ilana Shavitt Luis Hiar Amanda Pepo Jaqueline Mendonça Laura Feitosa Mariana Mercadante Marta Uber Lúcia Schablatura Raissa Loureiro Pediatrics Speech and Language Pathology Jacy Perisinotto Rebeca Pessoa Ana Carina Tamanaha Selma Isotani Brazil’s Open University (UAB) Luciano Gamez Rosa Resegue Yale University James F Leckman Angelica Panguta Kaveh Khoshnod Walter Gillian

“If we are to teach real peace in this world, … we shall have to begin with the children…” Mahatma Ghandi (1869 -1948)

The Context: Child Abuse Lack of integration between programs Low quality pre -school education Exposure to domestic and community violence Impact in child’s integral development Poor Nutrition Child Neglect Bordin et al. , 2009; Angold & Egger, 2007; Anselmi et al. , 2008

The Solution: Interventions focusing on both parental well-being and positive parenting behaviors; Interventions focused on developing child’s empathy, inhibitory control and mental flexibility; Interventions that improve parenting skills and parent -child relationships; Focus on the Child, Primary caregivers and Teachers Interventions focusing on violence reduction through ECD; Interventions improving the quality of preschool teaching; Brofenbrenner, 1979; Kagitcibasi et al. , 2001; Bierman et al. , 2008; Luthar et al. , 2000

Mother Support Program (MSP) to improve cognitive, social and communication skills of pre-school children, to improve the mother’s quality of life and to decrease the level of domestic violence Coordinator: Prof. Maria Conceição do Rosário, M. D. , Ph. D. Early Childhood Attention Program (PAPI) Child and Adolescent Psychiatry Unit (UPIA) Department of Psychiatry at the Federal University of São Paulo (UNIFESP) www. programaprimeirainfancia. com. br

Relevance of the project Ø Most of the programs implemented in Brazil to work with ECD are focused only on physical health and do not address mental health issues. Ø The initiatives are mainly directed to the first two years of life. Ø Currently, in Brazil, there very few intervention programs that integrate health, social and education sectors in order to improve physical and mental aspects of health trough empowerment programs that improve parenting and parent-child relationships focusing on both parental wellbeing and positive parenting behaviors. Ø The impact of these programs on the promotion of mental health, violence reduction and improvement on child’s executive functions have not been systematically evaluated. www. programaprimeirainfancia. com. br

Location – city of Embu das Artes www. programaprimeirainfancia. com. br

Location: City of Embu das Artes State of São Paulo www. programaprimeirainfancia. com. br

- Total Population = 261, 781 people; - Average monthly household income is R$ 1, 672 (US$500); - 36% high or very high social vulnerability; - Number of preschools = 33 - Human Development Index = 0. 772 www. programaprimeirainfancia. com. br

www. programaprimeirainfancia. com. br

www. programaprimeirainfancia. com. br

Mother Child Education Foundation (AÇEV) www. acev. org 14

Mother Child Education Foundation (AÇEV) • Founded in 1993 - AÇEV is a NGO working in early childhood and adult education. • Mission - To support every child from an early age to help him or her reach their highest possible potential • AÇEV - awareness-raising and advocacy campaigns, science-based education programs

Programs and Activities Program Name Target Group Goal Mother Child Education Program children aged 5 -6 & their mothers Develops children cognitively and socially for school, empowers mothers with tools needed to support them Preschool Parent Child Education Program children in state-run preschools & their parents children aged 5 -6 Equips parents and teachers with tools to support children’s cognitive development mothers of children aged 3 -11 Empowers mothers by supporting their parenting, relationships with children, and through information Preschool Education Program Mother Support Program Develops socioeconomically disadvantaged children cognitively and linguistically in preparation for school Father Support Program fathers of children aged 3 -11 Encourages fathers to take more positive, active roles in their children’s development Parental Seminars parents of children aged 0 -14 Informs parents about their importance in children’s development, child-rearing, parenting, communication Functional Adult Literacy & Women’s Support Program 1 Advanced Literacy – Access to Knowledge Program Rural Women’s Support Program Illiterate women over age 15 Imparts literacy skills to women, supports their social participation through information provided in trainings 1 st level literacy graduates Improves reading comprehension, encourages use of access to information, empowers women in society Young and adult women Enhance the life skills of young and adult women living in rural areas through education 16

Mother Child Education Foundation (AÇEV) • The “ 7 is Too Late” campaign – to raise awareness of ECE in Turkey and reached 40 million people with the exposure of various communication activities in media • The campaign resulted in a 144% increase in preschool enrollment, including the development of a mandatory attendance policy and accessible preschools in 57 Provinces

Mother Support Program www. programaprimeirainfancia. com. br

Mother Support Program Content Interpersonal Communication Skills Child Development Parenthood www. programaprimeirainfancia. com. br

Mother Support Program Main Principles Positive and Constructive Approach in Child Rearing Reciprocity / Intimate and Close Relationship Accepting Child as a Person Democratic Attitudes www. programaprimeirainfancia. com. br Knowledge about Child Development Understand the Child’s World

Main Aims of MSP • Increase the mother’s sensitivity to the whole development of the child • Aid her in preparing a stimulating home environment • Support her in creating a consistent and positive mother-child interaction • Increase mother’s feelings of competence, efficacy and self confidence. www. programaprimeirainfancia. com. br

Weekly Topics – Brazilian MSP • Being a woman, the different roles in • Reducing Undesirable Behaviors society and stress reduction in Children (2 sessions) • Parental styles and the influence on • Democratic Conflict Resolution Child’s development • The Contributions of Play to Child • Physical and Cognitive Development • Social and Emotional Development • Health and healthy diet • Listening to Children and Self • School-Family-Community Expression Relationships in Child • Instilling a Sense of Responsibility in Development Children • Father’s session • Instilling Desirable Behaviors in Children www. programaprimeirainfancia. com. br

Manual for Group Facilitators www. programaprimeirainfancia. com. br

www. programaprimeirainfancia. com. br

www. programaprimeirainfancia. com. br

Mother Support Program (MSP) - Brazil The proposed solution to improve ECD in Brazil: Ø We hypothesize that when the MSP is implemented with fidelity (i. e. , delivered as intended by design), there will be a significant positive impact on the child’s development and on health promotion for the entire family.

Mother Support Program (MSP) - Brazil Main Goal – to improve physical, social and emotional development of pre-school children (ages 4 to 6 years) by the implementation and evaluation of an empowerment program for mothers in the city of Embu das Artes, located in the metropolitan area of São Paulo, the biggest city in Brazil More specifically, the study has the following aims: Aim 1 - To implement the Mother Support Program (MSP) to empower mothers to act as facilitators of the development of their pre-school children; .

Mother Support Program (MSP) - Brazil Aim 2 - To evaluate the impact of the MSP on the cognitive, social, emotional and language development of the child; Aim 3 - To evaluate the impact of the MSP on the mother’s quality of life and stress levels; Aim 4 - To assess the impacts of the MSP on biological makers of affiliative bonding (measured by salivary oxytocin) and physiological indicators of stress and wellbeing (resting blood pressure and nutritional status)

Mother Support Program (MSP) - Brazil Sample – 600 mothers from preschools will be randomized and mothers will be assigned to one of 2 groups: - Group 1 (MSP Intervention) - 300 mothers who will attend the 13 sessions of the AÇEV mother support program (MSP); - Group 2 (control group) - 300 mothers whose children will only have the regular preschool activities (control group).

Mother’s Participation in the MSP Outcomes of Interest (Children) Lower rates of externalizing and internalizing symptoms – assessed by the CBCL; Program Content: 1) Being a woman, the different roles in society and stress reduction 2) Parental styles and the influence on Child 3) Physical and Cognitive Development 4) Social and Emotional Development 5) Listening to Children and Self-Expression 6) Teaching children responsibility; 7) Instilling Desirable Behaviors in Children; 8) Reducing Undesirable Behaviors in Children - Part 1; 9) Reducing Undesirable Behaviors in Children - Part 2; 10) Democratic conflict resolution; 11) Health and Healthy balanced Diet; 12) Importance of play and accident protection 13) School-Family-Community Relationships in Child Development; Improve Cognitive development and school readiness – assessed with the IDELA Improvement in vocabulary skills – assessed with the Language Development Survey (LAVE); Improvement in socioemotional scores – assessed by the Ages and Stages Questionnaire; Child biomarkers – increase in oxytocin levels and improvement in nutritional status

Mother’s Participation in the MSP Outcomes of Interest (Mothers) Improvement in Quality of Life – assessed with the WHOQOL-Brief Program Content: 1) Being a woman, the different roles in society and stress reduction 2) Parental styles and the influence on Child 3) Physical and Cognitive Development 4) Social and Emotional Development 5) Listening to Children and Self-Expression 6) Teaching children responsibility; 7) Instilling Desirable Behaviors in Children; 8) Reducing Undesirable Behaviors in Children - Part 1; 9) Reducing Undesirable Behaviors in Children - Part 2; 10) Democratic conflict resolution; 11) Health and Healthy balanced Diet; 12) Importance of play and accident protection 13) School-Family-Community Relationships in Child Development; Reduction in the stress levels – assessed with the Dysfunctional Parent-Child Interaction (DPCI) from the Parental Stress Index –Short Form (PSI/SF) Reduction in the violence scores in the home; assessed with the Section B of the Brazilian version of the World Studies of Abuse in Family Environments Core Questionnaire Mothers’ biomarkers – increase in oxytocin levels, lower heart blood pressure and improvement in nutritional status

International Development Early Learning Assessment (IDELA) • IDELA’s aim is to use evidence to promote best practice, inclusion and equity in Early Childhood Development and Education (ECDE) provision; • Designed for children ages 42 -78 months; • Direct child assessment (as opposed to relying on parent or teacher report of children’s skills); • Holistic, rigorous, open source instrument that is feasible and easily adapted to different national and cultural contexts. IDELA Technical Working Paper, (Pisani, et al 2015)

International Development Early Learning Assessment (IDELA) • 22 core items - five developmental domains: motor, language and early literacy, math and problem solving, socioemotional development, and approaches to learning • Administration time: 30 minutes; • These areas of development represent key early learning and development competencies that most often appear in national ECDE curricula and standards. Competence in all these areas will ensure that children are ready to benefit from educational activities offered in the school environment IDELA Technical Working Paper, (Pisani, et al 2015)

International Development Early Learning Assessment (IDELA) • Does not require a neuropsychological background; • Application of IDELA requires a minimal set of materials: a pencil, blank paper, small items for counting (such as beans or buttons), nine picture cards related to eight items on the assessment, and a storybook that contains pictures and text IDELA Technical Working Paper, (Pisani, et al 2015)

Mother Support Program (MSP) - Brazil IMPLEMENTATION: Ø Contact with schools and community Ø Contact and approval Secretary of Education from the Ø Training and reliability of interviewers Ø Pilot Project Interviews; for the Mother’s Ø Translation and Adaptation of AÇEV’s MOCEP to the Brazilian MSP Ø Training of the MSP by AÇEV’s Group

Mother Support Program (MSP) - Brazil IMPLEMENTATION: Ø Revision of the 14 sessions and preparation of the final version of the manual Ø Contat with Save the Children and MOU Ø Translation and adaptation of the IDELA to Brazilian portuguese; Ø Training on the IDELA by Save the Children’s personnel Ø Pilot and reliability of the IDELA Ø Revision of the IDELA – final version

Mother Support Program (MSP) - Brazil IMPLEMENTATION: Ø Pre-intervention evaluation (208 Mothers – Children) Mother’s Interview / IDELA / Speech-Language Assessment Ø Intervention (98 participants) 04 Preschools / 06 MSP Groups Ø Post intervention evaluation Mother’s Interview / IDELA / Speech-Language Assessment

Mother Support Program - Brazil “Every generation of children offers mankind the possibility of rebuilding this world” Eglantyne Jebb – Founder Save the children

THANK YOU!