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.