Home Visitor Training Manual: Minnesota Training Partnership
Minnesota Department of Health Maternal & Child Health Section P.O. Box 64882 St. Paul, MN 55164-0882 Telephone: (651) 215-8960 Fax: (651) 215-8953 www.health.state.mn.us
Home Visitor Training Manual: Minnesota Training Partnership This training manual was developed with funds from the Minnesota Department of Health and Part C of the Individuals with Disabilities Education Act (IDEA) through the Minnesota Early Intervention Program, a joint initiative of the Minnesota Departments of Health, Human Services, Children, Families and Learning and local Interagency Early Intervention Committees. The pilot training programs were supported through a grant from the Allina Foundation and funds from the Minnesota Department of Health. Funding for evaluation of the training program was provided by the Childrens Trust Fund, a division of the Minnesota Department of Children, Families and Learning. Thanks to the Minnesota Home Visitor Training Partnership for their many hours of work and valuable input in the development of the training manual. Members of the Partnership include representatives from the Minnesota Department of Health and several County Health Departments, the Department of Children Families and Learning, the Department of Human Services, Minnesota Extension Service, Head Start, Early Childhood and Family Education, MELD, Health Start, Lutheran Social Services, and others. Contributing Editors: Gloria Ferguson, BA; Mary Scott, MS; Contributors: Ann Ahlquist, ACSW; Judy Bergh, RN, PHN; Diane Elifrits, RN, PHN MS; Laura Kitaoka McLean, PNP, MPH; Mary Rossi, CNM; Barb Palmer, RN, MPH; Jessica Toft, MSW; Kerry Volkers, MSW; Project Managers: Kristen Nicklawske: RN, MPH; Betty Kaplan, RN, MPH: Sue Letourneau, BSW. Home Visitor Training Manual: Minnesota Training Partnership All rights reserved 2001 by the Minnesota Department of Health. Minnesota Department of Health Maternal & Child Health Section P.O. Box 64882 St. Paul, MN 55164-0882 Telephone: (651) 215-8960 Fax: (651) 215-8953 www.health.state.mn.us
Table of Contents
Introduction to Home Visitor Training Manual ...................... 1 Chapter 1: Training Preparation ...................................................................... 5 Chapter 2: introduction to home visiting.....................................................15 Chapter 3: Strength-Based APPROACH ............................................................. 21 Chapter 4: Culture and Cultural Context .................................................. 29 Chapter 5: Attachment Theory ........................................................................ 45 Chapter 6: Understanding Family Systems and Family Development .................................................................................... 65 Chapter 7: Early Parenting: A Focus on Mothering ................................ 83
References and resources
Chapter 3. TO Strength Based INTRODUCTION home visitor training manual Notes Background The Home Visitor Training Manual was developed out of initial work done by the Minnesota Home Visitor Training Partnership, an interdisciplinary group of collaborating organizations that included Head Start, Minnesota Early Learning design, Early Childhood Family Education, public health nursing programs, as well as child abuse and neglect prevention and child development programs. This group was convened to develop a statewide, multi-disciplinary training system that would be based on a core set of competencies needed by all home visitors and would be available on a regular basis. Overview of the Manual The Home Visitor Training Manual is designed to train home visitors, experienced and inexperienced alike, in the use of strength-based approaches to working with families. It emphasizes respect for diversity and interdisciplinary collaboration. It also offers participants the opportunity to share the unique knowledge and skills of their respective disciplines while learning additional practical skills to use in working with families.
¦
Goals
The goals of the training program are to: • Assure that families receive high quality home visiting services. • Assist local communities with training and staff development responsibilities. • Advance a strength-based approach to working with families throughout all systems in Minnesota. • Foster a cross systems orientation that will lead to improved working relationships. • Provide the varied disciplines with a means to share expertise. Topics The topics addressed in the Partnership curriculum for home visitors include: • History and philosophy of home visiting.
Minnesota Home Visitor Training Manual
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Chapter 3. Strength Based INTRODUCTION TO home visitor training manual Notes • • • •
Strength-based approaches to working with families. Knowledge and skills needed for effective home visits. Knowledge and skills necessary for working with families and children. Culture and cultural context of home visiting.
Knowledge and Skill Development Upon completion of all modules, participants will be able to: • • • •
Identify the diverse skills that home visitors from many disciplines bring to their work with families. Apply interviewing techniques that can be used with families from all cultural, economic and educational backgrounds. Utilize teaching techniques for use with families from all cultural, economic and educational backgrounds. Adapt the visit content for families that do not have identified problems and are meeting basic needs.
Icons have been used to identify learning activities and teaching materials. ICON KEY
¦ þ
PREPARATION lEARNING ACTIVITIES
eXERCISES
!
pOSSIBLE gROUP rESPONSES
¹ Page 2
Learning Objectives
handout OVERHEAD Minnesota Home Visitor Training Manual
Chapter 3. TO Strength Based INTRODUCTION home visitor training manual Notes Materials in the manual were developed primarily for home visiting programs with multidisciplinary providers in Minnesota. Adaptations to the manual may be necessary to meet the needs of your specific program and providers. Access to the Home Visitor Training Manual: MinnesotA training Partnership The Home Visitor Training Manual: Minnesota Training Partnership is available to community organizations through the Minnesota Department of Health library. A list of trainers familiar with the training is available upon request. To request the trainer list, contact: Minnesota Department of Health Maternal and Child Health Section 85 East Seventh Place, Suite 400 P.O. Box 64882 St. Paul, MN 55164-0882 Telephone: (651) 215-8960 Fax: (651) 215-8953 Internet: www.health.state.mn.us
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Chapter 3. Strength Based INTRODUCTION TO home visitor training manual Notes
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Minnesota Home Visitor Training Manual
Chapter 1: Training PReparation I.
Overview ...................................................................... 5
II.
Training Preparation Task Checklist .................. 6
III. Selecting the Training Team ................................... 7 IV.
Trainer Characteristics ..........................................8
V.
Training Environment ............................................ 9
VI. Guidelines for Selecting Learning Activities .... 10 VII. Adult Learning Principles .................................... 12 VIII. Home Visitor Training Daily Participant Feedback .................................................................... 13
Chapter 3. Strength Basedpreparation Chapter 1. Training Notes I. Overview This section is intended to assist the training coordinator in preparing for a local community team training. Training coordination is critical to the success of the training and the tasks described here can be accomplished by several people. Because the intent of this training is to bring together home visitors from a variety of programs and disciplines, promoting the training among all of the agencies who conduct home visiting in your community will be one of the most important tasks. A. Training Manual The training manual is divided by seven topic sections. In each section you will find an overview that includes: learning objectives, training outline, preparation checklist, description of training learning activities, overheads, handouts and in some sections, additional materials. The learning activities provide the trainer with a description of the activity and directions to use with the training group. Specific content to be used in mini-lectures in most cases is included in the text of the manual. While the training manual is somewhat directive in style, it is intended to be a guide for the trainer. Each trainer will have their own unique style and may have additional materials and content that can be used to enrich the training experience. B. Training Participants The training participants may range in home visiting experience from inexperienced to very experienced. Trainees can be from programs such as Early Childhood Family Education, Head Start and Minnesota Healthy Beginnings. They can represent public health, county social services and other public and private non-profit organizations. They may be volunteers, paraprofessionals and credentialed professionals. Some of the sessions may be optional based on home visitors experience. Attendance at some of the sessions by representatives from a broad scope of home visiting programs in a community enriches the training and can promote a community team approach to serving families.
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Chapter 3. Strength Based Chapter 1. Training preparation Notes
II. Training Preparation Task Checklist The first time this training is conducted in your community, it will be important to prepare for the training at least three months in advance. As with any new task, preparation is crucial to the implementation and overall coordination of the event. o Select training team o Promote training among local home visiting programs o Elicit assistance from local community programs and public systems involved with home visiting services to families with young children o Prepare trainers o Provide overview of training including intent and philosophy o Assign sections o Review training manual, general activities, and adult learning principles o Hold practice sessions for selected activities o Select training dates o Select training site (see additional information) o Market training using a variety of methods to appropriate agencies o Develop registration and confirmation system for participants o Prepare agenda o Arrange for snacks and meals as appropriate o Arrange for use of audio visual equipment including overhead projector and TV/VCR o Send confirmation letter to panelists o Prepare participant packets or binders including agendas, handouts and evaluations. o Prepare training certificates o Check with staff at training site to confirm dates, time, equipment, food, room set up, etc. o Hold final preparation meeting with trainers to review logistics and to go over any final questions o Prepare opening remarks and getting acquainted activity o Prepare name tags, training roster and sign in sheet o Determine small groups for selected interdisciplinary team activities On the Day of the Training o Do final check of room set up and audio visual equipment o Welcome participants o Introduce trainers o Provide a brief introduction to the training o Conduct a getting acquainted activity
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Minnesota Home Visitor Training Manual
Chapter 3. Strength Basedpreparation Chapter 1. Training o o o o o o o
Elicit expectations from training participants. Differentiate between expectations you feel will be met through the training and those that will not. Provide agenda and review the first day Make announcements regarding housekeeping details Establish training ground rules Create an atmosphere of team work and camaraderie Pass out training roster for review Conduct training evaluation
Notes
After Training o Send out final training roster to participants o Send thank you notes to panel member o Compile evaluation summary o Process training with training team o Make adaptations and changes in training as needed III. Selecting the Training Team Since this training is intended to be interdisciplinary, it will be important that your training team reflect the variety of disciplines represented by the training participants. Specific topics lend themselves to specific disciplines. You may want to consider the following professionals:
TRAINER
TOPICS
Public Health Nurse
Introduction to Home Visiting, Attachment, Early Parenting: A Focus on Mothering
Early Childhood Family Education Parent Educator
Understanding Family Systems and Family Development, Strength-Based Philosophy
Social Worker
Understanding Family Systems and Family Development
Head Start Social Service Staff
Strength-Based Philosophy, Culture and Cultural Context
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Chapter 3. Strength Based Chapter 1. Training preparation Notes
Trainers should also: • Be familiar with specific content of training module. • Be experienced in conducting a variety of training activities. • Have experience with home visiting whenever possible. • Reflect the community teams represented. • Should operate within a strength based philosophy in both practice and training style. • Can participate in team. • Have organizational skills. • Be open to feedback. IV. Trainer Characteristics KNOWLEDGE OF TRAINING METHODS The Trainer needs to be familiar with adult learning principles and learning styles and incorporate these into training activities. OPTIMISM Trainers need optimism about people, their innate capacities and their ability to grow. A positive attitude and acceptance of self and others conveys, Lets have fun, we are all in this together. ENTHUSIASM They need to keep trainees engaged and energized. Frequently participants are unfamiliar with sitting in a room all day. CONFIDENCE Trainers need to confidence in their abilities to perform training tasks, as well as, the content they are delivering. RESPECT Trainers demonstrate respect for others when they appreciate and listen to their ideas and feelings. ABILIY TO LISTEN AND OBSERVE A Trainer who is able to listen to and observe training participants can better respond to the unique needs and experiences of each training group. A Trainer can step out of a moment and reflect or anticipate situations. These experiences can also provide learning opportunities for both the Trainer and the training group.
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Chapter 3. Strength Basedpreparation Chapter 1. Training ABILITY TO CLARIFY A Trainer often has to simplify information, explain it or reorganize it so that people understand what is being said.
Notes
FLEXIBILITY A Trainer who is flexible can change behaviors or agendas when the occasion demands it. Trainers can create structure can develop a structure, but adjust the structure to meet the needs ofthe training group. APPROPRIATE SELF-DISCLOSURE A Trainer can enrich the training content with personal experiences and can also establish credibility with training group. However, it is important to draw upon the resources of the training group as much as possible. EMPATHY A Trainer listens to the thoughts and feelings of others and attempts to imagine the experience of the individual. HUMOR The ability to laugh at yourself, to see and create humor at appropriate times is liberating and evokes a feeling of camaraderie. v. Training Environment The training site should be selected based on the needs of your training group. If your participants will be driving some distance, you may want to consider utilizing a hotel space. Typically there are additional charges for use of meeting rooms and may require purchase of meals and snacks. Schools, churches, local health departments and community centers will often provide space for little or no charge. Some things to consider are: • convenience to trainees • parking • availability of audiovisual equipment • food on site or restaurants nearby The training room should comfortably accommodate your training group for both large and small group activities. There should be enough room to easily move into groups since this training provides many opportunities for small working groups. Availability of round tables and chairs or areas in the room where break out groups can move to assist in smoother transitions. Comfortable environments enhance the atmosphere essential to building the community team. Minnesota Home Visitor Training Manual
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Chapter 3. Strength Based Chapter 1. Training preparation Notes
Some things to look for might include: • Comfortable chairs • Adequate lighting • Free of visual obstruction such as columns • Carpeting • Adequate restrooms • Large enough to accommodate break outs and transitions • Kitchen or access to food and beverages • Adequate heat or cooling system • Telephones • Electrical outlets • Audio visual equipment • Free of outside distractions • Wall space for posting new sheets, etc. Estimated Cost of Training* Trainer Fees 5days@$700/day $3,500.00 Mileage .345/mile Per diem $30/day X 5days 150.00 Materials for trainees $10 per participant @40 400.00 Meeting Room fees $100/day 500.00 Costs for meals and snacks should also be considered. * These costs will vary from region to region VI. Guidelines for selecting learning activities: Ø Ø Ø Ø Ø
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Think about the needs of your training group. Think about your strengths and inclinations. Try to match the learning activity with the tone of the content. Consider the variety of learning styles of the training group. Involve as many learning modes as possible
Minnesota Home Visitor Training Manual
Chapter 3. Strength Basedpreparation Chapter 1. Training LEARNING ACTIVITY
ADVANTAGES
DISADVANTAGES
Group Discussion
• Actively involves learners • Helps personalize learning • Encourages participants to share ideas.
• Often difficult to facilitate when: the group is large, one person dominates, the discussion gets off track
Lecture
• Gets across technical information in short time • Presenter has control of time and content
• Participants passively involved • May require more preparation • Difficult to assess whether learning is taking place.
Brainstorm
• Generates alternatives • Can energize group by active involvement • Efficient use of time to gather many ideas
• Ideas are presented without a lot of discussion
Demonstration
• Participants can observe desired skill or outcome
• May need props and other preparation
Role Playing
• Active involvement • Draws on imagination • Helps participants anticipate or replay a situation
• Some participants may not like to perform • Might evoke difficult situations or feelings.
Small Group
• Large percentage of actively involved
• Hard to assess learning
Video
• Covers a lot of information • Can communicate complicated ideas by using both visual and auditory reinforcement
• Passive involvement
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Notes
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Chapter 3. Strength Based Chapter 1. Training preparation Notes
Panel
• Brings fresh information • Offers expertise and community resources • Can present contrasting experiences and ideas
• Passive involvement unless enough time is give for questions • Timing can be hard to control
VII. Adult Learning Principles 1. ADULTS CAN DIRECT THEIR OWN LEARNING. Ø Implications for trainers: Encourage trainees to be a part of their own learning. Involve them as much as possible in how the information is represented. Check in periodically to see how the training process is working. Do there need to be adjustments? Their involvement improves the training process, making it more relevant to their experience. 2. ADULTS HAVE STRONG, INDIVIDUAL LEARNING STYLES. Ø Implications for trainers: Including a variety of training activities will appeal to a broad range of learners. Timing and spacing of various activities is also important. 3. ADULTS NEED AND WANT TO SHARE THEIR EXPERIENCES. Ø Implications for trainers: As an adult matures, his or her readiness to learn becomes oriented to the tasks of their social roles. Opportunities that allow the participant to reflect on experiences in their work and home life will aide in their learning. 4. ADULTS NEED TO APPLY WHAT THEY HAVE LEARNED. Ø Implications for trainers: Provide opportunities for trainees to practice skills and strategies and apply them to their current work. Trainees can also get ideas from one another.
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Date Years of Experience
Home Visitor Training: Daily Participant Feedback At the end of each day, we would like your thoughts related to the training content and learning process. Your input is important because it will help us to determine what is worthwhile, what needs to be changed and what needs to be eliminated. Directions: Please check a box that best answers the question for you. Add any additional comments. 1.
Todays content is important for anyone involved in home visiting. AM
¤ ¤ ¤ ¤
PM Strongly Agree Agree Disagree Strongly Disagree
¤ ¤ ¤ ¤
Strongly Agree Agree Disagree Strongly Disagree
Please explain: 2.
I learned enough new information today to keep me interested. PM ¤ Strongly Agree AM ¤ Strongly Agree ¤ Agree ¤ Agree ¤ Disagree ¤ Disagree ¤ Strongly Disagree ¤ Strongly Disagree
Please explain: 3.
I learned enough new information today to keep me interested. PM ¤ Strongly Agree AM ¤ Strongly Agree ¤ Agree ¤ Agree ¤ Disagree ¤ Disagree ¤ Strongly Disagree ¤ Strongly Disagree
Please explain:
Daily Participant Feedback - continued
4.
Please describe how todays training helped you improve a skill. AM PM
5.
Please describe how, if at all, todays training sparked a new idea. AM PM
6.
Please comment on todays information or content. What worked well? AM
PM
What needs work? AM
PM
VV
V
Chapter 2: Introduction to Home Visiting Overview ............................................................................ 15 learning objectives ......................................................... 15 Preparation Checklist .................................................. 16 Outline .............................................................................. 16 Learning Activities ..........................................................17 Handouts 1. History of Home Visiting (1-1) - (1-4) 2. Case Study
Chapter 2. Introduction to Home Visiting Notes
Overview Home visiting in the United States began over a century ago to improve the health and welfare of the poor. Over the years, home visiting has continued to be used as a strategy for delivering services to familes that face economic barriers as well as personal barriers to receiving needed health, social and educational resources. Home visiting has been viewed as an effective strategy to 1) overcome barriers to preventive health care; 2) promote learning readiness; and 3) to prevent child abuse and neglect. This strategy provides the home visitor with the unique opportunity to see the child and parents in their natural environment, to better understand their strengths and needs, and to provide practical learning experiences for families. This introductory lesson gives participants an overview of 1) home visiting in a historical context; 2) the benefits, limitations and challenges of home visiting; and 3) the use of home visiting by multiple programs with different goals.
¦ Learning Objectives By the end of this segment, trainees will be able to: 1. 2.
Describe how the charity organization movement of the late 1800s has influenced the current practice of home visiting in the United States. Identify two benefits and two limitations of home visiting.
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Chapter 2. Introduction to Home Visiting Notes
þPreparation Checklist In addition to standard training materials, you will need: Several 81/2 x 11 cards with selected historical events from Handout 1, History of Home Visiting
Outline I. II. III.
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Historical perspective on home visiting. Why home visit? Variety in home visiting across disciplines and programs
Handouts 1.
History of Home Visiting
2.
Case Study
Minnesota Home Visitor Training Manual
Chapter 2. Introduction to Home Visiting
Learning Activities
Notes
I. Historical perspective on home visiting Ø A strategy for service delivery. Home visiting has a long history in the U.S. and Europe. It began in the US as a strategy for improving the health and welfare of the poor (e.g. new immigrants, families with babies, ill people). Ø Used by many disciplines to serve many different populations and to achieve many different goals. Example Public health nurses, Home care nurses, Early Childhood Family Ed parent educators, Early Childhood Special Ed teachers, Head Start teachers, Social workers, Volunteers such as Parent Mentors and Parish Nurses, community home visitors and Paraprofessionals. Ø Used by many Minnesota programs to promote healthy pregnancy and birth outcomes, to prevent injuries to young children, prevent child abuse and neglect, to reassure and support new parents in their roles as parents.
Exercise:
History of Home Visiting Timeline
Take a few minutes to look at the broader historical perspective of home visiting in America. Instructor: Post five or six dates in the front of the room and distribute individual handouts of the corresponding events to 5 or 6 trainees. Have the trainees read off the event and ask the audience to match the event with a date posted in the front of the room. Review HANDOUT 1: History of Home Visiting. Highlight the following events: Settlement House initiatives of the late 19th Century. This was a time of increasing industrialization, massive immigration, and rapid urbanization. In response to these changes, wealthy women provided services to new immigrants to help them better adjust to American life. This included teaching classes in English, homemaking, and child care.
Minnesota Home Visitor Training Manual
HANDOUT 1: History of Home Visiting
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Chapter 2. Introduction to Home Visiting Notes
Late 19th century volunteer middle and upper class women regularly visited poor families in major cities to provide guidance and serve as a role model for how to live right. Charitable organizations believed that poverty caused character flaws. Teddy Roosevelt conducts the First White House Conference on Children. Creation of PTAs Creation of Head Start Program Child Abuse Prevention and Treatment Act Education of all handicapped children Childrens Trust Fund Crime Omnibus Bill Minnesota Healthy Beginnings II. Why Home Visit? Home visiting is used by many different disciplines and programs to provide services to families.
Exercise: Advantages of Home Visiting Instructor: Ask participants to give examples of : Professional disiplines/programs that visit families in the home setting. Services that are provided in the home setting. Advantages of using home visiting to provide services. List comments on newsprint and summarize discussions. Comments should include: Reaches isolated families. Convenient for families. Families feel more comfortable on own turf . Allow provider to see realistic environment. Opportunity for individualized services.
Exercise: Whining Allowed! Disadvantages and Difficulties of Home Visiting. (allow at least 20 minutes) Despite these advantages, home visiting is not the universal answer to every problem. Working with people in their homes brings with it some practical problems and can also take an emotional toll on staff. Page 18
Minnesota Home Visitor Training Manual
Chapter 2. Introduction to Home Visiting Notes Instructor: Have participants break into small groups of 5 mixed with representatives from multiple visiting experiences. Have group members introduce themselves by telling name, position, and length of work as a home visitor. Have group members list and discuss the hardest parts of home visiting, from the practical and personal perspectives. Ask groups for highlights from their discussions including common responses and surprises. Expect answers such as the following:
!PRACTICAL DIFFICULTIES:
Time consuming. Clients often dont have phones. Some services require equipment and resources that cant be easily transported. Some clients do not want home visits. There is far less control in the hands of the home visitor on home visits than in an office.
!STRESSES FOR STAFF:
Seeing the home situation close-up can be overwhelming for the home visitor and contribute to feelings of frustration and hopelessness. There are more distractions on home visitstelevision, children, and other adultsthat make it difficult to focus on goals. Other people in the home can also raise privacy issues. When people are not home for scheduled visits, staff can feel disappointed, angry, rejected. A chaotic or dirty environment can make it harder to relate to the people. Concern for personal safety. Feeling alone in dealing with the family. May be harder to establish and maintain appropriate boundaries.
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Chapter 2. Introduction to Home Visiting Notes
HANDOUT 2: Jane Smith Case Study
III. Variety In Home Visiting Across Disciplines and Programs
Exercise:
Personal Styles in Home Visiting
Instructor: Ask participants to work in small groups. Give each person the handout with the Jane Smith case study and related questions. Ask that one person read the case study aloud and then have members take a few minutes to think about and write answers to the accompanying discussion questions. Ask one representative from each group to share with the large group one way in which approaches were similar and one way in which they differed from one discipline to another. Summary No one discipline will be able to meet the needs of every family. Through training with people from other disciplines it will enable home visitors to better understand the local resources available to families and to build bridges of communication.
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Chapter 2. Introduction to Home Visiting Notes
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History of HOme visiting Time
Event/service
description
Colonial America
Outdoor Relief
Provided to the poor at home, this approach was adopted by colonial America due to British influence.
1800s
Shift to institutional care
Almshouses provided help when families couldnt do so, especially for orphaned or neglected children. This effort received considerable criticism for braking up families.
1850s
District Visitors Friendly Visitors
Florence Nightengale pioneers training nurses in home care skills. In England, nurses were assigned to geographic areas.
1874
Mary Ellen Wilson story
Mary Ellen Wilson was an 8 year old child abused by her adoptive parents whose story was brought to the attention of the legal system by Henry Berg. At that time, America had a Society for the Prevention of Cruelty to Animals, but not for children. Her story changed the course of services to children.
Last half of 19th C.
The Progressive Era; beginning of the US family support movement, dedicated to teaching immigrant families the normative values of American life.
Service delivery strategies were affected by immigration, urbanization, poverty, environmental health issues, and school delinquency as service providers recognized that environmental conditions influence personal problems and illness. Settlement houses were one of the first products of this era. Through Settlement House programs, wealthy women raised funds for day nurseries, visited children in their homes, taught night classes in English, homemaking skills, and child care. Settlement house teachers became a liaison between home and school.
Introduction to Home visiting
Handout 1-1
Time
Event/service
description
Early 20th Century
Increase in varity of home visitors.
By the 20th century, communities had home visitors representing education, nursing, social services, lay volunteers, and churches. Roles were often blurred.
1909
President Theodore Roosevelt conducts the First White House Conference on Children
The philosophical approach reverted to valuing the home as the best place for serving families. Children were maintained at home, and Widows Pension Laws of 1911 allocated public money to do so. This was the beginning of AFDC.
1920s
PTAs began
In the beginning, PTAs focused primarily on educating parents. Experts taught parents what they felt they needed to know to raise successful children. This philosophy continued through the 1970s.
1929
Depression began
During the Great Depression, a variety of federal relief programs were established to help individuals and communities.
Social Security Act
Created programs for public assistance, maternal-child health services and services to handicapped children. Over time, the wording changed to reflect strengthening families, rather than a deficit approach.
1940-1945
World War II
Shortage of hospital personnel during the war contributed to more in-home care.
1960s
Modern home visiting begins as part of the War on Poverty
Child development research provided evidence of the importance of the first 5 years of life for intellectual development. Greater focus on parent-child relationship as a
Introduction to Home visiting
Handout 1-2
Time
Event/service
description force in child development (as opposed to focus on the child alone). Money became available for a number of programs supporting family and child development, including those that incorporate home visiting.
1965
Head Start
Head Start was created by the 84th Congress and included provisions for home visiting. Some Head Start programs deliver all services to families in their homes; others use a combination of center-based activities and home visits. Even center-based programs provide a few home visits each year.
1970s
Marked increase in singeparent homes, teenage parenting, and employed mothers of children under 6.
Home visiting became a primary means of service delivery as changes in the traditional family, economic realities, and social values brought new family support programs across the nation.
1974
Child Abuse Prevention and Treatment Act
Created by 93rd Congress. Provided funds for demonstration projects for the prevention, identification and treatment of child abuse. Prevention and treatment services often delivered via home visits.
1975
Education of All Handicapped Children Act
Provided educational and social services to all handicapped children ages 3-18; sometimes delivered via home visits.
1980
Adoption Assistance and Child Welfare Act
Promoted placement prevention and permanency planning for child abuse victims. Services aimed at maintaining children in their home often delivered via home visits.
1986
Childrens Trust Fund
Created by Minnesota legislature.
Introduction to Home visiting
Handout 1-3
Time
Event/service
description
Education of all Handicapped Children Act
Was amended by the 99th Congress to include educational, health and social services to children birth to 3 years of age who have developmental delays or special needs. This is referred to as the Part H program. Due to the very young age of Part H population, many services are delivered at home.
1991-92
Crime Omnibus Bill MDH Home Visiting Program
Recognized risk factors that lead to negative outcomes for children and made money available for home visiting in Minnesota through Early Childhood Family Education and the MN Dept. of Health.
1997
Minnesota Healthy Beginnings
Minnesota Legislature passed legislation to begin a pilot program of universally offered home visiting to families with new babies. The program is administered by the MN Department of Health.
Introduction to Home visiting
Handout 1-4
Case Study Ask participants to work in their small groups. Give each person the handout with the Jane Smith case study and related questions. Ask that one person read the case study aloud and then have members take a few minutes to think about and write answers to the questions that follow. Jane Smith is the mother of two children, Ryan Smith, age two years, and Aaron Jones, two months. Your agency has received a referral from the local food shelf (with Janes permission) to provide home visiting services. Jane had been going to the food shelf every couple weeks for food and diapers. The information you have is limited. Jane has a history of depression, and the staff at the food shelf are concerned about her ability to care for the two boys. She has only been in once since having the new baby. At that time, she appeared disheveled and seemed unable to manage the demands placed on her. The two year old ran wildly about the food shelf, emptying boxes and tipping over racks. Jane made feeble attempts to put limits on his behavior, but without consistency or success.
Discussion questions: 1.
On your first visit, how would you describe your role to Jane?
2.
What concerns do you have for Janes situation? List at least 3 possible areas in which she and her family need help.
3.
What would be the strengths and limitations of your discipline in working with Jane on each of those areas of need?
4.
What are you likely to do on a first visit to Janes family? What other information would you like to gather?
5.
How much time would your agency typically allow you to work with a family like Janes, if she accepted services? How often would you be able to visit? How would you use your time together?
Introduction to Home visiting
Handout 2
Chapter 3: Strength-Based approach
Overview ............................................................................ 21 learning objectives ......................................................... 21 Preparation Checklist .................................................. 22 Outline .............................................................................. 22 Learning Activities ......................................................... 22 Overheads 1. Premises of Family Support: What is Our Thinking? (1-1 & 1-2) 2. Principles of Family Support Practice: What Are Our Standards? (2-1 & 2-2) 3. Practices of Family Support: What Do We Do? 4. Strength-Based Family Support: Discussion Questions (4-1 & 4-2) Handouts 1. Family Support (1-1 & 1-2) 2. Lucas Family Scenario 3. Case Study 1 4. Case Study 2 5. Effective Communication (5-1 & 5-2) 6. New Approaches to Practice
Chapter 3. Strength Based Chapter 3. Strength-Based approach Overview
Notes
This section introduces strength-based family support philosophy that provides the foundation of this training. Its purpose is to teach the home visitor how to integrate a strength-based approach with all families, regardless of their circumstances or characteristics, in order to increase the likelihood of positive outcomes. It offers a specific philosophy, premises, principles, and practice guidelines for a strength-based approach as described by the Family Resource Coalition of America. It also provides an opportunity for trainees apply this learning while practicing interview skills.
¦ Learning Objectives 1.
To promote an understanding of family support principles and their application to strength-based home visiting strategies.
2.
To recognize that these principles apply to working with all families regardless of culture, religion, or sexual orientation.
By the end of this segment, trainees will be able to: 1.
List two principles of the strength-based approach to working with families.
2.
Identify two strength-based approaches to practice that support healthy family development.
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Chapter 3. Strength-Based approach Notes
þ Preparation Checklist In addition to standard training materials, you will need to: Select trainee or another trainer to demonstrate listening activity.
Outline I. II.
Strength-Based Family Support Framework for Family Support Practice (Family Resource Coalition, 1996) Practicing a Strength-Based Approach Communication Techniques Summary
III. IV. V.
Learning Activities I.
Strength-Based Family Support
In this segment of training, we will offer an introductory look at the philosophy of service that provides the basis for this training. It has two names that you may hear used interchangeably: strength-based approach and the family support model. The term strength-based is sometimes confusing. At first glance, it may seem that the term implies that problems are ignored, but that is not the case. Rather, this philosophy emphasizes the need to assess both strengths and problems, and to use individual and family strengths as the most effective means for creating positive change.
Exercise: Journal Activity
Instructor: Ask participants to take a few minutes to write about their favorite and least favorite teachers. Teacher can be loosely defined. Allow 10 minutes for this exercise. Before beginning the discussion, let people know that they can use their own good judgment about sharing or not sharing identities of those about whom they wrote. Ask several volunteers to discuss what theyve written. Keep notes on a board or newsprint. Questions to be discussed include:
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Chapter 3. Strength Based Chapter 3. Strength-Based approach Notes 1. 2. 3. 4.
What was it about this teacher that made him/her your favorite/least favorite? How did it feel to be in the class? How did the teachers attitude affect your performance? Did the teachers beliefs about you become a self-fulfilling prophecy?
P OSSIBLE R ESPONSES I NCLUDE :
Favorite teachers:
Seemed to enjoy being with us and enjoyed the subject matter. Drew the best from us. Helped us enjoy learning. Inspired us. We would work harder to prepare for their class. Treated us as equals in many waysequally intelligent, interested, capable.
Least favorite teachers:
Looked for flaws. Didnt seem to enjoy us or teaching. Treated us as untrustworthy, punished everyone for the misdeeds of a few. Seemed to think we were unworthy of their efforts; that it was unlikely we would understand what they had to say; that if we didnt understand, it was our fault because they had explained it all perfectly well. Strength-Based Approach The strength-based approach to family support builds on the normal, human need to be seen as a whole person. It recognizes that each individual has both strengths and weaknesses. Respect for culture in its various forms is an inherent part of this model of service. A strength-based approach sometimes requires that we take on the role of anthropologist, respectfully inquiring about an unfamiliar culture. When we learn that cultures view of risk and protective factors and their view of what constitutes a healthy family, we can then better understand and serve the people we hope to support. A strength-based approach requires the home visitor to recognize the assets as well as the risks in any situation. It assumes that all parents want to be good parents and will use whatever is available to them to achieve that goal. It helps us engage people cooperatively, to help them observe, comment upon, and set goals for their own lives. It is a challenging and respectful practice that asks Minnesota Home Visitor Training Manual
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Chapter 3. Strength-Based approach Notes
home visitors to discover the meaning people have for their own lives and situations, and to discover the solutions they have for themselves. It defines the home visitors role as one of helping support people in their quest for healthy living. In short, a strength-based philosophy, allows us to recognize hurt while focusing on hope, and recognize pain while focusing on promise. II.
¹
OVERHEAD 1: Premises of Family Support
Framework for family support
In 1996, the Family Resource Coalition established philosophical premises, principles and practices that provide the framework for strength-based family support services. A.
Premises Primary responsibility for the development and well-being of children lies within the family, and all segments of society must support families as they rear their children. Assuring the well-being of families is the cornerstone of a healthy society and requires universal access to support programs and services. Children and families exist as part of an ecological system. Child-rearing patterns are influenced by parents understanding of child development and of their childrens unique characteristics, personal sense of competence, and cultural and community traditions and norms. Enabling families to build on their own strengths and capacities promotes the healthy development of children. The developmental processes that make up parenthood and family life create needs that are unique at each stage in the life span. Families are empowered when they have access to information and other resources and take action to improve the well-being of children, families and communities. The premises identify our thinking or frame of mind as we engage with families.
Instructor: Briefly discuss the premises. Ask if there are any premises with which people disagree. If so, why? Can participants think of community members who would disagree with these premises or would they anticipate general acceptance?
Exercise:
Small group discussion
Instructor: Ask participants to spend 5 minutes reading the discussion questions thinking Page 24
Minnesota Home Visitor Training Manual
Chapter 3. Strength Based Chapter 3. Strength-Based approach about them, and choosing the one they would like to discuss first. Ask for a show of hands to indicate interest in each question and assign areas of the room for each group. Allow a few minutes for groups to gather. Encourage groups to work on several questions in the next 30 minutes. Give a 5-minute warning. When is it hardest for you personally to respect a family or individual? What helps you find your foundation of respect when it is danger of being lost? Which is easier for you in your work with families - celebrating strengths or addressing concerns? Share with the group one personal strength that helps you in your work. What is your greatest personal challenge? What has been your greatest surprise in your work so far? Something you now know or accept about others that you didnt anticipate? What stereotypes have you faced in your life? What stereotypes do your clients face? How can sterotypes be overcome? Can a home visitor ever be too flexible? Discuss when it is important to set aside an agenda and when it is important to return to it. After 20 minutes, ask for highlights of small group discussions. B. Principles Review each of the principles and practices in HANDOUT 1: Framework for Family Support Practice. Staff and families work together in relationships based on equality and respect. Staff enhance families capacity to support the growth and development of all family membersadults, youth and children. Families are resources to their own members, to other families, to programs, to communities. Programs affirm and strengthen families cultural, racial and linguistic identities and enhance their ability to function in a multicultural society. Programs are embedded in their communities and contribute to the community-building process. Programs advocate with families for services and systems that are fair, responsive, and accountable to the families served. Practitioners work with families to mobilize formal and informal resources to support family development. Programs are flexible and continually responsive to emerging family and community issues. Principles of family support are modeled in all program activities, including planning, governance, and administration.
Minnesota Home Visitor Training Manual
Notes
¹
OVERHEAD 4: Strength-Based Family Support Discussion Questions
¹
OVERHEAD 2: Principles of Family Support
HANDOUT 1: Framework for Family Support Practice
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Chapter 3. Strength-Based approach Notes C.
¹
OVERHEAD 3: Practices of Family Support
HANDOUT 2: Lucas Family Scenario
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III.
Practices Promote long-term relationships between staff members and parents that are characterized by warmth, responsiveness and compassion. Incorporate a variety of educational experiences for parents, which offer them opportunities to increase their knowledge and understanding, to examine their habitual ways of thinking and doing things, and to make positive changes. Meet parents where they are, knowing the most effective programs are planned with the involvement of the parents themselves to assure that programs are relevant to the parents specific interests, concerns, and needs. Build on families strengths, understanding that all families have them, and that these strengths are building blocks for growth and improvement. Acknowledge and address the context in which families exist, appreciating and valuing each familys community, culture, and individual traditions, values and life-styles. Insofar as possible, staff members are representative of the participant population. Work with parents as partners, appreciating the value, role, challenges, and satisfactions of parenthood. Balance parents need to learn information and skills with their need to receive attention and be nurtured. Respond to the practical needs of parents who participate. Incorporate outreach efforts to recruit families into the program, inform the community of their existence, and promote collaboration with other agencies, services, and organizations. Practicing a Strength-Based Approach
Exercise:
Identifying strengths: The Lucas Family
Scenario
Instructor: Distribute HANDOUT 2: the Lucas family scenario. Instruct participants to work in small groups, read the scenario aloud, then spend 5 minutes listing all the strengths they can identify for this family. When 5 minutes have passed, call on one small group after another, asking each to name one family strength, until the responses are exhausted. Note each response on newsprint. Chances are that the group is able to identify more strengths than one might have assumed, at first reading.
Minnesota Home Visitor Training Manual
Chapter 3. Strength Based Chapter 3. Strength-Based approach
Exercise:
Notes Identifying strengths: Gail and Jimmy
Instructor: Distribute HANDOUT 3. Ask groups to identify as many strengths as possible in 5 minutes. Next Distribute HANDOUT 4 and ask again that the groups identify strengths. Instructor: After a couple of minutes the trainees may realize that the two scenarios are the about same family, but reflected differently based on how we view the family and the terms we use every day. Again, how we integrate the Family Support Principles into our practice is important. We dont want to ignore problems or strengths. IV.
HANDOUT 3: Case Study One HANDOUT 4: Case Study Two
communication Techniques
A strength-based approach requires that we engage people cooperatively and help them observe, comment upon, and set goals for their own lives. That is far more easily said than done and many people find it helpful to have some tools to use and even words to say to help them get started. Well look at some advice about what to say and what not to say in a strength-based approach. Review HANDOUT 5: Effective Communication inlcuding Discussion Questions.
Exercise:
HANDOUT 5: Effective Communication
Practice Interviews
Instructor: Have participants work in groups of three to practive interviewing a family using some of the effective communication techniques described above. In each group: The parent will talk about her own, real-life experiences and choose what information to share or not share. The home visitor will conduct the interview The observer will take note of strengths in both the visitor and the parent. Allow 25 minutes for this exercise, 15 minutes for the interview, 5 minutes for discussion in small groups and 5 minutes for large group processing. Ask participants what they learned. Focus on strengths. Interviewing is an art form. There is no one right way to do it and it takes years of practice to do it well. Allow yourself time to gain comfort and Minnesota Home Visitor Training Manual
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Chapter 3. Strength-Based approach Notes expertise as an interviewer. As you assess your progress, keep in mind that your goal is to focus on what works by helping people find the hope and motivation they have within. When you see clients as the experts on their lives and treat them as such, there is less pressure and expectation that you as the home visitor will be responsible for a cure. Rather, you will support people in addressing their own issues. Thats the essence of a strength-based approach.
HANDOUT 6: New Approaches to Practice
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V.
Summary
Review HANDOUT 6: New Approaches to Practice to summarize this section of training. As agencies continue to make this shift, practice will continue to change.
Minnesota Home Visitor Training Manual
Premises
of Family Support What is Our Thinking?
(Family Resource Coalition, 1996)
1. Primary responsibility for the development and well-being of children lies within the family - all segments of society must support families as they rear their children. 2. Assuring the well-being of all families is the cornerstone of a healthy society, and requires universal access to support programs. 3. Children & families exist as part of an ecological system. 4. Children-rearing patterns are influenced by parents understanding of child development and of their childrens unique characteristics, personal sense of competence, and cultural and community traditions and mores.
Strength Based Approach
overhead 1-1
Premises
of Family Support What is Our Thinking? (Continued)
(Family Resource Coalition, 1996)
5. Enabling families to build on their own strengths and capacities promotes the healthy development of children. 6. The development processes that make up parenthood and family life create needs that are unique at each stage in the life span. 7. Families are empowered when they have access to information & other resources & take action to improve the well-being of children, families, and communities.
Strength Based Approach
overhead 1-2
Principles
of Family Support Practice What Are Our Standards? (Family Resource Coalition, 1996)
1. Staff and families work together in relationships based on equality and respect. 2. Staff enhance families capacity to support the growth and development of all family membersadults, youth, and children. 3. Families are resources to their own members, to other families, to programs, and to communities. 4. Programs affirm and strengthen famlies cultural, racial, and linguistic identities and enhance their ability to function in a multicultural society.
Strength Based Approach
overhead 2-1
Principles of Family Support Practice What Are Our Standards? (Continued)
5. Programs advocate with families for services and systems that are fair, responsive, and accountable to the families served. 6. Practitioners work with families to mobilize formal and informal resources to support family development. 7. Programs are flexible and continually responsive to emerging family and community issues. 8. Principles of family support modeled in all program activities planning, governance, and administration.
Strength Based Approach
overhead 2-2
Practices of Family Support What Do We Do? (Family Resource Coalition, 1996)
√
Promote long-term relationships
√
Incorporate a variety of educational experiences
√
Meet parents where they are
√
Build on families strengths
√
Acknowledge and address the context in which families exist
√
Work with parents as partners
√
Respond to the practical needs of parents
√
Incorporate outreach efforts.
Strength Based Approach
overhead 3
Strength-Based Family Support Philosophy Discussion Questions
1. When is it hardest for you personally to respect a family or an individual? What helps you find your foundation of respect when it is in danger of being lost?
2. Which is easier for you in your work with families-celebrating strengths or addressing concerns? How do you combine the two?
3. Share with the group one personal strength that helps you in your work. What is you personal challenge?
Strength Based Approach
overhead 4-1
Strength-Based Family Support Philosophy
4. What has been the greatest surprise in your work so far? Something you now know or accept about others that you didnt anticipate?
5. What stereotypes have you faced in your life? What stereotypes do your clients face? How can stereotypes be overcome?
6. Can a home visitor ever be too flexible? Discuss when it is important to set aside an agenda and when it is important to return to it.
Strength Based Approach
overhead 4-2
Framework for Family Support Practice Family Resource Coalition of America, 1996 1. 2. 3. 4. 5. 6. 7.
1. 2. 3. 4. 5. 6. 7. 8. 9.
Premises Primary responsibility for the development and well-being of children lies within the family, and all segments of society must support families as they rear their children. Assuring the well-being of families is the cornerstone of a healthy society and requires universal access to support programs and services. Children and families exist as part of an ecological system. Child-rearing patterns are influenced by parents understanding of child development and of their childrens unique characteristics, personal sense of competence, and cultural and community traditions and norms. Enabling families to build on their own strengths and capacities promotes the healthy development of children. The developmental processes that make up parenthood and family life create needs that are unique at each stage in the life span. Families are empowered when they have access to information and other resources and take action to improve the well-being of children, families and communities. Principles Premisesiples Staff and families work together in relationships based on equality and respect. Staff enhance families capacity to support the growth and development of all family membersadults, youth and children. Families are resources to their own members, to other families, to programs, to communities. Programs affirm and strengthen families cultural, racial and linguistic identities and enhance their ability to function in a multicultural society. Programs are embedded in their communities and contribute to the communitybuilding process. Programs advocate with families for services and systems that are fair, responsive, and accountable to the families served. Practitioners work with families to mobilize formal and informal resources to support family development. Programs are flexible and continually responsive to emerging family and community issues. Principles of family support are modeled in all program activities, including planning, governance, and administration.
Strength Based Approach
hANDOUT 1-1
Framework for Family Support Practice Family Resource Coalition of America, 1996 Practices 1. 2. 3. 4. 5. 6. 7. 8.
Practices Promote long-term relationships between staff members and parents that are characterized by warmth, responsiveness and compassion. Incorporate a variety of educational experiences for parents, which offer them opportunities to increase their knowledge and understanding, to examine their habitual ways of thinking and doing things, and to make positive changes. Meet parents where they are, knowing the most effective programs are planned with the involvement of the parents themselves to assure that programs are relevant to the parents specific interests, concerns, and needs. Build on families strengths, understanding that all families have them, and that these strengths are building blocks for growth and improvement. Acknowledge and address the context in which families exist, appreciating and valuing each familys community, culture, and individual traditions, values and life-styles. Insofar as possible, staff members are representative of the participant population. Work with parents as partners, appreciating the value, role, challenges, and satisfactions of parenthood. Balance parents need to learn information and skills with their need to receive attention and be nurtured. Respond to the practical needs of parents who participate. Incorporate outreach efforts to recruit families into the program, inform the community of their existence, and promote collaboration with other agencies, services, and organizations
Strength Based Approach
hANDOUT 1-2
Lucas Family Scenario Lucas Family Scenario
The Lucas Familyas Family
At first glance, the Lucases seem to live a chaotic lifestyle. They have seven children, ranging from 3 to 14 years of age, four dogs, and a lot of neighborhood kids coming in and out of the house. Mr. Lucas travels a lot due to his job. When you visit, Mrs. Lucas is often cooking or giving a child stern directions or a scolding. Mrs. Lucas and the children go to church almost every Sunday, and it is here that Mrs. Lucas says she draws her strength. Mr. Lucas brings his children presents from his travels, and the family will often go out for dinner or order in on the night he returns. He is home about one week out of the month. The children spend much of their time with other kids down at the school-yard about a block away. Many of the Lucas children are athletic and often play football and basketball, the girls included. Some of the older children have begun to run into some problems at school such as not doing very well on their homework or getting into fights about someone bad-mouthing a sibling. The oldest child was caught smoking. The Lucas children are popular among their friends, and other than an occasional tussle over a toy or borrowed clothes, seem to get along with one another.
Strength Based Approach
Handout 2
Case Study One
Jimmy and Gail live with their two-year-old daughter and Gails 13year-old niece, and are expecting another baby in two months. Both adults are 21 years old, and they have been together for four years. When Gail requested child development services for her daughter, she said, Shes smart, and I want her to stay that way. She also requested after-school care for her niece. Six months after her baby is born shed like job training for herself. Jimmy, who is working part-time, requested job training so he could get a better-paying job to better support his family. Please list this familys strengths.
From “Learning To Be Partners” Family Resource Coalition, 1997
Strength Based Approach
Handout 3
Case Study two
Gail is a single, female head of household in a multi-problem, lowincome family. She has a two-year-old daughter, is seven months pregnant, and for the last four months has been caring for her 13year-old, acting-out niece. Gail has requested job training, although she stated she wants to stay home with the newborn at least six months. Gail and her live-in boyfriend, Jimmy, are both 21 years old. Jimmy is underemployed and is looking for work. Please list this familys strengths.
From Learning To Be Partners Family Resource Coalition, 1997.
Strength Based Approach
Handout 4
Effective Communication
Open-Ended Questions Tell me what happened. Id like to know more about your difficulties with
. What will that mean to you? What was that like for you? Could you tell me more about that? Say more about whats going on with . . . . Tell me about last night. Closed-Ended Questions When long have you had this relationship? How old is your first child? What did the judge say you need to do? When do you need to go back (to the doctor, welfare office, court, etc.)? Clarifying Im not sure I understand. Give me an example. Tell me what you mean when you say your partner nags you. How do you feel about it? You seem to be (angry, happy, worried, etc.). Is that right? Do you mean that
? Are you saying
? Do you think you might be worried? You say youre fine, yet you look very sad. Can you tell me about it? Relabeling Another way to look at that is . . . I wonder if youve ever thought about thinking about it this way? Paraphrasing/Reflecting So youre wondering what to do now? Youre feeling that things are out of control. Problem Solving What have you tried so far? What you did seemed the best choice at the time. Now what might you consider? What more do you need to find out about this? What would it look like if this got better? What support do you have from friends, family, community? Have you ever faced a similar situation in the past? What did you do then? How did it work? What have you learned from your family about this? Which lessons helped? Which didnt? What do you want to do? What would you like help with? What are your hopes for the future? How do you plan to get there? What are your options?
Strength Based Approach
Handout 5-1
Avoiding Ineffective Communication _
SIDING WITH THE UPSET PERSON: Youre too good for him, anyway. Hes such a
jerk.
_
MINIMIZING: Look at the bright side. I dont see why youre so upset.
_
BLAMING THE VICTIM: Youre always having a crisis. Youre not thinking
clearly.
_
OFFERING SOLUTIONS, ADVICE PREMATURELY: Everything will be okay if you will just
. You should tell your mother you wont put up with that any more.
_
REASSURING, CONSOLING, EXCUSING: Things arent as bad as they seem. Itll all
_
work out.
Youll see. Anybody would have freaked out in a situation like that.
COVER FEELINGS WITH HUMOR OR POTENTIALLY MEANINGLESS SAYINGS: I think
you should run away from home. God never gives us more than we can handle.
JUDGING, CRITICIZING, BLAMING: What did you do that made him so mad?
_
MORALIZING AND SERMONIZING:You ought to pay that bill right now. You need
•
LEADING QUESTIONS: “How did you feel? Angry or worried? What did you do? X
to stop doing that. If you really wanted to be a good mother, you would
.
or Y? When you heard from your mother, didnt you feel wonderful?
DOMINATING INTERACTIONS: Talking too much, asking too many close-ended
questions, pressuring, interrupting, making judgements about whats best without checking with clients, lengthy efforts to persuade clients to do what you think is best.
DISCUSSION:
Give examples from your personal experience with this kind of communication. Talk about how it feels to be on the receiving end. Why would someone say this? Why would you want to avoid this kind of communication in your work with clients? Would there ever be a time when it would be appropriate? From a strength-based perspective, what might you say instead?
Strength Based Approach
Handout 5-2
NEW APPROACHES TO PRACTICE
To
From Deficit-focus: Being aware only of the problems families have.
Seeing strengths.
Short-term thinking: relying on quick, easy solutions to serious problems.
Long-term thinking: recognizing that changes, in behavior take time and being willing to make a long-term commitment.
Emphasis on crisis intervention.
Emphasis on crisis intervention.
Ignoring and/or devaluing cultural differences.
Recognizing and affirming cultural differences.
Expecting little of program participants.
Expecting much of participants, who are seen as resources
People of lower social/economic status are seen as having different aspirations than those with higher status.
Recognition that aspirations of people are similar; their degree of access to resources differs.
Professionals have the right kind of knowledge to solve all problems.
People have the right kinds of knowledge. Families have thie own areas of expertise.
Organizations set norms and goals for families.
Families set norms and goals for themselves.
Practitioners choose solutions for families.
Families and practitioners work together to choose solutions.
Program staff have power over families using their programs.
Program staff and families share power.
My views and values are better.
My views and values are different.
*Adapted from Learning to Be Partners, Family Resource Coalition of America, 1997
Strength Based Approach
Handout 6
Chapter 4: Culture and Cultural Context Contents Overview ...........................................................................29 learning objectives ........................................................29 Preparation Checklist ................................................. 30 Outline ............................................................................. 30 Learning Activities .......................................................... 31 Overheads 1. Culture 2. Cultural Portrait 3. The Goal of Working Cross-Culturally 4. Culture Shock Handouts 1. Some Things to Know About Culture 2. What to Learn About Others Cultures 3. How to Learn About Others Cultures (3-1) - (3-3) 4. Stranger to Trusted Friend
cHAPTER 4: Culture and Cultural Context Notes
Overview This session is not an attempt to teach everything home visitors need to know about the many cultural groups that live in Minnesota. Rather, it is an attempt to help home visitors see the importance of learning about other cultures and to provide a foundation for doing so. More specifically, participants will broaden their understanding of the influence of culture on families and their interactions with home visitors. Emphasis is placed on gaining insights into ones own culture, the difficulties that arise when two cultures meet, the process of cultural adaptation, and steps the home visitor can take to facilitate that process. Working to improve cultural competence demonstrates the home visitors interest in and concern for her clients. It also enhances the ability to accurately interpret and assess client situations, and to involve the family in designing and implementing plans that are culturally appropriate. In this curriculum, the role of the home visitor can be viewed as one of liaison between the sponsoring agency, the family, and the individual home visitors cultures. Using this approach, the partners have an opportunity to discover similarities, strengths, and enduring relationships that can emerge from cultural differences.
¦LEARNING OBJECTIVES By the end of this segment, trainees will be able to: 1. Identify 2 personal values derived from culture that influence personal views of other cultures. 2. Identify two common problems that home visitors face in working cross-culturally. 3. Identify two strategies that a home visitor can use to learn about culture.
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
þ Preparation Checklist Colored paper, chalk, markers, tape, glitter, glue sticks, scissors, yarn, etc. Choosing Facilitators Cultural diversity is a highly sensitive and difficult topic for many of us to discuss. This becomes clear when one tries to choose the appropriate language with which to discuss issues or facilitate discussions. A middle-class, white, heterosexual facilitator, for instance, may be seen as less threatening to an audience that shares the same cultural viewpoint. In addition, he/she may also find some authenticity in facilitating the discussion from the point of view of a person from the majority culture who has learned valuable lessons about working cross-culturally. A facilitator of color, on the other hand, or a person from a different sexual orientation or religious or ethnic minority group, can offer a perspective that is generally unavailable to the majority culture. This person can bring a richness to training based on his/her cultural experience, world-view, and personal understanding of the complexities of cultural diversity. In pilot-testing this curriculum, the best results came from cofacilitatorsone majority trainer with significant cross-cultural experience; and one experienced trainer of a local minority culture. The curriculum was sent to the local facilitator ahead of time. When shed had a chance to read through it, the co-facilitators talked by phone about what each person would do, and a face-to-face meeting was held just before the training session. Although the training went well, it would have felt less stressful if the cofacilitators had had more time to meet face-to-face before the training. A consistent team of co-facilitators representing different cultural perspectives would be even better.
Outline I. II. III. IV. V.
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What Is Culture and Why Is It Important We Know About It Defining Culture Recognizing Ones Own Culture and Its Influence Working Cross-culturally Summary
Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context
Learning Activities
Notes
For this training segment, it is particularly important for trainers to share their own experience in working cross-culturally and their feelings about it. Telling what has been hard for us, what we have learned that has been helpful, and sharing mistakes and progress helps reinforce the concept that we are all continually learning together. It is also important to acknowledge that there are multiple cultural perspectives in the training group and that all perspectives offered will enrich the experience. No single half-day of training can adequately prepare home visitors for working cross-culturally. The focus of todays training is to explore the importance and principles of cross-cultural work. Education specific to populations in particular geographic regions should be part of continuing staffdevelopment plans. I. What is culture and why is it important that we know about it? We live in an increasingly diverse society. The 1970 census found that 12% of people in the US were of backgrounds other than Anglo European. That number increased to 30% by the 1997 census. That number is expected to continue to increase significantly in the coming decades. Ethnic diversity is only part of the picture. For this training, we also recognize that diversity includes other powerful influences such as sexual orientation, rural vs. urban dwellers, and social class. Instructor: Before defining culture, I want to share this quote:
At any given moment, our behavior is a product of millions of years of evolution, our genetic makeup, the groups we have been affiliated with, our gender, age, individual histories, our perception of the other person, the situation we find ourselves in, and a long list of other factors. Although culture is the cardinal context, and also offers us a common frame of reference, none of us is ordinary. Simply put, we are our culture and much more. -Samovar and Porter
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
II.
Defining Culture
¹ OVERHEAD 1: Culture
Exercise:
Personal Reflection
Instructor: Ask participants to write a definition of culture beginning with: Culture is
or Culture includes
Allow 5 minutes for writing, then ask participants to share their ideas, as you note them on newsprint posted in the room. Definitions of Culture Culture has been defined in many ways and by many people over the years. Culture is a lens through which we view the world. Culture is our reality. (Strong, 1993). Culture encompasses beliefs and behaviors that are learned and shared by members of a group (Galanti,1997). Culture is the learned, shared and transmitted values, beliefs, norms and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways (Leininger, 1991). Culture is a set of beliefs, attitudes, values, and standards of behavior which are passed from one generation to the next. It is what everybody knows that everybody else (like you) knows (Abney & Gunn, 1993). Culture is a much more than what country ancestors came from, and the types of foods we eat on special occasions. It is an influence so vast and pervasive that it can easily be perceived as simply the way things are until we meet people from different cultures and discover that their view of the way things are is vastly different from ours. Culture is fed to us in our oatmeal, slipped into the bath-water, sprayed into the air we breathe, in the words we hear, sewed into the lining of the clothes we wear. It can bind us together or separate us from one another. If we are to be effective home visitors. We need to seek out the origins and effects of our own culture, to see its importance, and to realize that our own culture is not the way things are for everyone. Our next task, then, is to bring to the front of consciousness our own culture.
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cHAPTER 4: Culture and Cultural Context III. Recognizing ones own culture
Exercise:
Notes
Relaxation/Guided Imagery
Instructor: Ask participants to pretend that a storm has come up and you will need to sleep here for the night. Find a position, either in your chair or on the floor that would be comfortable enough to fall asleep in (but dont fall asleep.) Take off your glasses and shoes if you like. Get as comfortable as you can. Over the next ten minutes, Ill ask you to use several of your senses in a remembering exercise. Imagine that you are laying in bed on a Saturday morning. Its early fall and the room is cool, but your spot on the bed is warm and comfortable. Youre in that lovely stage between sleep and wake where you are aware of sounds and smells and sensations, but your body is still so completely relaxed, your breathing so slow and deep, that anyone who say you would think you were still asleep. The sun is just beginning to warm the room a little. You become aware of a ray of sun shining on your hair, warming your scalp and adding to your relaxation. The relaxation spreads its warmth across your forehead, around your eyes, your cheeks, and your jaw...your trunk...your entire body is warm and soft. Breathe with your whole body. Reposition yourself any time you need to in order to be as comfortable as possible. Relax and imagine years falling away until you are remembering your high school years. Its a Saturday morning, youve just awakened, and you are aware of but separate from your surroundings. Listen to the voices in your house. What language is predominant? What is the tone of voice when adults talk to children? Do people curse? Do they pray? Are voices often raised? Are there long stretches of silence or is there almost always sound of one kind or another? Do the voices sing? Do they read to you or tell you stories from imagination or memory? What do you hear? Remember the voices. They are part of your culture. Smell the food in your house. What will you eat when you get up? Taste it. Picture your kitchen at mealtime. Who is there and how do they interact? Remember who shopped, who cooked, what you ate for everyday and what you ate for special occasions. How were infants fed and who fed them? Were babies held or bottles propped? Was there always enough to eat? Remember food and the feelings connected to it. They are part of your culture. Who, if anyone, did you find sexually attractive when you were 16 and what did you do (or not do) about it? Remember what it was that you found most appealing in others and picture those who caught your eye. What were the rules in your family, spoken and unspoken, about relationships between couples of the opposite sex? Of the same sex? About dating people of another race, religion, or class? From what you saw in real life, what perspective did you have on marriage? How was that the same or different from what you saw on TV or what you dreamed? All these messages, spoken and unspoken, from real life, fantasy, and the media, are part of your culture. Think about how youve pieced them together in your own life.
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
Remember what you thought the future would hold for you when you were sixteen. What assumptions did you make about school and work? About where you might live? How much money you might make? What options did you see as open and what options did you see as closed? Why? What parts of that vision came true? The options you saw for yourself, the power you had to influence the course of your life, and the sense that you should or should not try to do so-- both then and now--all grow from culture.
All of these sights, sounds, smells, connections, and perspectives and thousands more create your culture. They shape your ideas, beliefs, attitudes, and values. They help you learn what to see as normal and healthy, what to see as right and wrong. They guide your thinking, decisions, and actions in patterned ways. Take a moment to step back and see your culture from an outsiders perspective--not as the way things are, but as one way they can be, as the way they have been for you. Imagine that you can put your culture in a deep, elaborate gift-box and hold it on your lap. Whenever you want to, you can take off the lid and look through the intricately fitted layers of things inside. Whenever you need to, you can take out a particular experience, idea, value or belief. You can hold it in your hands, examine it, evaluate it, show it to others. You may even choose to add or remove items from your box, but you know it will take considerable effort to rearrange things to fit well again if you do. Still, sometimes it is necessary and worth the effort. The decision is yours. Think of the people around you in this room and picture them with their own gift-boxes on their laps... Now, imagine a wider circle of people that includes your clients and other professionals you may encounter, each with their own gift-boxes containing their own abundance of experiences, ideas, values, and beliefs. They, too, have the power to hold, examine, evaluate and share what is theirs with others as they choose. They, too, may choose to add or remove items from the box, knowing it will take considerable effort to rearrange things to fit well again if they do. Sometimes they will have the energy and motivation to do so, and sometimes they will not. The decision is theirs. Look back into your own box. Once more, look, feel, taste, smell, touch, and hear... Now stretch and come back.
¹ OVERHEAD 2: Cultural Portrait
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Exercise:
Make Your Culture Visible
Instructor: Tell participants that they are to create a representation of their own culture so that others can understand it better. They can begin with images that came to them in the relaxation exercise. The goal is to convey their cultural perspective. Encourage them to express themselves in whatever way is most comfortable and meaningful to themfrom writing poems or key ideas, to cutting colored shapes, to creating a collage, sharing songs, stories, or dancesany form of expression that will fit the time-frame and setting. Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context Encourage participants to use anything they happen to have with them in their briefcases, pockets, purses, etc. or that they can find outdoors or in the room in the time allowed. Tell them you will reconvene in 30 minutes to share creations.
Notes
When the time has passed, ask participants to share as much about their creation. Allow 30 minutes for discussion. Those who have a song, dance, or story are invited (and encouraged and cajoled) to share with the whole group. Those who would rather not share at all are welcome to stay and listen to others share, or to move to a quiet space to journal about their discoveries. Ask participants for their comments about the exercisewhether it was fun, hard, and/or helpful, and what people may have noticed as they did it. The offerings of the group may be all the closure thats needed for this exercise. If more is needed, try this: while the human experience encompasses many similarities of experience from person to person and culture to culture, there is no doubt that your experience will include encounters with people • Who hear other voices, speaking other languages, using words that have no equivalent in yours. • Whose food had different tastes, aromas, textures
and meaning. • Who grew up learning rules about relationships you might never truly comprehend. • Whose Saturdays may have been spent working in a field or playing computer games, trying to survive in a refugee camp or working in McDonalds, going to a movie with the family, or taking care of younger siblings because parents were working or didnt come home last night. • Whose beliefs about parents and children and the use of power and time and god and medicine and spirituality and fate and a thousand other things are foreign to you. • And whose investment in those beliefs is a strong and legitimate as any you hold. Some Things to Know About Culture Instructor: Review HANDOUT 1: Some Things to Know about Culture. • The influence of culture, language, ethnicity and race is always easier to see in other people than in ourselves. • Culture is learned. Cultural understanding in one’s first culture is typically established by age 5. We learn early how to dress, what to eat, who to talk to and how, what to avoid, whether to look at people we are speaking to or not, language, table manners, how to interact with those of different ages, rules of acceptable emotional Minnesota Home Visitor Training Manual
HANDOUT 1: Some Things to Know About Culture Page 35
Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
•
• •
•
•
¹
OVERHEAD 3: The Goal of Working CrossCulturally
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• IV.
responses, etc. Many of the behaviors and beliefs learned at an early age persist into adulthood and achieve the status of truth in our minds. (Example: Two 5 year old children are arguing over whether people of the same sex could be like married couples. One had been told by her mother that only men and women married. The other argued that her uncle and his partner were like any other married couple.) Culture is resistant to change, yet changes, nonetheless. Ask the group for examples, such as the role of women in the workforce and the roles of fathers as parents. What has changed and what hasnt about these parts of culture? Culture is strongest in the home and in social situations. In describing any culture or cultural practice, within-group differences are as great as across-group differences. In other words, no cultural, ethnic,linguistic,or racial group is homogenous. Dont assume that people who share a common culture or language are alike. Socioeconomic status, education, how much people identify and affiliate with their roots, the language they speak, the length of time theyve been here, and their reasons for coming are all important factors that shape who they are. Values are determined by one’s first culture and may have to be revised to be effective in another. Which of the following would a foreigner think Americans value more? Cooperation or competition, youth or age, family or friends, independence or interdependence, action or passivity. Long-standing behavior patterns are typically used to express one’s deepest values. We as individuals generally behave as we have been culturally conditioned to behave. When we work cross-culturally, its inevitable that our culural perspective and the behavior that expresses it will conflict with someone elses. Being reared in one’s first culture introduces errors in interpreting a second culture. Working cross culturally
Assume that your goal in working with a family is to find a mutually agreeable approach consistent with the clients belief system, and meets the purposes and goals of the home visits.
Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context
Exercise:
Brainstorm or Case Study
Notes
Instructor: Have participants break into small groups to listen and talk about why its hard to achieve that goal when working with people of other cultures. These differences include ethnicity, as well as sexual orientation, religion, political views, and childrearing beliefs. Share specific examples whenever possible to illustrate the difficulty. Group members with limited cross-cultural experience may find it helpful to have a case study as a starting point. If so, consider the following: Case study Your agency has been assigned a family with five children under the age of seven. The familys culture leads them to be distrustful of birth control. Two of the five children are handicapped and eligible for services. The father works two jobs and the mother takes care of her children and her mother-inlaw, with whom the family lives. You have had difficulty getting into the home because the husband in the family does not want interference from outsiders. When you finally make it into the home, you find an exhausted mother who feels trapped and confused by the conflicting demands of her culture and the mainstream culture, the needs of her children, the expectations of the local education and medical systems, and her own need for support. Allow 20 minutes for discussion, then collect responses on a master list.
P
OSSIBLE
R ESPONSES I NCLUDE : You may not know what the clients beliefs are. Their beliefs may be at odds with yours or your agencys. Communication is more difficult. You are more likely to misunderstand one another. Cultural differences may get in the way of building trust. You may feel less sure of yourself or even frightened in this new situation; so may your client.
Culture Shock When people from different cultures interact, the result can be culture shock. It is a normal and universal response to the unfamiliar (Lynch & Hanson, 1998). It can happen when we visit or move to another culture (whether that
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¹
OVERHEAD 4: Culture Shock
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
new culture is New York City or Biloxi, Mississippi or New Delhi) and when we interact with people of other cultures in our home area. Lynch and Hanson(1998) describe it this way:
Culture shock is the result of a series of disorienting encounters that occur when an individuals basic values, beliefs, and patterns of behavior are challenged by a different set of values, beliefs, and patterns of behavior are challenged by a different set of values, beliefs, and behaviors.
Exercise: Personal reflection
Intructor: Ask participants to reflect on personal experiences with culture shock. Perhaps you have liked or worked in another part of the US or in another country. Perhaps you have had close contact with others who are new to the area and unfamiliar with its ways. Perhaps youve had little contact so far with people whose life experience has been very different from yours. Take a few minutes to recognize your experiences so far. For this exercise, recognize small moments of culture chock, as well as longer experiences. Here are a few examples to get you started, from several peoples perspectives: • My friend and her husband worked in the Peace Corps in rural India in the early 70s. Because he was male, he was free to go about his work and found acceptance relatively quickly. Because she was female, her activities were far more confined, and because she could not winnow rice or perform other household activities learned in childhood by native girls, she was considered too incompetent to be of much help in any other way. • I am the mother of a lesbian daughter and thought I had made the adjustment well. One night, not too long after our daughter had come out, my husband, our gay friend and his boyfriend went out to dinner. As we sat in the restaurant talking, my friend put his arm around his boyfriend and squeezed his shoulder. I was surprised at the alarms that went off in my head over all that simple touch implied. The conversation continued uninterrupted and soon the alarms quieted. I thought for a long time about my reaction. • I am an adult blessed with hair I choose to style in many different ways-finger-waves, cornrows, braids, freeze-styles, curls--and proudly wear these various styles to my place of work, just as my colleagues may do after a perm, coloring, or haircut. Yet, unlike them, Ive been followed to my desk with a barrage of questions about my new hair length, how long it took, whether it hurt, whether they can touch it, is it real and comments about how you people have to do a lot with your hair. Page 38
Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context • When I was 5 or 6 years old, my mother and I attended school conferences. We are meeting other families when one of the other parents patted me on the head--and then wiped her hands on her clothes.
Notes
• I am a white women who has worked with a group of mostly AfricanAmerican, drug-addicted women for several years. The first year was very hard for me. It was a loud group and, in my mind, loud often meant aggressive. Over time, I came to admire many qualities of the women in the group and learned that, sometimes, loud is just loud. Several years after starting the group, I was working in a school when a group of young black girls came in to talk to a black staff person who had befriended them. They talked about getting into trouble with a white administrator who apparently thought they were fighting. They explained, We werent fighting! We were just black girls talking loud! Give 5 minutes for person reflection and journaling, then ask for volunteers to share their reflections, asking what, if anything, helped their adjustment. Cultural adaptation Most of us meet new cultures with the expectation that it will go well. If we enter the new culture with the goal of providing help, we are generally optimistic that we will be able to do so. Dissatisfaction results when we discover that the problem-solving strategies weve learned thus far are ineffective in the new environment, so our expectations are not met. This can lead to anger directed toward the people of the new environment and/or ourselves. If we can adjust and find new problem-solving strategies, we can find satisfaction in our interactions and our work, and comfort in the new environment. In the case of long-term travelers, culture shock can happen again upon the return home, though in a shorter and milder version. (In the case of the Peace Corps workers mentioned earlier, the husband was outrages as they flew into New York and saw swimming pools from the air, because he had been made so keenly aware of the shortage of clean water in the Indian village.)
exercise: What to learn about others culture
Ask participants to choose what they see as the 3 most important things to learn first. Instructor: Briefly review HANDOUT 2: What to Learn about Others Culture. What is their history? What was their home of origin? Why did they settle in Minnesota? What religious or spiritual beliefs are influential in this culture and for this individual/family? Minnesota Home Visitor Training Manual
HANDOUT 2: What to Learn About Others Culture
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
HANDOUT 3: How to Learn About Others Culture
Page 40
What are their family customs and roles, especially around child-rearing and discipline? Every culture has a line defined as child abuse. Where is it for this culture? Who are considered excellent parents and what are their practices? What are gender roles? What is their concept of health? What are customary health practices and beliefs? Who is responsible for and influences health care? Do they use home or folk remedies, a healer, shaman, etc.? What is their work? Work ethic? What is the state of the economy employment, unemployment for skilled and unskilled laborers. What are the power structures in this culture? Is age a factor in who has power? Is age a factor in how the home visitor is perceived? Who held positions of power in the past? Who are the most powerful informal leaders? How are decisions made at the community and family levels? How can you communicate effectively in this culture? Learn to recognize the meaning of voice tone, gestures, eye contact, overall body language, terminology used to describe health, face-saving behaviors. What is the clients concept of time and how does it compare to yours? What is the clients concept of personal space? What is considered appropriate touch between people of various relationships? What is your clients role within the family and what are family customs? How closely does your client identify with, affiliate with, his or her culture? How assimilated into mainstream culture are members of the family and how well is that accepted? Identify and verify customs, beliefs, and practices that might be misinterpreted by established institutions within your community, e.g. schools, law enforcement, social services, health care providers. (This includes such beliefs around certain body parts such as the head, intact hymen, female circumcision as well as certain beliefs contrary to Western medicine; e.g. beliefs about cutting or puncturing the skin, transfusions, autopsies, etc.)
Instructor: Remind participants that it’s not safe to assume mutual understanding, shared view, beliefs, concerns or approaches. How to Learn About Others Cultures Briefly review HANDOUT 3: How to Learn About Others Cultures Identify and consult with respected elders or leaders in the community and ask for their assistance, but remember that they dont represent the views of everyone. Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context
Start with the basicslearn proper ways to greet and address clients and correct pronunciation of names, as well as American behaviors clients from this culture may find disrespectful or offensive. Ask questions in a respectful manner. You can say, Ive observed
Im wondering...is that right? Readhistory, journal articles, cultural newspapers, fiction and nonfiction. Read materials written by members of the culture and by those outside the culture. Attend community celebrations that are open to all. Talk to other providers who have more experience and ask for their lessons and insights. Learn about hiring, training, and using interpreters. It is a mistake to think that someone who knows both languages automatically makes a good interpreter.
Notes
Look for someone who: Ø Has the sensitivity, skills and experience to help bridge the cultural gap; who understands and endorses the goals of your project and your fundamental approach for reaching those goals; Ø Can help modify program approaches so that they can be more culturally appropriate; Ø Can translate even technical information in terms families can understand.
Before visiting a family with an interpreter, meet with him/her to discuss your goals, discuss terminology and possible translations of technical terms, forms or other materials you will use, and any sensitive areas that you might discuss. Examine the pros and cons of having family members serve as interpreters. In addition to lacking the skills described above, age and gender issues may make it awkward or embarrassing for the family member to assume this role. Build time into your schedule for cultural learning. These steps should not have to be squeezed in around the edges or rely on conferences every couple of years. (Portions adapted from Developing Cross Cultural Competence, E. Lynch/M.Hanson, 1998).
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes V.
HANDOUT 4: Stranger to Trusted Friend
Page 42
Summary
Adjustment to new cultures, our own and others, takes time, understanding, continued exposure, sensitivity, lowered defenses, taking risks, practicing behaviors that may feel unfamiliar and uncomfortable, for both the home visitor and the client. It requires flexibility, an open heart, and a willingness to accept alternate perspectives. As that process unfolds, we should be able to see changes in our relationships with clients. Stranger to Trusted Friend, and ask for comments/examples from participants. Exercise: Stranger to Trusted Friend Review HANDOUT 4: Stranger to Trusted Friend with large group. Ask group members for comments and examples.
Minnesota Home Visitor Training Manual
cHAPTER 4: Culture and Cultural Context Notes Home Visitor as Stranger Actively protect self and others. Is a gate keeper and guard against outside intrusions: • Suspicious and questioning. • Actively watches and is attentive to what the home visitor does and says. • Skeptical about the home visitors motives and work. • May question how documentation of visits will be used. • Reluctant to share cultural secrets and views that are seen as private knowledge. Protective of local lifeways, values and beliefs. • Dislikes probing by the home visitor or stranger. • Values, beliefs, and practices are not spontaneously shared. • Tends to offer inaccurate data. Modifies truths to protect self, family, community, and cultural lifeways. • Too uncomfortable to become friends or to confide in stranger. May come late, be absent, and withdraw at times from the home visitor
Home Visitor as Trusted Friend Less actively protects self. More trusting of home visitors (less gatekeeping.) • Less suspicious and less questioning. • Less watching the home the home visitors words and actions. • Less questioning of the home visitors motives, work and behavior. Signs of working with and helping the home visitor as a friend: • Willing to share cultural secrets and private world information and experiences. • Offers most local views, values, and interpretations spontaneously or without probes. • Signs of greater comfort, enjoying the home visitor, greater sense of a shared reltionship. • Gives presence, is on time. • Wants home visitor to understand beliefs, people, values, and lifeways. Explains and interprets ideas so home visitor has accurate data. (Adapted by L. Kitaoka & by G. Ferguson from Stranger to Trusted Friend, Leininger, 1991a).
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Chapter and 4: Culture andContext Cultural Context Culture Cultural Notes
Page 44
Minnesota Home Visitor Training Manual
Culture is... _ A lens through which we view the world.Our reality. (Strong, 1993) _ Culture encompasses beliefs and behaviors that are learned and shared by members of a group. (Galanti, 1997) _ Culture is the learned, shared and transmitted values, beliefs, norms and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways. (Leininger, 1991) _ A set of beliefs, attitudes, values, and standards of behavior which are passed from one generation to the next.It is what everybody knows that everybody else (like you) knows. (Abney and Gunn, 1993)
Culture and Cultural Context
Overhead 1
Cultural Portrait
_ The assignment is to find a way to share your culture, past and present, with the group. _ Start with the images from the relaxation exercise. _ Use anything you may have brought with you, any of the art materials in the room. Make something we can see or heara poem, collage, song, dance/movement, collection of key words or concepts, a storywhatever you can share in this space.
Culture and Cultural Context
Overhead 2
The Goal of Working Cross-Culturally
The goal of working cross-culturally is to find a mutually agreeable way for working together that is consistent with the clients belief system and meets the purposes and goals of the home visits.
Culture and Cultural Context
Overhead 3
Culture Shock ]Is a normal and universal response to the unfamiliar.^(Lynch & Hanson, 1998) Results when our basic values, beliefs, and patterns of behavior are challenged by a set of different values, beliefs, and patterns of behavior. Occurs when the ways weve used to solve problems, make decision, and interact are not effective. Leads to an overwhelming sense of discomfort that may appear as frustration, anger, depression, withdrawal, fatigue, aggression, or illness. In any of these states, its hard for us to take constructive action.
Culture and Cultural Context
Overhead 4
some Things to Know About Culture Portions adapted from Developing Cross-Cultural Competence, E. Lynch/M. Hanson, 1998 • The influence of culture, language, ethnicity and race is always easier to see in other people than in ourselves. • Culture simplifies everyday decisions of living. We dont have to make major decisions about what to wear or eat, how to interact, how far to stand from another when we speak to them, etc. because it is established by culture. • Culture is learned. Cultural understanding in one’s first culture is typically established by age 5. We learn early how to dress, what to eat, who to talk to and how, what to avoid, whether to look at people were speaking to or not, language, table manners, how to interact with those of different ages, rules of acceptable emotional responses, etc. Many of the behaviors and beliefs learned at an early age persist into adulthood and achieve the status of truth in our minds. (Example: Two 5 year old arguing over whether people of the same sex could be like married couples. One had been told by her mother that only men and women married. The other argued that her uncle and his partner were like any other married couple.) • Culture is resistant to change, yet changes, nonetheless. • Culture is strongest in the home and in social situations. • In describing any culture or cultural practice, within-group differences are as great as across-group differences.In other words, no cultural, ethnic, linguistic, or racial group is homogenous. Dont assume that people who share a common culture or language are alike. Socioeconomic status, education, how much people identify and affiliate with their roots, the language they speak, the length of time theyve been here, and their reasons for coming are all important factors that shape who they are. • Values are determined by one’s first culture and may have to be revised to be effective in another.Which of the following would a foreigner think Americans value more? Cooperation or competition, youth or age, family or friends, independence or interdependence, action or passivity. Long-standing behavior patterns are typically used to express one’s deepest values. We as individuals generally behave as we have been culturally conditioned to behave. When we work cross-culturally, its inevitable that our cultural perspective and the behavior that expresses it will conflict with someone elses. • Being reared in one’s first culture introduces errors in interpreting a second culture.
Culture and Cultural Context
Handout 1
What to Learn About Others Cultures Portions adapted from Developing Cross-Cultural Competence, E. Lynch/M. Hanson, 1998
What is their history? What was their home of origin? Why did they settle in Minne sota?
What religious or spiritual beliefs are influential in this culture and for this individual/ family?
What are their family customs and roles, especially around childrearing and disci pline? Every culture has a line defined as child abuse. Where is it for this culture? Who are considered excellent parents and what are their practices?
What are gender roles?
What is their concept of health? What are customary health practices and beliefs? Who is responsible for and influences health care? Do they use home or folk remedies, a healer, shaman, etc?
What is their work? Work ethic? What is the state of the economyemployment, unemployment for skilled and unskilled laborers.
What are the power structures in this culture? Is age a factor in who has power? Is age a factor in how the home visitor is perceived? Who held positions of power in the past? Who are the most powerful informal leaders? How are decisions made at the community and family levels?
How can you communicate effectively in this culture? Learn to recognize the meaning of tone of voice, gestures, eye contact, overall body language, terminology used to describe health, face-saving behaviors.
What is the clients concept of time and how does it compare to yours?
What is the clients concept of personal space? What is considered appropriate touch between people of various relationships?
What is your clients role within the family and what are family customs?
How closely does your client identify with, affiliate with, his or her culture? How assimilated into mainstream culture are members of the family and how well is that accepted?
Identify and verify customs, beliefs, and practices that might be misinterpreted by established institutions within your community, e.g. schools, law enforcement, social services, health care providers. (This includes such beliefs around certain body parts such as the head, intact hymen, female circumcision as well as certain beliefs contrary to Western medicine; e.g. beliefs about cutting or puncturing the skin, transfusions, autopsies, etc.)
Culture and Cultural Context
Handout 2
How to Learn About Others Cultures Portions adapted from Developing Cross-Cultural Competence, E. Lynch/M. Hanson, 1998 Identify and consult with respected elders or leaders in the community and ask for their assistance, but remember that they dont represent the views of everyone. • Start with the basicsalearn proper ways to greet and address clients and correct pronunciation of names, as well as American behaviors clients from this culture may find disrespectful or offensive. Ask questions in a respectful manner. You can say, Ive observed
Im wondering...is that right? Readhistory, journal articles, cultural newspapers, fiction and non-fiction. Read materials written by members of the culture and by those outside the culture. • Attend community celebrationsthat are open to all. Talk to other providers who have more experience and ask for their lessons and insights. Learn about hiring, training, and using interpreters. It is a mistake to think that someone who knows both languages automatically makes a good interpreter. Look for someone who has or who, with training, could have: the sensitivity, skills and experience to help bridge the cultural gap; who understands and endorses the goals of your project and your funda mental approach for reaching those goals and can help modify that ap proach to be more culturally appropriate; who can translate even technical information in terms families can under stand. Before visiting a family with an interpreter, meet with him/her to discuss your goals, discuss terminology and possible translations of technical terms, forms or other materials you will use, and any sensitive areas that you might discuss. Examine the pros and cons of having family members serve as interpreters.In addition to lacking the skills described above, age and gender issues may make it awkward or embarrassing for the family member to assume this role. Build time into your schedule for cultural learning.These steps should not have to be squeezed in around the edges or rely on conferences every couple of years.
Culture and Cultural Context
Handout 3-1
How to Learn About Others’ Cultures (Continued) Additional Background Information on Communication and Culture 1.
When the language of the family and the home visitor is different, it is clear that communication will be difficult. However, speaking the same language doesnt guarantee good communication. In fact, linguists have suggested that more than 14,000 meanings can be gleaned from the 500 most commonly used English words.)
2.
In Anglo-European American culture, eye-to-eye contact broken by brief glances in another direction is expected. This is seen as a way to convey trustworthiness, sincer ity and directness.
3.
Eye contact has different interpretations among other cultural groups. Some African Americans and Latinos see making eye contact with someone in authority as disrespectful. Among some Asian groups, eye contact between strangers may be considered shameful.
4.
Among Anglo-Americans, smiling typically shows happiness or amusement. Smiling or laughing is often used to mask other emotions in Asian cultures. It is not unusual for an Asian person to smile or laugh softly when describing something that is confusing, embarrassing, or even sad.
5.
Amount and type of physical contact that is allowed and comfortable varies signifi cantly by culture and is complicated within cultures by differences in age, gender, religion and personal preference.
6.
Among many Chinese and other Asian groups, hugging, back-patting, and handshak ing are not typical and should not be initiated by the home visitor.
7.
Among Muslims and some non-Muslim Middle Easterners, use of the left hand to touch another person, to reach for something, or to take or pass food is inappropriate, because the left hand is associated with more personal bodily functions.
8.
In these same cultures, shoes and the soles of ones feet are thought to be unclean. So, stretching out your legs and causing the feet to point at someone or to touch someone is not appropriate.
9.
Many Americans show affection for children by patting them on the head. This is not an acceptable form of touch among many Asians who may believe that the head is fragile.
10.
Gestures can be used to supplement verbal communication or as symbols that substitute for words. Research on the cross-cultural interpretation of gestures sug gests that members of different cultures say they can recognize 70-100% of the
Culture and Cultural Context
Handout 3-2
How to Learn About Others’ Cultures (Continued) gestures from other groups, but their rate of correct interpretation of these gestures is, in fact, as low as 30%. As a result, gestures more often contribute to misunder standing than to better communication. 11.
For example, nodding the head up and down is taken as a sign of understanding and agreement in mainstream American culture. This same gesture may mean, I hear you speaking to some Asian, American Indian, Middle Eastern and Pacific Island groups. It does not signal that the listener necessarily understands or agrees with
12.
Everything mentioned so far is relatively minor when compared to differences in world view. Take, for example, a home visitor who offers an early intervention program for a handicapped child. The program includes parent education and support, therapy and early education for the child. The family refuses services because their world view tells them that acceptance is the key to a good life. For them, the greater good comes not from trying to change what has happened, but by living in harmony with it.
Culture and Cultural Context
Handout 3-3
Stranger to Trusted Friend
Home Visitor as Stranger Actively protects self and others. Is gate keeper and guards against outside intrusions: Suspicious and questioning. Actively watches and isattentive to what the home visitor does and says. Skeptical about the home visitors motives and work. May question how documentation of visits will be used. Reluctant to share cultural secrets and views that are seen as private knowledge. Protective of local lifeways, values and beliefs. Dislikes probing by the home visitor or stranger. Values, beliefs, and practices are not spontaneously shared. Tends to offer inaccurate data. Modifies truths to protect self, family, community, and cultural lifeways. Too uncomfortable to become friends or to confide in stranger. May come late, be absent, and withdraw at times from the home visitor.
Home Visitor as Trusted Friend Less actively protects self. More trusting of home visitors (less gate-keeping.) • Less suspicious and less questioning. • Less watching the home visitors words and actions • Less questioning of the home visitors motives, work and behavior. Signs of working with and helping the homevisitor as a friend: • Willing to share cultural secrets and private world information and experiences. • Offers most local views, values, and interpretations spontaneously or without probes. • Signs of greater comfort, enjoying the home visitor, greater sense of a shared relationship. • Gives presence, is on time. • Wants home visitor to understand beliefs, people, values, and lifeways. Explains and interprets ideas so home visitor has accurate data.
Adapted by L. Kitaoka and by G. Gerguson from Stranger to Trusted Friend Enable Guide (Leininger, 1991a).
Culture and Cultural Context
Handout 4
Chapter 5: Attachment Contents
Overview ........................................................................... 45 learning objectives ........................................................ 45 Preparation Checklist ..................................................46 Outline ..............................................................................46 Learning Activities .........................................................46 Overheads 1. Attachment Theory 2. Early Interactions 3. Baby Crying Scenes 4. Response Cycle 5. Attachment Behaviors 6. Secure Attachment 7. Insecure Attachment: Anxious Resistant/Ambivalent 8. Insecure Attachment: Anxious-Avoidant 9. Insecure Attachment: Disorganized/Disoriented 10. Working Models 11. Attachment & Culture 12. Goals for Working with Families 13. Practical Suggestions 14. Story Skeleton/Bedtime 15. Stranger in a Strange Land Handouts 1. Attachment and Cultural Considerations 2. Attachment Theory in the Real World
Chapter 3. Strength Based
Chapter 5. Attachment
Overview
Notes
Attachment theory is included in this training because it offers a practical explanation of the critical role of early interactions between parents and children. Supported by on-going research at the University of Minnesota and throughout the world, attachment theory tells us that the way we are cared for in infancy profoundly affects our development and relationships throughout life. It also tells us what good parents have known for years that it is important and necessary to answer childrens cries, to smile back at them, to answer when they talk to usin short, to try to understand what children are telling us and to respond as sensitively and consistently as possible. If we respond to childrens needs, they are more likely to learn to see themselves as competent and effective in getting their needs met, to see others as trustworthy, and to behave in the long run in ways that reflect those positive views of self and others. They are more cooperative, resilient, better at making friends and getting through hard times, and tend to expect the best of themselves and others. If we do not respond well to childrens cues, they may eventually view themselves as unworthy of attention and incompetent. They see the world as comfortless, unpredictable, and unsafe, and respond by withdrawing from it or doing battle with it, not only in childhood but throughout life. The segment introduces attachment theory by discussing key components, types of attachment, cultural considerations, and the idea of working models. It goes on to discuss goals for working with parents around attachment issues and offers practical suggestions for meeting those goals.
¦Learning objectives By the end of this segment, trainees will be able to: 1. Describe two infant attachment behaviors. 2. Define the working models concept. 3. Identify two questions that the home visitor needs to consider regarding the influence of culture on parent/child attachment.
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þ Preparation Checklist You will need: Baby bottle A soft baby toy or two Pieces of candy (optional) for baby volunteers Something that makes noise (a rattle, a small box with paper clips inside, taped shut) 3 x 5 cards prepared as described in Section II/Activities--feelings cards • Open-ended statements/questions Stranger in a Strange Land worksheet (or transparency) Overhead projector Easel, markers and paper or black/white board to write on Story skeleton sheets (or transparency)
Outline I. II. III. IV. V.
Attachment Ways that Babies Communicate Assessment of Attachment Behaviors The Working Model Concept Practical Applications of Attachment Theory
Learning Activities I. ATTACHMENT THEORY It is now widely accepted that the most important thing that happens in the first year of life is the development of attachments between infants and caregivers. Attachment is a mutual, reciprocal relationship that is the result of thousands of interactions over the childs first year of life--interactions in which the child expresses a need and learns how those needs will or will not be met. It is through these interactions that children learn essential information about themselves, others, and the world in which they live.
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An infant whose needs are consistently and sensitively met has the foundation needed to mature into an adult who perceives him/herself as a worthy, lovable person and sees others as trustworthy and caring. An infant whose needs are not met or are inconsistently met will more often become an adult who perceives him or herself as unlovable, and others as rejecting, unavailable or unpredictable and untrustworthy. Thus, understanding the development of attachments in childhood helps us understand both the children and adults we encounter in our work, and can help guide and support us in meeting their needs. It can also provide a lens through which we view all decisions that touch the lives of children.
¹ OVERHEAD 1: Attachment Theory
John Bowlby, a child psychiatrist first presented attachment theory in the 1950s. Mary Ainsworth advanced Bowlbys work with her classification of attachment into discernible types and development of the Strange Situation protocol used to assess the security of a childs attachment to a parent. Out of their work has grown the knowledge that: Babies have ways of letting us know what they need from the moment theyre born. Adults can and should do their best to meet the babys needs. You can care for children and meet their needs without spoiling them. We are most likely to succeed in life if, most of the time, we feel safe, important and competent and if we have people in our lives we can trust. The need to depend on others is normal, healthy and lifelong.
Exercise: Good/Bad Listeners
Instructor: Ask participants to think of someone in their lives who is a really good listener. Give them a moment to bring someone to mind. For those who have a hard time with this, you can give permission to think of someone who is really bad at listening. Make four lists: Good Listeners and Resulting Feelings and Bad Listeners and Resulting Feelings. Ask for volunteers to tell about the person they have in mind (a) What they do that makes them such good (or bad) listeners. (b) How it feels to have someone listen well (or not).
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!P
OSSIBLE
¹ OVERHEAD 2: Early Interactions
RESPONSES INCLUDE:
GOOD LISTENERS Make eye contact Dont interrupt Focus attention on you; are not doing other things while they listen Reflect back what you say Are non-judgmental Dont assume they know what you should do Are empathetic Seemed pleased to be able to help in this way
FEELINGS Valued Accepted Trusting Respected Important Understood
BAD LISTENERS Are distracted Interrupt, cut you off Are focused on whats going on in their own minds, not on what youre saying Often assume they know what you should do or try to fix it for you Stupid
FEELINGS Small Unimportant Patronized Mad Dismissed Judged
When the lists seem fairly complete, ask participants to imagine that for the next year, all of the most important people in their lives would treat them like the person they brought to mind. This would include their boss, co-workers, every member of their family, friends, and doctor. What influence is such a year likely to have on their view of themselves, other people and the world? II. Ways that babies communicate When we were infants, the people who took care of us most of the time were the world to us. The ways in which they interacted with us in those thousands of exchanges over the first year of life answer these critical questions: Am I worthy of attention? Can I count on someone to respond to my needs? Are people trustworthy? Do I have power to affect my environment? Am I safe enough here that I can explore and learn? Ideally, parents interact with children in such a way that the answer to each question is YES.
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Exercise: Cry Box
Instructor: Note: For this, you will need a baby bottle, a soft toy or two, and something small that makes noise, such as a small box with paper clips inside. Hand the box to a trainee and tell the group that this is the babys cry. The baby shakes the box gently if s/he is crying softly and more vigorously to represent crying harder. Play out several scenes with yourself as the parent. If you do not feel that you can do the role-plays effectively, another option is to simply read and discuss the scene descriptions. Possible scenes to include: This two-month old baby has just awakened after a long nap and is very hungry. His mother is on the phone talking to her sister about her concerns about spoiling the baby and all the pressure she feels from her partner and mother to let the baby cry. She says things like: Mom keeps telling me that he has to cry to exercise his lungs. Tom says Im spoiling him; he wants me to let him cry all night, too. He says hell never sleep through if I keep going in there. Im trying to do whats right, but its so hard sometimes. Hes just a little baby! Keep talking to me. I can wait it out better if I have something to distract me.
¹ OVERHEAD 3: Baby Crying Scenes
Though the baby cries long and hard, she does not go to him.
Mom has had a difficult labor and birth and has had sleepless nights caring for the baby. She is home alone, has just done the dishes and some picking up, and is finally laying down for a nap. Just as she lays down, the baby awakens from a nap and needs attention. Mom hopes the baby will go back to sleep but he doesnt. She says things like: Oh, please go back to sleep. I cant take care of you if I cant ever sleep. Dont you know how tired I am! Somebody please help me! You are such a BRAT!
She eventually goes to the baby but is short-tempered with him. She yells at the baby to Stop crying!, props a bottle, slams the door and leaves again. Baby has spent the day with a sitter and Dad is anxious to play with him when they get home. Unfortunately, the baby is exhausted and just
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wants to sleep. Dad continues to try to engage the baby in play, despite the babys cues that he needs to sleep. Dads efforts include patting the babys face, head and face with a soft toy, repeating the babys name and saying things like: Come on play with Daddy. Dont you like Daddy today? Daddys been at work all day. Come on, honey, play with Daddy.
(If role-playing, make this a short scene as it is very annoying to the volunteer baby!) Baby has been sleeping for a long time and wakes up very hungry. The parent is busy with something, but stops and tells the baby that s/he is coming. The parent is gentle with the baby and first offers a toy. When the baby continues to cry, the parent realizes how long its been since the baby was fed and offers the bottle. Process each scene immediately after it’s done. If you have done a role-play, begin by asking the baby how s/he felt. Ask the group the following questions: What happened? Why? Whose needs were met? At what cost? If this happens all the time, the baby will grow up feeling that he or she is . . . and other people are . . . . I would call this kind of parenting. . . . Compare the results of this exercise with the exercise on listening. Instructor: Ask participants to help you brainstorm a list of all the ways babies have of letting us know what they need/dont need. After they have listed a number of cues (crying, sucking, rooting, startling, smiling, cooing, grimacing, yawning, etc.), point out that some of these have opposites and some can be put on a continuum. There are various stages of crying and calming. Babies can suck vigorously, steadily, with pauses, they can play with the nipple, and stop sucking altogether. Some of the less recognized cues are gazing (Im interested. Talk to me.) and disengagement of gaze by turning the head, or closing the eyes (I need a break.) Babies have needs beyond food, clean clothes, sleep, and appropriate clothing. They need interaction, comfort, touch, conversation, movement, stimulation and opportunities to learn through new experiences.
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Instructor: Ask participants to help you brainstorm all the possible responses parents can use to try to help babies. It may be helpful to have parents and home visitors think of this on a continuum of least to most effort. Least effort items include waiting a few minutes to see what happens, using your voice to calm and reassure, swaddling the baby and holding his arms crossed on his chest. Higher effort responses include picking the baby up, walking, rocking, bouncing, changing, and feeding. Looking at possible adult responses in this way can help remind participants of the wide range of possibilities available and alert them to parents who may have a limited repertoire (e.g. parents who always try feeding to calm the baby, or who always put the baby in a wind-up swing.) This may also be a good time to bring up the question of who generally has the largest repertoire of responsesfathers or mothersand to encourage discussion of how the less-experienced parent can gain confidence and skills. Emphasize that fathers and mothers repertoires will have some similarities and some differences and thats good for everyone. THE CUE/RESPONSE CYCLE Its important to point out that there are plenty of times when even the most sensitive and responsive parents guess wrong about what the baby needs. When the baby gives a cue, we make a guess about what to doact or wait. If we decide to act, we need to decide what well try. If we decide to wait, we need to make a decision about how long. After trying whatever weve decided on, we watch for more cues and modify our decisions accordingly.
¹ OVERHEAD 4: Cue/ Response Cycle
Its important to stress that being sensitive and responsive doesnt mean that parents always have to do something or give children what they want. It does mean that parents should do their best to consistently give children what they need. Sometimes, children need time to try to calm themselves, or to work out a problem on their own, or to be left alone. At other times, they need our active assistance. The trick is to figure out what their cues mean and to choose from our repertoire of responses what is the best for that child at that time. When babies and parents are new, its not uncommon to go through this cycle several (or many) times before the cues tell us the need has been met. What is important in the long run is not that we get it right immediately every time, but that we keep trying and learning together. As we try various alternatives, we learn more about how to meet this babys particular needs, the baby learns that we are there trying to help, and we gain confidence in our parenting skills.
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¹ OVERHEAD 5: Attachment Behaviors
III. Assessment of Attachment Behaviors Mary Ainsworths, a pioneer in attachment theory, developed the strange situation, a mini-drama in eight parts, to assess attachment behavior. A parent and child are put in an unfamiliar room with age-appropriate toys. A stranger enters the room, the mother leaves, she returns, she leaves again, returns again, the stranger leaves briefly, the stranger returns, and the mother returns. Throughout these events, childrens responses are videotaped to assess for the following attachment behaviors for later coding. •
•
• •
¹ OVERHEAD 6: Secure Attachment
Seeking closeness, especially when threatened. In the research, this is called proximity-seeking. The child stays within the protective range of the parent. This range is reduced in threatening situations. Using parent as a secure base for exploration. The presence of the attachment figure fosters security and greater exploration. The child plays more freely and creatively in the presence of the parent. Separation protest and active attempts to ward off separation. Showing observer that no one else will do in quite the same way. In the research, this is called specificity of attachment figure. The child shows a preference for the presence of the parent. If s/he is distressed at separation, the parents return is calming in a way that the presence of the stranger is not.
SECURE ATTACHMENT Securely attached children are those who have learned through interaction with their parent that: They are worthy of attention. Someone will consistently respond to their needs People are trustworthy. They do have power to affect their environment. They are safe enough in the world that they can take the risks needed to explore and learn. In the general population, 80% of children are securely attached. Among families encumbered by poverty, highly stressful life circumstances and lack of support, this number drops to 50%. In a strange situation, a one-year old securely attached child will actively play and explore as long as the caregiver is nearby and will check in with him or her through a look, a call, a smile, or by showing a toy. When the caregiver leaves, the child is sometimes upset, and you can see the interest in exploration and play decline. There is pleasure and relief at reunion and the child readily accepts
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the comfort of the parents return, sinking into her embrace and returning to play. The young child uses the caregiver as a secure base because that is where his security liesin their relationshipnot yet inside himself. In school, teachers describe securely attached children as enthusiastic, persistent, effectively positive, cooperative, socially competent and ego-resilient.
Notes
Securely attached children carry with them the expectation that they will be well-treated and liked, and will more often behave in ways that help convey and fulfill that expectation. When they run into people that contradict that expectation, they can usually incorporate it into their view of themselves without too much damage. Anxious resistant/ambivalent attachment: This is the result of inconsistent, unpredictable care in the early months of life. The child never knows whether cries or other cues will be answered or whether his/her basic needs will be met. This can lead to: • Anxiety. • Preoccupation with maintaining contact with the caregiver, clinging or checking back with them so often that the childs ability to engage in meaningful play and exploration is impaired. • Extreme distress at separation from the caregiver and the appearance of ambivalence at reunion as the child alternates between desperate clinging and active resistance to comfort, including pushing away or hitting the parent. Even when comfort is offered, the child cannot calm or continue to explore.
¹ OVERHEAD 7: Anxious Resistant Ambivalent Attachment
In school, these children may: • Be overly dependent on teachers for help and attention. • Lack confidence and self-esteem. • Have trouble forming friendships and tend to socially withdraw from peers. • Be victims or victimizers. A teachers initial response may be to give such children extra care, attention and reassurance. In the long-run, they find that this is not enough and that they need to divide their time more equitably among all students in the class. When the teacher pulls back, the child experiences this as another rejection, and her view of herself as incompetent and unworthy is reinforced. In adolescence, such children often become easy targets for exploitation, because they tend not to use good judgment in choosing people to meet their needs. They also tend to be in a constant state of crisisoften calling out for and rejecting help at the same time.
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¹ OVERHEAD 8: Anxious-Avoidant Attachment
In working with such children or the adults these children become, it is important to promise only what you can deliver, to be very consistent, and to make age-appropriate maturity demands. Anxious-avoidant attachment This type of attachment stems from experience with a caregiver who is chronically unresponsive to the childs cues, either in a neglectful or intrusive way. Parents may provide physical care, so the baby may be clean and welldressed, but care is driven by the parents needs rather than the childs. The child learns, What I want doesnt count. In the Strange Situation assessment, the childs play is flat and of low quality whether the parent is there or not. The child tends to ignore the presence of the parent, shows no signs of distress when the parent leaves, and actively avoids interaction when the parent returns. When the child is stressed, less communication is directed to the parent, so there is even less opportunity for relief of stress. In school, these are often children with significant behavior problems. They are described by teachers as disobedient, aggressive, or withdrawn. Because they lack empathy and will often laugh if someone is hurt, they are unpopular with peers. They lack motivation and perseverance and teachers admit they are happy when these children miss school.
¹ OVERHEAD 9: Disorganized/ Disoriented Insecure Attachment
Disorganized/disoriented insecure attachment This attachment is less well-described and results from the confusion of children who are abused by a primary caretaker. In the Strange Situation, both the environment and the attachment figure are perceived as threats. Children appear torn between proximity seeking and avoidance of the parent. At reunion, a these children may walk toward the parent but then freeze, or reach out their arms to the parent and grimace and turn the head away. Characteristic responses to parents include simultaneous displays of contradictory behaviors, incomplete or undirected movements, behavioral stillingall indicative of confusion and apprehension. This pattern of attachment is linked with dissociative symptoms in adolescence. In later life, any pattern of insecure attachment is strongly implicated in a number of problems, including attention problems, poor social skills, acting out and difficulty with authority figures. These have clear implications beyond school, including future parenting abilities. Children who lack adequate parenting more often become inadequate parents themselves, continuing the cycle and its consequences.
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IV. The Working model Concept Attachment theory holds that the quality of attachment between a parent and child is a major force in determining each persons view of the world, for good or for ill, throughout life, by creating within each of us a working model or blueprint of the self and social relationships. This working model sets the pattern for all relationships that follow, leading the person to engage in behavior that not only confirms but perpetuates early relationship experiences. Many adults in home visiting programs will not have had the benefits of early secure attachments. Their working models tell them: • • •
¹
OVERHEAD 10: Working Model Concept
That others are unresponsive and controlling. That they are unworthy of care and ineffective in getting their needs met. That they are powerless.
Adults with poor attachment models will tend to view behavior of home visitors in a way that fits their working models and behave in ways that perpetuate the treatment they have received. So, they will miss appointments, fail to follow through, say one thing and do another, and set themselves up for rejection. If we want the relationship these clients form with their children to be different from those they knew growing up, we must help them experience relationships in which trusting another person is safe. So, in our interventions, we must try to form relationships unlike others they may have known beforeone where we do what we say we will do; where people can get mad and talk about it, rather than leave or resort to violence; where they can learn that they dont have to shout to be heard; where they can screw up and not be shamed; where they can say what they need and someone will respond; and where they can set us up to quit and we keep coming back, noticing the good things they do and valuing their strengths. Home Visitors may find that clients may "push their buttons" and try to create situations that demonstrate their working models. In essence "treat me like my parents did." In the context of that relationship, we can offer people the chance to look at themselves as individuals and as parents, and to consider the possibility that they have the power to make things better. Areas of general agreement about culture as it relates to attachment include the following ideas: • Attachment theory deals with issues in human development that are fundamental to the human condition and, at the same time, open to influence Minnesota Home Visitor Training Manual
¹ OVERHEAD 11: Attachment and Culture Page 55
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•
HANDOUT 1: Attachment and Cultural Considerations
by culture. Across cultures, experiences of sensitive, warm, loving care produce a securely attached children who are emotionally healthy and socially competent and have great potential to become sensitive and loving care providers for their own children. Human infants are remarkably flexible in what they can perceive as sensitive, warm, loving care. From the African !Kung san baby who is in physical contact with her mother the majority of the time during the first year; to the baby in an Israeli kibbutz who spends the majority of his time, including sleeping, in a separate house from his mother; to infants raised using the wide range of American childrearing practices, most infants and parents from all cultures studied, find ways to become securely attached.
The fundamental question related to attachment for home visitors is: For this family in this cultural setting, what does it mean to provide sensitive, responsive care? Related questions are: • What personal and cultural supports does this parent have for providing such care (from a spouse, extended family, elders, the church, the community)? • What are the forces that determine the norms of child care for this family? • What is the parents attachment history? How might this be tied to his/her culture? • How does this parents culture influence her view of such fundamental issues as dependence/independence, compliance, spoiling, crying and comforting? • How much independence from familial or cultural influences is this parent likely to assert? • Given this familys cultural context, what are the best avenues to use in supporting sensitive, responsive caregiving? Though generalizations may be drawn about some cultural groups childrearing practices, research has consistently found vast intercultural differences. So, while reading about the cultures you are most likely to encounter in your practice is helpful as background information, it is important to see each individual family as unique within its cultural context and to remember that there are many good ways to raise children. V. PRACTICAL APPLICATIONS OF ATTACHMENT THEORY (Adapted from Erickson, M.E. and Kurz-Riemer, K, 1999) Goals for working with families Martha Farrell Erickson in her work with the STEEP (Steps Toward Effective Enjoyable Parenting, 1999) project identified the following goals for helping families:
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•
Learn to respond sensitively to infant cues and signals. Our job here is to help parents recognize the importance of responsive parenting, learn to interpret cues, and develop a repertoire of responses.
•
Understand child development and form realistic expectations and attitudes based on that knowledge and understanding. Parents need to know not only what children are expected to do at a given age, but also what they should not be expected to do. Its important to emphasize individual differences among children and the range of normal development. It may also be necessary for the home visitor to help parents correctly interpret normal developmental steps that might easily be misinterpreted, such as genital play, mouthing objects, use of a pacifier, fear of strangers, and saying no. A good foundation for realistic attitudes about childrearing is ambivalence acceptance and acknowledgment of the enjoyable and difficult parts of each new stage in a childs development.
•
Become better perspective takers on their own childhood issues as well as on their role as parents. Research has found some important differences between adults who pass on abuse to their own children versus those who do not. Those who do not pass on abuse: • See that the way they were treated was wrong. • Resolve not to repeat the abuse. • Get the help they need to look at whats happened and what they want to have happen now. • Find a responsive relationship that changes for the better their view of what relationships can be. Whatever our attachment history, it is helpful to reflect back on our own upbringing and make decisions about what we would like to pass along to our own children, and what we would like to change.
•
Find and learn to use social support. Babies needs are best met by parents whose needs are met. Having needs met generally requires social support that adults with poor attachment histories may be poorly equipped to obtain. The therapeutic relationship established with the home visitor can help lay a foundation for other, supportive relationships to follow.
Practical suggestions for Working with Parents • Help parents learn to talk about feelings. Many of us have difficulty getting started thinking about feelings, sorting them, and expressing them well. Yet, the ability to do so is important in successfully addressing the goals Dr. Erickson has outlined. Activity A below has been a relatively easy way for Health Start clients to find words for their feelings.
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Notes
¹ OVERHEAD 12: Goals for Working with Families
¹ OVERHEAD 13: Practical Suggestions
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HANDOUT 2: Attachment Theory in the Real World
•
Help parents use what they already know. Find and use hidden knowledge. Anyone who is raised by humans has a wealth of knowledge about attachment. We have knowledge about the parts of our own upbringing that made us feel safe and secure and those that did not. Activities B, C and D below provide opportunities for parents to uncover hidden knowledge.
•
Help parents focus on the child and look at things from the child’s point of view. One of our most important tasks is literally to speak for the child. Activities E and F are designed to help mothers step outside their own experiences become better listeners.
ATTACHMENT ACTIVITIES The following activities were developed for Health Start projects and are included in a curriculum resource called, Tools for Mother-Baby Interventions, (Health Start, 1995). They are included here as illustrations of a variety of methods that can be used to help families work toward secure parent-child attachment. Distribute one of the following activities to the group. • Feeling buffet • Message sorting • Story skeletons • Bedtime at home • Open-ended statements • Stranger in a strange land
EXERCISE: Tools for Mother-Baby Intervention Instructor: This exercise is designed to give the trainees practice in using home visit activities which help promote secure attachments. Separate training participants into pairs. Pass out samples of each of the following activities to each pair. Ask that they review the activity and then role play practicing the activity as home visitor and parent. 1. Feelings Buffet (Bring some blank cards so people can write their own words, if they need to.) To prepare for this activity, the following words are typed in large print,cut apart and taped to 3 x 5 cards. They can be used as part of check-in with a client, to help clients identify feelings about a particular event or stage in their childs development. In training, ask people to spread them out and find the three cards that best describe how theyve felt about their work in the past two sweeks. People have a moment to choose cards and then take turns talking about the feelings they identified.
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After 10-15 minutes, ask them to talk about what they thought of the activity and whether they could see themselves using it during home visits. Words to include on cards:
Notes
Happy, liked, annoyed, lonely, anxious, tired, respected, upset, stressed, fulfilled, sad, patient, mad, frustrated, proud, confused, loved, peaceful, exhausted, joyful, stuck, unappreciated, excited, worried, care for, safe, welcome, silly, content, weird, interested, busy, appreciated, disappointed, afraid, trusting, defensive, relieved, jealous, irritated, impatient, depressed, bored, satisfied. 2. Message Sorting Following are some messages people may hear as they grow up. Cards (or slips of paper) containing the messages are spread out on the table. Mothers select cards that reflect what they heard as children and discuss how it felt. For added dramatic effect, they can hold onto those messages they want to pass on to their children and tear up those they want to leave behind. Training participants try out this exercise as just described and then talk about how they feel it might work for them in the field. Messages include: Youll never amount to anything. I knew youd screw it up. Shut up! Stop crying or Ill give you something to cry about. You drive me to drink. I wish Id never had you. Dont be such a baby. Big girls (boys) dont cry. Youre so stupid. Im proud of you. Good for you! Go, Girl! Youre learning. Thanks for your help. Good job. Im glad youre here. Youre a great kid. I love you. Everybody makes mistakes. What would I do without you? Youre so smart. Look how strong you are! Im sorry. Minnesota Home Visitor Training Manual
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¹ OVERHEAD 14: Story Skeleton
I know youre a good person, even when you make mistakes. I was wrong. Good idea! Youre nothing but a slut! I dont care what you want. Im here when you need me. You can count on me. Its okay to be mad. Its not okay to hurt people. I will keep you safe. Youre a spoiled brat. Youre just like your father (mother...). You have a bad temper. If you act like that, you deserve to be hurt. Stay here and get lost if you want, Im going home.
3. Story Skeleton The following story skeleton was invented after a mothers group discussion revealed lack of routines was making bedtime difficult families. The story is completed by mothers with words and pictures, based on what they know about their children and their household. Only a sentence or two is put on each half page, then the pages are cut and fastened into a bedtime story. For training, participants complete the story and volunteers share their stories with the group. As with all the activities listed, they then have time to process with the trainer the value of this kind of tool in promoting attachment on home visits. Use the overhead or give each participant will need a copy of the story. ’s House 4. Bedtime at After supper and after playtime, when Mom and I are getting a little tired, its time to get ready for bed. At our house, bedtime is special. Its special because its always the same and its always nice. (Draw a picture of night outside.) This is what we do. At about __ oclock, my Mom says, Its almost time to get ready for bed. That gives me time to finish what Im doing. Then we get started. I like to be clean at bedtime so (fill in what you do to clean up.) We use . . . . (Draw a picture of clean-up stuff.) My favorite thing to wear to bed is (write what the child wears.) Heres how I look (Draw your child ready for bed.) Then comes my favorite part. My mom helps me feel quiet and cozy by (write what Mom does or could start doing.) Every night, my mom says, (fill in the blank). And I say, (fill in the blank).
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Chapter 5. Attachment
I know my mom will keep me safe through the night and shell be here in the morning when I wake up. For now, my pillow is soft and deep. I close my eyes, and go to sleep. (Draw your sleeping child.)
Notes
5. Open-Ended Statements Using open-ended statements is a way of exploring many issues with parents, including anger, hitting, relationships with partners, and babys changing needs. The statements are typed, cut apart and taped to 3 x 5 cards. Following are some open-ended statements and questions about discipline. Training participants are asked to take turns drawing a card and answering the question or completing the statement. After each person has had a turn, process the exercise, discussing its potential value for home visitors. • In general, I think spanking is ... • I think my parents ways of disciplining were ... • I think when people make a mistake, they should ... • A really dumb rule we had at our house when I was growing up was ... • Parents are most likely to let their kids get away with bad behavior when ... • Someone I know who is good at setting limits is ... • I think its wrong to punish children for ... • In my view, the best discipline results in children who feel ... 6. Stranger in a Strange Land This analogy was written in response to mothers frustration at their childrens clinging and difficulties in separation. It is meant to help mothers understand their supreme importance in the babys sense of security and the key role security plays in the successful accomplishment of all that lies before the child. In training, read the story to the group as participants sit relaxed, with eyes closed. When youre finished, asked the participants to take a moment to write answers to and then discuss questions 1, 4, and 5 listed on the worksheet that follows the story. An optional transparency listing discussion questions is provided and may be used in place of a handout.
¹ OVERHEAD 15: Stranger in a Strange Land
The Story Imagine that you are in a foreign country. You havent been here very long and the language is very complex. Though youve managed to pick up a few words, most of what you understand comes from peoples tone of voice and their faces when they speak to you. You know when people are angry and when theyre happy, but you often cant figure out why. This is a land of very large peopleall of them are at least five times your weight and have ten times your strength. Picture them towering above you. Minnesota Home Visitor Training Manual
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Chapter Based Chapter3.5.Strength ATtachment Notes
You have come to this country as a student and you have an incredible amount to learn and a very short time to learn it. Fortunately, you love to learn and are a hard-working student. You put hours and hours of effort into your schoolwork every day, listening, observing, and practicing your new skills over and over, again and again until you are exhausted, just to wake up the next morning and do it all again. Your task is hugeto learn not only this complicated language, but all the rules and customs and skills required to survive in this strange, new place. If you succeed, your chances for a happy life are good. If you fail, you face the real possibility of years of unhappiness. You have one suitcase on this trip and in it is everything you possess, everything in this world that is important to you. Without it, you are sure you would go hungry, homeless, dirty, and unloved. It holds not only your food, clothing, and money, but all of your I.D.everything that tells you who you are in this scary world. It also holds all your security and safetyall the softness, smells, touch, sights and sounds that comfort you in this place. It should come as no surprise that this suitcase is so big and full and heavy, you cant possibly carry it. You need help. Fortunately, you have found one friend in this worlda native who greeted you when you arrivedsomeone who can speak the language, who is big and strong, and can carry your suitcase for you until you have gained enough strength to carry it yourself. If you had your way, your friends only responsibility would be to help you but that is not the case. As much as she cares for you and wants to help, sometimes she has to do other things that require her to be away; and when she goes, the suitcase goes. When your friend is near, you feel safe and secure and can devote all your energy to meeting the constant demands of learning. But, when shes gone, youre so worried that learning stops. Where could she be? Doesnt she know how much you need your things? How can you get your work done when shes away? When she finally returns, youre overwhelmed with relief and anger, and relief. How could you leave me? You ask. I was scared. I needed you and you were gone. I trusted you and you left me. Thank goodness youre back. What would I do without you? Discussion Questions: How is a baby like the student in the story? List as many similarities as you can.
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Who has your suitcase or at least some of the important stuff from it? Who helps you feel secure, tells you youre okay, supports you? Have they been trustworthy? How does it feel to depend on other people? Whose suitcase do you carry and how does it feel to be responsible for it all the time? What do we need from those who have our suitcases?
Notes
7. Letters from Children to Mothers An idea that comes from Project STEEP is for the home visitor to send a letter to the parent, written on behalf of the baby. Following is a letter written from a child to his mother, who had a lot of trouble separating from her son at group: Dear Mom, I want to thank you for letting me play with the kids and toys at group last Friday. You know I love you and need you and like being with you, but that Mom Room is boring! You did everything I need to help me feel good staying with the kids. You told me good-bye and that youd come back and then just walked on our the door. Of course I cried a little (I wasnt used to it yet) but then I really had fun. Betsy is really nice (like you) and, thanks to you, Im ready now to explore and learn on my own sometimes. I hope you had fun with your friends, too. You have been so good to me and helped me so much through these darned ear infections. I love you. Love you, Your Baby Participants then write a letter from a child they know to an adult they know with these guidelines: the letter must be positive in tone, reflect the developmental stage of the child, and convey a need. Participants then volunteer to read their letters and process the exercise.
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Chapter Based Chapter3.5.Strength ATtachment Notes
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Attachment Theory Babies have ways of letting us know what they need from the moment theyre born (cues). Adults can and should do their best to read those cues and meet the babys needs. You can care for children and meet their needs without spoiling them. We are most likely to succeed in life if, most of the time, we feel safe, important and competent and if we have people in our lives we can trust. The need to depend on others is normal, healthy, and lifelong.
Attachment Theory
Overhead 1
Early Interactions between caregivers and children answer the following questions:
Am I worthy of attention? Can I count on someone to respond to my needs? Are people trustworthy? Do I have power to affect my environment? Am I safe enough here that I can explore and learn? Attachment Theory
Overhead 2
Baby Crying Scenes
√
What happened? Why?
√
Whose needs were met? At what cost?
√
If this happens all the time, the baby will grow up feeling that s/he is . . .
√
and other people are . . .
√
I would call this kind of parenting . . .
Attachment Theory
Overhead 3
cue Response Cycle
Cue
Watch
Watch
Decide: Do something or not. If so, what? If not, how long?
Attachment Theory
Overhead 4
Attachment Behaviors
√ Seeking closeness, especially when threatened. √ Using parent as a secure base for exploration. √ Separation protest. √ Adult is special. No one else will do in quite the same way.
Attachment Theory
Overhead 5
secure attachment Results from: √ Consistent, sensitive, responsive care Leads to: √ Using caregiver as secure base for exploration. √ Infant readily separates to play. √ Affiliative to stranger in caregivers presence. √ Able to accept comfort when distressed and more often able to return to play. √ Active in seeking contact or interaction upon reunion. If distressed, seeks and maintains contact. √ Contact terminates distress. √ If not distressed, shows happiness at reunion and initiates interaction. In school: √ Positive affect, enthusiastic √ Cooperative √ Socially competent √ Perserverant √ Ego resilient Attachment Theory
Overhead 6
insecure attachment: anxious resistant/ambivalent Results from: √ Inconsistent, unpredictable care Leads to: √ Anxiety especially in new situations √ Preoccupation with contact √ Poverty of exploration √ Extreme distress at separation √ Inability to be calmed √ Mixed reaction at reunionmay continue to cry and fuss √ Show striking passivity, mix contact-seeking with resistance (hitting, kicking, squirming) In school: √ Overly dependent on teachers √ Lack confidence, self-esteem √ Lack social skills √ Often victims or victimizers
Attachment Theory
Overhead 7
Insecure Attachment: Anxious-avoidant Results from: √ Chronic unresponsiveness, either in the form of neglect or intrusiveness. Leads to: √ Giving up √ Little checking in, sharing with caregiver. √ Low quality play, flat affect √ Little distress at separation √ Little preference shown for caregiver over stranger √ Avoidance at reunionturns away, looks away, moves away, ignores √ Avoidance more extreme on 2nd reunion √ No avoidance of stranger In school: √ Described as disobedient, aggressive, or withdrawn √ Lack of empathy for peers √ Lack of motivation, perseverance √ Significant behavior problems
Attachment Theory
Overhead 8
INSECURE ATTACHMENT: disorganized/disoriented
Results from: √ Abuse from primary caregiver Leads to: √ Simultaneous display of contradictory behaviors. √ Incomplete or undirected movements. √ Confusion, apprehension.
Attachment Theory
Overhead 9
WORKING MODEL Early attachment relationships largely determine, for good or for ill, our view of the world throughout life, by creating within each person a WORKING MODEL (blueprint) of the self and social relationships. This model sets the pattern for all relationships that follow, leading the person to engage in behavior that not only CONFIRMS but PERPETUATES early relationship experiences.
Attachment Theory
Overhead 10
Attachment & Culture √
√
√
Attachment theory deals with issues in human development that are fundamental to the human condition yet open to influence by culture. Across cultures, experiences of sensitive, warm, loving care produce securely attached children who are emotionally healthy and socially competent. Human infants are remarkably flexible in what they can perceive as sensitive, warm, loving care.
Attachment Theory
Overhead 11
Goals for Working With Families FIND WAYS TO HELP PARENTS: √
Learn to respond sensitively to infant cues and signals.
√
Understand child development and form realistic expectations and attitudes based on that knowledge and understanding.
√
Become better perspective takers on their own childhood issues as well as on their role as parent.
√
Find and learn to use social support.
Attachment Theory
Overhead 12
Practical Suggestions
√ Help parents learn to talk about feelings. √ Help parents use what they already know. √ Help parents focus on the child and look at things from the childs point of view.
Attachment Theory
Overhead 13
Story Skeleton/Bedtime After supper and after playtime, when Mom and I are getting a little tired, its time to get ready for bed. At our house, bedtime is a special time. Its special because its always the same and its always nice. This is what we do. At about oclock, my Mom says, Its almost time to get ready for bed. (That gives me time to finish what Im doing.) Then we get started. I like to be clean at bedtime so we .... My favorite things to wear to bed is .... (Heres how I look!) Then comes my favorite part. My Mom helps me feel quiet and cozy by .... Every night, my Mom says .... And I say .... I know my mom will keep me safe through the night and shell be here in the morning when I wake up to start a new day. For now, my pillow is soft and deep. I close my eyes and go to sleep. Attachment Theory
Overhead 14
Stranger in a Strange Land How is a baby like the student in the story? List as many similarities as you can. What do people need from those who have their suitcases?
Additional questions: Who has your suitcase or at least some of its contents? Have they been trustworthy? How does it feel to depend on other people? Whose suitcase do you carry and how does it feel to be responsible for it? Attachment Theory
Overhead 15
attachment and Cultural Considerations
√
For this culture, what does it mean to provide sensitive, responsive care?
√
What personal and cultural supports doesthis parent have for providing such care?
√
What are the forces that influence the norms of child care for this family?
√
What is the parents attachment history? How might this be tied to culture?
√
How does this parents culture influence the family view of such fundamental issues as dependence/ independence, compliance, spoiling, crying and comforting?
√
How much independence from familial or cultural influences is this parent likely to assert?
√
Given this familys cultural context, what are the best avenues to use in supporting sensitive, responsive caregiving?
Attachment Theory
Handout 1
Attachment Theory in the Real World Practical suggestions for approaching parenting issues, including sample activities chosen from the following: 1. 2. 3. 4. 5. 6.
Stranger in a Strange Land Message sorting Identifying feelings Letters from child to parent Story skeletons Mothers Journal pages
Activity Sample: Letter from Baby to Mother Dear Mom, I want to thank you for letting me play with the kids and toys at CARES last Friday. You know I love you and need you and like being with you, but that Mom Room is boring! You did everything I needed to feel good staying with the kids. You told me good-bye and that youd come back and then just walked on out the door. Of course I cried a little (I wasnt used to it yet) but then I really had fun. Betsy is really nice (like you) and, thanks to you, Im ready to explore and learn on my own sometimes now. I hope you had fun with your friends, too. Youve been so good to me through these darned ear infections. I love you, Mom. Your Baby
Attachment Theory
Handout 2
Chapter 6: understanding Family Systems and Family Development Overview ...........................................................................65 learning objectives ........................................................65 Preparation Checklist ..................................................65 Outline ............................................................................. 66 Learning Activities ........................................................ 66 Overheads 1. A Family Is... 2. Key Elements of Family Systems Theory 3. Components of Family Functioning Handouts 1. The Changing American Family 2. Circle of Human Needs 3. Key Elements of Family Systems Theory 4. Components of Family Functioning (4-1 & 4-1) 5. My Family (5-1 & 5-2) 6. Family Systems: What to Look For (6-1) - (6-3) 7. Eriksons Personality Development (7-1 & 7-2) 8. The Family Life Cycle 9. Gallinsky Stages of Parenthood 10. Ways to Provide Support
Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Overview
Notes
The first and most fundamental relationships we have are with our families, and these family relationships form the basis for all future relationships. The ways in which family members work together, interact with each other, make decisions, and make behavioral changes provide home visitors with valuable information about how new relationships are developed. The family can be seen as a system that consists of extended family groups, a neighborhood, community, culture and society. Using a family systems approach helps home visitors understand the complexity of issues that a family may be facing. It provides a framework for organizing family information and offers a set of principles that describe human behaviors. This lesson examines family structure, needs and functions; identities key elements of family systems theory, and describes the family life cycle. The influence of culture and family values on family systems is also considered. Practical methods for recognizing patterns of interaction among family members and different subsystems are offered.
¦Learning Objectives By the end of this segment, trainees will be able to: 1. List two key elements of family systems theory. 2. Give two examples of how family cohesion is measured. 3. List two ways to provide family support.
þ PREPARATION CHECKLIST You will need: A copy of the childrens book, Love You Forever by Robert Munsch
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
OUTLINE I. II. III. IV. V. VI.
Defining the Family Structure Needs and Functions of the Family Understanding Families through a Family Systems Approach Child Development and the Family Life Cycle Providing Support: Practical Approaches Summary
V LEARNING ACTIVITIES I. Defining the Family Structure Family structure refers to the size, beliefs, and culture of the family. This structure determines how the family will meet its needs (physical, social, economic, etc.) and fulfill its functions. People from various cultures and lifestyles may view the term family very differently. Home visitors must respect each familys culture and value system even if it varies greatly from their own.
Exercise: Family Configuration
Instructor: Ask the large group to think about families that they know or work with. Ask the following questions and list responses on a flipchart. 1. 2. 3.
¹ OVERHEAD 1: A Family Is....
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Who is in the Family? What do all of these families have in common? What makes these groupings of individuals a family?
A family is any group of people who have history (past and future), are united by some form of regular interaction and interdependence, and who function to meet the needs of family members. The Changing Family Over the last few decades the traditional American family structure of mom, dad and 2.2 children has changed along with the roles and functions which members perform.
Minnesota Home Visitor Training Manual
Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Instructor: Highlight two or three changes listed in HANDOUT 1. The Changing American Family 1. More and more women are in the workforce. 2. A rise in deferring marriage and cohabitating instead. 3. Families are having children later in life. 4. Many grown children are returning home to live. 5. Single parent families have doubled. One in three children grow up in a single parent household. 6. Divorces rate continues to climb. Fifty percent of marriages end in divorce. 7. More people are remarrying and forming blended families. 8. Births to unmarried mothers have tripled, one in four. 9. Births to teenage mothers have increased. 10.Nearly 2/3 of female headed households with children live in poverty. 11.One out of five children live in abusive/neglectful environments. 12. One in ten adults in our nation has a problem with alcohol consumption.
Notes
HANDOUT 1: The Changing American Family
These changes have taken place as a result of a variety of factors such as stress, unemployment, lack of adequate health insurance, high mobility, and lack of extended family and friends. They impact the family system in a variety of ways. Home visitors must be aware of these issues and take them into account while assisting a family in identifying needs and setting priorities. The reality of family life is sometimes inconsistent with the expectations, hopes and dreams of family members. II. Needs and Functions of the Family Individuals come from different backgrounds, have different belief systems, and incorporate different cultures. However, all individuals have basic needs that most every family tries to meet. There is a core set of needs and functions that remains fairly constant across families and cultures. There may be differences in the intensity or priority ranking given to any single item.
Exercise:
CIRCLE OF HUMAN NEEDS
(Adapted from Healthy Families Initiative Workshop, 1998) Instructor: Ask participants to work in groups of 4-5. Have the small groups designate a representative to share highlights of their discussion with the larger group. Distribute HANDOUT 2: Circle of Human Needs. Ask participants the
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HANDOUT 2: Circle of Human Needs
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
following questions: When we think of families, perhaps even our own family, what needs do we have that we hope can be filled within our family? Ask participants to individually fill in their own circles. After 3 minutes ask participants to complete the Circle of Human Needs as a group. Draw a large circle on poster paper. During the large group discussion, fill in the circle with the responses from each group representative.
!P
OSSIBLE
RESPONSES INCLUDE:
Laughter Love Time Shelter Stimulation Health
Boundaries Belonging Food Spirituality Success Self-worth
Intimacy Meaningful Work Trust Safety Security Positive Attachment
Continue the large group discussion by asking, What may happen to the familys ability to meet individual needs if the following scenario takes place? Read the following: The family consists of a young, female single parent with a 2-month old. The infant seems to constantly be crying. Mom is tired and having a difficult day. She does not know how to stop the crying. The baby starts crying and mom does not come the first 5 minutes, 10 minutes, 45 minutes. What needs are not being met for the mom? What needs are not being met for the baby? As participants respond, cross out responses such as food, love, security listed on the large Circle of Needs. Use different colors to represent the mothers needs and the babys needs. What if this becomes more than a one day occurrence? In fact, it happens with regularity. What needs or functions would not be met for mom? What needs would not be met for the baby? Again, cross out participants responses e.g., trust, positive attachment, self-worth, feel listened to, loved, stimulated, respect, etc. The circle begins to empty out for both mother and child. When this occurs, the family becomes overburdened. This term is used to describe the accumulation of risk factors. Similarly, families may be undernourished or lack sufficient protective factors to balance negative influences.
Exercise:
Journaling Self Reflection
Most of us have felt overburdened or undernourished at sometime in our life, for example with the birth of a baby, changing jobs, or losing a trusted relationship. Our own circles may have been more empty than full. Page 68
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Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Instructor: Ask participants to take a moment and think about a stressful period when they felt overburdened and/or undernourished, but has now been resolved. Have them refer back to the needs that were listed in HANDOUT 2: Circle of Human Needs. Ask them to cross out the needs that were not being met for them. Ask them to consider how they interacted with others during this time, e.g. strangers, friends, family members. Ask them to consider how others would have described their behavior (e.g. difficult, resistant, unfriendly).
Notes
HANDOUT 2: Circle of Human Needs
Many of the families you may be visiting are overburdened families. It is our role as home visitors to recognize this. We need to view families as survivors discovering how the parent(s) managed to survive in very difficult situations. All people and their environments have strengths that can improve the quality of a familys life. We can help familys recognize and build upon their own existing strengths and the strengths of the communities they live in. We must follow the familys direction. III. Understanding Families through a Family Systems Approach The family is more than a configuration of individuals. Traditionally, when families were studied, they were studied using a deficit model looking at what was going wrong in the family instead of what was going well. Problems were viewed as occurring in one person, the identified patient. This person was often seen as having and or causing problems resulting in blame or scapegoating. The identified patient would often feel guilty, different, or isolated. The approach to intervention was often limited to working with one person, the identified patient. By looking at families through a family systems approach, problems or family concerns, as well as their strengths, are viewed as occurring within the family system as a whole. The family systems approach considers the functioning of the whole family, identifying family themes and similar behavioral patterns among family members. All family members capabilities, strengths, and resources can be drawn upon for positive growth and change. In addition, this approach recognizes and draws upon resources and strengths within the extended family, neighborhood, and community. Key Elements of Family Systems Theory Review HANDOUT 3: Key Elements of Family Systems Theory together. Invite further examples from the group. Individual family members make up a complex whole. All individual family members regardless of the number can be grouped together to form a family. Minnesota Home Visitor Training Manual
HANDOUT 3 Key Elements of Family Systems Theory Page 69
Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
This whole is greater than the sum of its parts. We need to know how these individual family members interact with one another to really understand how the family functions. The family is a structure of related parts or subsystems. Each part carries out certain functions, e.g. spousal subsystems, parent-child subsystem and personal subsystem (each individual and his or her relationships). The goal of the family, like a mobile, is to be balanced or to reach equilibrium. This can be accomplished by changing the relative distance between the parts or subsystems (roles, communication, closeness, power and control). Family has a structure that can only be seen in its interactions. Each family has certain preferred patterns of transactions that ordinarily work in response to day to day demands. Patterns of interaction become ingrained habits that make change difficult. Patterns of interactions among family members must be studied including communication, roles, rules, beliefs, culture, etc. This structure determines how the family will meet its needs or fulfill its functions (physical, socialization, economic, etc.) Each action or change affects every other person in the family. Any change or action (e.g. child leaves family, family member forms new alliance, hostility, mother separating from father) affects the familys stability and causes disequilibrium. Each family has certain rules that are self-regulating and peculiar to itself. These develop over time and become the family history. Family is a purposeful system that has a goal. In most instances, the goal of the family is to remain intact and maintain equilibrium or stability. When change happens the family reaches disequilibrium. This often manifests itself in emotional turmoil and stress. Families try to restore equilibrium by forcing errant members to return to their former position or to create new balance with members in changed relationships. This makes change difficult. Change threatens the old patterns and habits to which a family is accustomed. For families to function well, subsystems must maintain their boundaries. Family members like parts of a mobile, require certain distances or boundaries between each other to maintain balance. When boundaries are blurred the family develops dysfunction. For example, a husband-wife conflict might spill over to the parent-child subsystem if a parent turns to a child for affection ordinarily received from a spouse.
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Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Despite resistance to change each family system constantly adapts to maintain itself in response to its members and environment. Each family exists within a holding environment. The surrounding community, small or large may be a source of nurturance or deprivation.
Notes
Changes in family systems are caused by both nominative (predictable life cycle changes) and non-normative (crisis) stresses. Systems change through the family life cycle. Parent-child relationships change as children and parents pass through developmental stages. For example, a parent must adapt to adolescence by increasing the independence offered to a child and relinquishing more parent control. The family may adapt to stress by restructuring in order to maintain family continuity. For example, if dad loses his job, the children may find work, recreation may be cut or the family may be forced to move. Components of Family Functioning In order to better understand how families function as a unit there are three areas to consider in observing family interactions - cohesion, adaptability, and communication patterns. Family Cohesion is the emotional bonding family members have with each other. How separate/autonomous and how together/intimate are family members? Balancing the I vs. We mentality. Cohesion is measured by the degrees of emotional bonding such as time spent together, decision making patterns, common interest, friends, recreation. How close or connected is the family? According to the research, healthy families have a balance between autonomy and intimacy. CONTINUUM OF FAMILY COHESION Disengaged
Balanced
Enmeshed
¹ OVERHEAD 3 Components of Family Functioning
HANDOUT 4: Components of Family Functioning
EXAMPLES: Disengaged - There is an I mentality. Individual family members look out for themselves only. They spend a lot of time away from the family. Everyone does their own thing. Family members do not eat meals together. No one really knows whats happening with other family members. Balanced - Family members spend time together as a family (e.g. meal times several times a week, camping in the summer, family night). Family members Minnesota Home Visitor Training Manual
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
also participate in activities outside of the home (e.g. softball, friends for lunch, church group, etc.). Enmeshed - There is a We mentality. Family members dont see themselves as separate. They answer we for everything. The family does everything together. Family members are not allowed to have different opinions. Family adaptability is a familys ability to change. It is the ability of the family system to adjust its rules, provide structure, adjust relationship patterns in response to changes (e.g. developmental changes, such as children becoming adolescents, structural changes such as wife becoming employed or stress (family member becomes chronically ill). Family adaptability also includes family control and discipline, styles of negotiating family rules and roles. Some families change everything all the time. Some families try their hardest never to change, even when they should. All families need to change some things and keep some things the same. Adaptability is also measured from high to low. There are two extremes in adaptability. To be rigid means to never change and to be chaotic means always changing.
CONTINUUM OF FAMILY ADAPTABILITY Rigid
Balanced
Chaotic
EXAMPLES: Rigid - The clock is very important. Schedules are always the same and there is no room for change. (e.g. cant ever watch a favorite TV show, even if there is not school the next day because bedtime is bedtime.) Rules and roles dont change, even when they should. There is one way of thinking and one way of doing things. Men do the finances, yard work, discipline. Women do the cooking cleaning, raising children. And children have their roles, chores, dont talk back, complete their home work. Balanced - Family members feel safe because they know they can count on the important things to stay the same. Rules are flexible enough to change when needed. Parent(s) are able to change as the kids change. For example, mom or dad may lay down with a sick child, though he or she usually doesnt; or let kids eat a sandwich later if they need to do something after school; or let a Page 72
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Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter child sleep in a stocking cap if she want to (who cares?) The children are given more freedom and responsibility as they become older and more capable.
Notes
Chaotic - No one knows what the rules are. They change from day to day and person to person? Important things frequently change; families move often, kids frequently change schools, there are many different people in and out of the house, theres no set time for meals, bed, bath, stories, shopping, laundry, etc. Communication patterns facilitate or discourage cohesion and adaptability. Positive communication enables family members to understand, empathize with and support one another. Negative communication fosters criticism, blaming, yelling, that detract from cohesion and adaptability.
V
Exercise: Journaling My Family
Instructor: Give each participant the HANDOUT 5 - My Family. Acknowledge that the best way to learn about how families function is to look a the family you grew up in. Ask home visitors to answer the following questions, choosing a specific time period in their lives (e.g. teen age years, elementary school, when we had our first child, etc.).
HANDOUT 5: My Family
Cohesion Think about the family you grew up in. 1. How did your family celebrate birthdays and holidays? 2. Describe your typical dinner time meal in terms of who is present, who prepares the meal, who cleans up and the type of interaction. 3. What was a typical weekend like in your family. 4. Did you have special times you got together as a family? Please place an X along the continuum of how cohesive you see your family.
CONTINUUM OF FAMILY COHESIVENESS
Disengaged
Balanced
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Enmeshed
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
How would you describe the adaptability/flexibility of your family of origin? 1. Were there established rules and routines (e.g. mealtime, bedtime, curfew, etc.)? Were there ever exceptions to these rules or routines? Did rules, roles, expectations change as you grew older? 2. Were there specific roles for the females vs. the males in the household? 3. How were decisions made? As a group, by an individual, etc. 4. Who was the disciplinarian and what types of discipline were used? 5. How open was your family to change? Please place an X along the continuum of how adaptable you see your family: CONTINUUM OF FAMILY ADAPTABILITY
Rigid
Balanced
Chaotic
Communication Patterns How would you describe the adaptability/flexibility of your family of origin? 1. Did you feel listened to and respected in your family? 2. Where family members free to express their own opinions and feelings? 3. Where messages in your family clear and consistent?
HANDOUT 6 Family SystemsWhat to Look For
This is private information and will not be collected. After 10 minutes, ask group for volunteers to share responses regarding cohesiveness, adaptability, or communication. Refer to HANDOUT 6: Family Systems-What to Look For. IV. Child Development and the Family Life Cycle Instructor: Read Love You Forever by Robert Munsch. This story illustrates how both individual and family development takes place throughout the life course. Along the way individuals grow and take on different roles. Therefore different tasks to attend to at different roles. The family of origin will always influence home visitors and, in turn, their work with families. Personality Development A Psychologist, Erik Erikson, described the development of an individuals personality throughout life (1968). He identified eight successive stages, each of which is characterized by a different personal conflict. Successful
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Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter completion of each stage is necessary so that the individual can move on to the next stage. The environment in which an individual lives, including other people, is an important influence in the successful completion of each developmental stage. Review information from HANDOUT 7: Personality Development (Erikson, 1968) STAGE 1: TRUST VS. MISTRUST (Birth to 15 months) The developmental crisis centers around the babys need to perceive the world as basically friendly and comfortable. Parents and caregivers foster an infants sense of trust by providing responsive care based on observation of the infants behavior, making an effort to make the baby feel loved, respected and capable of eliciting responses from adults. In addition, the baby gains a feeling of wellbeing because his or her basic physiological and emotional needs are met. Mistrust occurs when the infant feels abandoned, threatened, or uncared for in a hostile, nonresponsive environment. Thus babies left to cry for long periods in their cribs or fed and played with only on overly strict schedules may grow to feel that the adults in their lives are harsh and powerful, indifferent to the needs of a helpless child.
Notes
HANDOUT 7 Eriksons Personality Development
STAGE 2: AUTONOMY VS. SHAME AND DOUBT (15 months to 2 1/2 years) The crisis of autonomy occurs when a child perceives his or her separateness from parents and acts to test or gain personal independence. Auto means self. Toddlers try to develop a sense of self by experimenting, challenging, and exploring. Part of their discovery involves pushing away from the people who so far have controlled them. Thus much of their behavior appears to be negative. Me do it, Mine, and No are often heard toddler words which indicate that a child is trying hard to be a person in his or her own right. Toddlers need help in the task of becoming independent. Parents and caregivers who remember that a toddler is trying to develop self-control will understand the childs need for an ally someone who will help him or her develop autonomy. Children who are made to feel that they are bad for trying to stand on their own feet or who are severely punished for saying no or mine or for refusing to share can develop a lasting sense of shame and self doubt. Toddlers need safe limits and wise adult supervision but they also need many opportunities to test themselves. Adults need a strong sense of humor, a lot of patience, and determination to help toddlers develop the inner controls they need so desperately. STAGE 3: INITIATIVE VS. GUILT (2 1/2 TO 5 years) For children in this stage, the developmental task or crisis is to establish a sense of initiativethe courage to have ideas and try them out. This is the stage of I Minnesota Home Visitor Training Manual
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
can do it. Like toddlers, preschoolers are intensely self-centered, but often their behavior is more positive, more active, and more adventuresome. The toddler practices walking, carrying, filling containers and dumping them, going up and down steps, and beginning climbing. Preschoolers can run, hop (sometimes skip), may climb higher than adults would wish, and explore over a wide territory. Most preschoolers have an extensive vocabulary and, in addition to using words they know, experiment with nonsense words or swearing. They enjoy being with children their own age but still require careful supervision because they are quick to insult, hit, bite, or kick their friends and do not always remember rules that are designed to keep them safe. Being able to develop initiative depends on having many opportunities to explore, to create, and to play in ways that engage every one of the five senses. Adults foster childrens initiative when they provide opportunities for play with unstructured materials like boxes, blocks, blank paper and crayons, clay and miniature housekeeping equipment. Preschoolers can also learn through books, but books can never substitute for firsthand experience with real people and objects. STAGE 4: INDUSTRY VS. INFERIORITY (6 to 12 years) School age children address the crisis of industry versus inferiority. Children in this age group need to be productive and succeed in their activities. In addition to play, a major focus of their lives is school. Therefore, mastering academic skills and material is important. Those who do learn to be industrious by expending energy master activities. Comparison with peers becomes exceptionally important. Children who experience failure in school, or even in peer relations, may develop a sense of inferiority. STAGE 5: IDENTITY VS. ROLE CONFUSION (Adolescence) Adolescence is a time when young people explore who they are and establish their identity. It is the transition period from childhood to adulthood when people examine the various roles they play (i.e., child, sibling, student, catholic, native American, basketball star, or whatever), and integrate these roles into a perception of self, an identity. Some people are unable to integrate their many roles and have difficulty coping with conflicting roles; they are said to suffer from role confusion. Such persons are confused; their identity is uncertain and unclear. STAGE 6: INTIMACY VS. ISOLATION (Young Adulthood) Young adulthood is characterized by a quest for intimacy and involves more than the establishment of a sexual relationship. Intimacy includes the ability to share with and give to another person without being afraid of sacrificing ones own identity. People who do not attain intimacy are likely to suffer isolation. These people have often been unable to resolve some of the crises of earlier psychosocial development.
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Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Notes STAGE 7: GENERATIVITY VS. STAGNATION (Mature Adulthood) Mature adulthood is characterized by the crisis of generativity versus stagnation. During this time of life, people become concerned with helping, producing for, or guiding the following generation. In a way, generativity is unselfish. It involves a genuine concern for the future beyond ones own life track. Generativity does not necessarily involve procreating ones own children. Rather, it concerns a drive to be creative and productive in a way that will aid people in the future. Adults who lack generativity become self absorbed and inward. They tend to focus primarily on their own concerns and needs rather than on those of others. The result is stagnation, that is, a fixed, discouraging lack of progress and productivity. STAGE 8: INTEGRITY VS. DESPAIR (Old Age) The crisis of ego integrity versus despair characterizes old age. During this time of life, people tend to look back over their years and reflect on them. If they appreciate their life and are content with their accomplishments, they are said to have ego integrity, that is, the ultimate form of identity integration. Such people enjoy a sense of peace and accept the fact that life will soon be over. Others, who have failed to cope successfully with past life crises and have many regrets, experience despair. The Family LIFE Cycle (Adapted from The Marriage and Family Experience. Strong, B. and DeVault C. 5th ed. West Publishing Company, 1992) Review HANDOUT 8: The Family Life Cycle. STAGE I: BEGINNING FAMILIES: Married couple with no children Average length of stafe is 2 to 3 years Greatest marital satisfaction experienced STAGE II: CHILDBEARING FAMILIES: Childbearing about 30 months apart Childrearing Average 2 children/family Half of women work outside of the home Average length of stage is 2 years Marital satisfaction begins to lessen (continues to decline through stage IV or V)
HANDOUT 8 The Family Life Cycle (Duvall & Miller, 1987)
STAGE III: FAMILIES WITH PRESCHOOL CHILDREN: This familys oldest child is 30 months to 6 years. Minnesota Home Visitor Training Manual
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
Deeply involved in childrearing Average length of stage is 3 years STAGE IV: FAMILIES WITH SCHOOL CHILDREN: Familys oldest child is between six and 13 years old. With children in school, mom has more free time and most enter work force Average length of stage is 7 years STAGE V: FAMILIES WITH ADOLESCENTS: Oldest child is 13 to 20 years old Marital satisfaction reaches its lowest point Average length of stage is 7 years STAGE VI: FAMILIES AS LAUNCHING CENTERS: The first chld has been launches into the adult world The stages lasts until the last child leaves home, average 8 years Marital satisfaction begins to rise STAGE VII: FAMILIES IN THE MIDDLE YEARS: This stage lasts from the time the last child has left home to retirement Commonly referred to as the empty nest stage Sometimes adult children return home Begin caretaking activities for elderly relatives, especially parents and parents-in-law STAGE VIII: AGING FAMILIES Working members of the family have retired Chronic illnesses begin to take effect Eventually one of the spouses dies The surviving spouse may move in with other family members or be cared for by them.
HANDOUT 9 Gallinskys States of Parenthood
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Stages of Parenthood Parents at different times throughout the life cycle have very specific feelings and face specific issues. Ellen Galinsky (1987) described six predictable stages of parental growth. Awareness and understanding of these stages can help parents with the transition from one stage to the next. STAGE 1: IMAGE MAKING (PREGNANCY TO BIRTH) Parents prepare for changes in themselves, their significant relationships and their environments. They form and reform images of whats to come and of the
Minnesota Home Visitor Training Manual
Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter Notes parents that they want to be. This stage becomes a base for comparing these expectations, seeded and consolidated during pregnancy, with the reality of experience. STAGE 2: NURTURING Parents compare images and expectations of themselves and or their child with their actual experience. They are developing an attachment with their baby and learning how much and when to give. STAGE 3: AUTHORITY Parents have the task of deciding what kind of authority to be in guiding their childs behavior. STAGE 4: INTERPRETIVE Entrance into Kindergarten or first grade prompts parents to review images of parenthood. The major task is interpreting how well they are doing and how they have influenced the development of their childs self-concept. STAGE 5: INTERDEPENDENT Issues similar to those in the authority stage reemerge. However, they require different solutions. Parents redefine their relationship with their almost adult child. STAGE 6: DEPARTURE This stage is characterized by evaluations. Parents evaluate images of departure, the parent-grown child relationship, and overall successes and failures. Discussion Questions: • What images or expectations did you have of how things would go at this stage--of how you would be as a parent and of how your child would be? • What polar conflicts do you experience (i.e. wanting to let go and wanting to hold on at the same time?) • What issues or perspectives might be expecially important for fathers at this stage? V. Providing Support: Practical Approaches As home visitors, the goal is to help families build their capabilities and use all the resources available to them in order to promote their familys and childs
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
HANDOUT 10: Ways to Provide Support
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greatest development. Carl Dunst has identified four steps to provide support to families: Instructor: Review HANDOUT 10: Ways to Provide Support 1.
Identify the families needs and priorities. A need is a resource that the family desires but lacks. Needs are to be identified by the family, not the home visitor. (e.g. information, food shelter, vocational opportunities, emotional security, financial security, etc.). Priorities are the things families say they need most. When home visitors listen and respond to those priorities, this lays the groundwork for giving helpful help and building trusting relationships. Family needs change frequently. An important part of your job as a home visitor is monitoring changes in family concerns, priorities, and resources to promote their babys development. As you work with your families, listen to them and be aware of the problems that are creating the most stress in their lives.
2.
Discover the families resources and capabilities. Family resources are the familys abilities to find and use support systems inside and outside of the family that can create a sense of well-being for the family as a group and the individual members of the family. (e.g. being motivated to help the child, having close emotional bond with extended family members or friends, resourceful, being able to budget wisely, reading to your child or knowing how to play with the child in a way that promotes learning). Emphasizing and expanding the familys abilities are likely to increase the confidence and self-esteem of individual family members.
3.
Map the family’s social support network. Identifying the resources and social support that the family already has available. Sources of support may be either informal or formal. The home visitor tries to strengthen each familys informal support network by identifying additional sources of information support and then helping the family access that support. If family needs cannot be met through informal supports, the home visitor helps the family access formal supports.
4.
Mobilize the family’s resources. Home visitors review their familys concerns, priorities, and resources, and then assist family members in developing plans to get the help they want. A rule of thumb to follow is: “Never supply help that the family Minnesota Home Visitor Training Manual
Chapter6.3.UNDERSTANDING Strength BasedFAMILY SYSTEMS & development Chapter can get on its own.” A major goal of home visitors is to encourage families to use members of their informal support network as resources. Doing so empowers families because they learn to meet their own needs. When the informal support network is functioning, the familys dependence on professionals is lessened. It is very easy to rush in and try to fix all the familys problems. For example, you could offer a ride to the clinic when mom says she doesnt have a car. The consequences of doing so is that in the future mom will probably call you whenever she needs a ride to an appointment. This creates a self-defeating dependency on you and prevents their family from gaining self-sufficiency. The fix it approach contradicts the enable and empowering philosophy and may lead to burnout of the home visitor.
Notes
--Adapted from Baird, S. (1994). Preparing Paraprofessional Early Intervention (PPEI) Communication Skill Builders. VI.
Summary The family is a system organized to meet the basic needs of its members. The history, values, culture, and developmental stages of family members all influence how the family functions. Changes in the family system can be brought about by predictable personal and/or family developmental stages as well as unexpected life events. Understanding how the family works together, makes decisions and adapts to change can help the home visitor develop strategies for working with individual families who have a range of backgrounds and resources.
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Chapter 6. 3. Strength Based FAMILY SYSTEMS & development Chapter UNDERSTANDING Notes
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A Family Is... Any group of people
0
who have history (past and future)
0
are united by some form of regular
0
function to meet the needs of family
interaction and interdependence
members
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
OverHead 1
Key Elements of family systems theory
0
Individual family members make up a complex whole and that cannot be understood by examining members separately.
0
The family is a structure of related parts or subsystems.
0
Family has a structure that can only be seen in its interactions.
0
Patterns of interaction become ingrained habits that make change difficult.
0
Each action or change affects every other person in the family.
0 0 0 0 0
Each family has certain rules that are self-regulating and peculiar to itself. The family is a purposeful system; it has a goal. Usually the goal is to remain intact as a family. For families to function well, subsystems must maintain boundaries.
Despite resistance to change each family system constantly adapts to maintain itself in response to its members and environment. Changes in family systems are caused by both nominative (predictable life cycle changes) and non-normative (crisis) stresses.
Systems change through the family life cycle.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
Overhead 2
Components of Family Functioning 1. Family Cohesion
2. Family Adaptability
3. Communication Patterns
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
Overhead 3
The Changing American Family 1.
More and more women are in the workforce.
2.
A rise in deferring marriage and cohabitating instead.
3.
Families are having children later in life.
4.
Many grown children are returning home to live.
5.
Single parent families have doubled. One in three children grow up in a single parenthousehold.
6.
Divorce rate continues to climb. Fifty percent of marriages end in divorce.
7.
More people are remarrying and forming blended families.
8.
Births to unmarried mothers have tripled, one of four.
9.
Births to teenage mothers have increased.
10.
Nearly 2/3 of female headed households with children live in poverty.
11.
One out of five children live in abusive/neglectful environments.
12.
One in ten adults in our nation has a problem with alcohol consuption.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 1
Circle of human needs (Adapted from Healthy Families Initiative Workshop, 1998)
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 2
Key Elements of family systems theory
√
Individual family members make up a complex whole and that cannot be understood by examining members separately.
√
The family is a structure of related parts or subsystems.
√
Family has a structure that can only be seen in its interactions.
√
Patterns of interaction become ingrained habits that make change difficult.
√
Each action or change affects every other person in the family.
√
Each family has certain rules that are self-regulating and peculiar to itself. The family is a purposeful system; it has a goal. Usually the goal is to remain intact as a family.
√
For families to function well, subsystems must maintain boundaries.
√
Despite resistance to change each family system constantly adapts to maintain itself in response to its members and environment.
√
Changes in family systems are caused by both nominative (predictable life cycle changes) and non-normative (crisis) stresses.
√
Systems change through the family life cycle.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 3
components of family functioning Family Cohesion is the emotional bonding family members have with each other. How
separate/autonomous and how together/intimate are family members? Balancing the I vs. We mentality. Cohesion is measured by the degrees of emotional bonding such as time spent together, decision making patterns, common interest, friends, recreation. How close or connected is the family? According to the research, healthy families have a balance between autonomy and intimacy. CONTINUUM OF FAMILY COHESION Disengaged
Balanced
Enmeshed
Examples: Disengaged - There is an I mentality. Individual family members look out for themselves only. They spend a lot of time away from the family. Everyone does their own thing. Family members do not eat meals together. No one really knows whats happening with other family members. Balanced - Family members spend time together as a family (e.g. meal times several times a week, camping in the summer, family night). Family members also participate in activities outside of the home (e.g. softball, friends for lunch, church group, etc.). Enmeshed - There is a We mentality. Family members dont see themselves as separate. They answer we for everything. The family does everything together. Family members are not allowed to have different opinions. CONTINUUM OF FAMILY ADAPTABILITY Rigid
Balanced
Chaotic
Family adaptability is a familys ability to change. It is the ability of the family system to adjust
its rules, provide structure, adjust relationship patterns in response to changes (e.g. developmental changes, such as children becoming adolescents, structural changes such as wife becoming employed or stress (family member becomes chronically ill). Family adaptability also includes family control and discipline, styles of negotiating family rules and roles. Some families change everything all the time. Some families try their hardest never to change, even when they should. All families need to change some things and keep some things the same. Adaptability is also measured from high to low. There are two extremes in adaptability. To be rigid means to never change and to be chaotic means always changing.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 4-1
Examples: Rigid - The clock is very important. Schedules are always the same and there is not room for change. (e.g. cant ever watch a favorite TV show, even if there is not school the next day because bedtime is bedtime.) Rules and roles dont change, even when they should. There is one way of thinking and one way of doing things. Men do the finances, yard work, discipline. Women do the cooking cleaning, raising children. And children have their roles, chores, dont talk back, do home work, etc. Balanced - Family members feel safe because they know they can count on the important things to stay the same. Rules are flexible enough to change when needed. Parent(s) are able to change as the kids change. For example, mom or dad may lay down with a sick child, though he or she usually doesnt; or let kids eat a sandwich later if they need to do something after school; or let a child sleep in a stocking cap if she want to (who cares?) The children are given more freedom and responsibility as they become older and more capable. Chaotic - No one knows what the rules are. They change from day to day and person to person? Important things frequently change; families move often, kids frequently change schools, there are many different people in and out of the house, theres no set time for meals, bed, bath, stories, shopping, laundry, etc.
Communication is what facilitates or discourages cohesion and adaptability. Positive
communication enables family members to understand, empathize with and support one another. Negative communication fosters criticism, blaming, yelling, that detract from cohesion and adaptability.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 4-2
My Family COHESION Think about the family you grew up in. How would you describe or answer the following? 1. 2. 3. 4. 5.
How did your family celebrate birthdays and holidays? Describe your typical dinner time meal in terms of who is present, who prepares the meal, who cleans up and the type of interaction. What was typical weekend like in your family. Did you have special times you got together as a family? Please place an X along the continuum of how cohesive you see your family:
Disengaged
Balanced
Enmeshed
ADAPTABILITY How would you describe the adaptability/flexibility of your family of origin? 1.
Were there established rules and routines (e.g. mealtime, bedtime, curfew, etc.)? Were there ever exceptions to these rules or routines? Did rules, roles, expectations change as you grew older?
2.
Were there specific roles for the females vs. the males in the household?
3.
How were decisions made? As a group, by an individual, etc.
4.
Who was the disciplinarian and what types of discipline were used?
5.
How open was your family to change? Rigid
Balanced
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
Chaotic
HANDOUT 5-1
My Family COMMUNICATION PATTERNS How would you describe the adaptability/flexibility of your family of origin? 1.
Did you feel listened to and respected in your family?
2.
Where family members free to express their own opinions and feelings?
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 5-2
Family systems - what to look for FAMILY STRUCTURE 1. FAMILY COMPOSITION Who are the members of the family system? Do they all live in the household? Who are the decision makers? Is decision making related to a situation, group, or individual orientation? What is the relationship of friends and other family members to the family system? What is the hierarchy of the system? Is status related to gender? 2. PRIMARY CAREGIVER(S) Who is the primary caregiver? Who else participates in caregiving? What is the amount of care given by mother vs. others? Is there any conflict between caregivers regarding appropriate practice? What ecological/environmental issues impinge upon general caregiving? (e.g. jobs, housing, transportation, etc.) 3. ROLES OF FAMILY MEMBERS Who does the day to day tasks (cleaning, cooking, etc.)? Who handles the finances? 4. CHILDREARING PRACTICES a. Family sleeping patterns Does the infant sleep in the same room/bed as the parent(s)? At what age is infant moved away from close proximity of the mother? Is there an established bedtime? b.
How does the caregiver calm an upset infant?
c.
Family feeding practices
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 6-1
Family mealtime rules What types of food are eaten What are the beliefs of breastfeeding, weaning, bottle feeding? Is food purchased or homemade? Who makes the meals? FAMILY PERCEPTIONS AND ATTITUDES 1. Familys perception of health and well being What is the familys approach to medical needs (Western, holistic, etc.)? Who is the primary medical provider or conveyer of medical information (i.e. family member, elders, folk healer, family doctor)? Do all members agree on approaches to medical needs? 2.
Familys perception of help-seeking and intervention From whom will the family accept help? Does the family seek help directly or indirectly? What are general feelings of the family when seeking help (ashamed, angry view as unnecessary)? How are these interactions completed (fact to face, by phone, letter)? Which family members interact with other systems? What is the comfort level in interacting with other systems?
LANGUAGE AND COMMUNICATION STYLES 1.
Language Is the family proficient in English? Is the home visitor proficient in the familys native language? If an interpreter is used: With which culture is the interpreter primarily affiliated? Is the interpreter familiar with colloquialisms of the family members country or region of origin? Is the family member comfortable with the interpreter?
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 6-2
2.
Interaction styles Does the family communicate with each other in direct or indirect style? Does the family tend to interact in a quiet manner or a loud manner? Do family members share feelings when discussing emotional issues? Does the family ask you direct questions? Does the family value a social time at each home visit unrelated to program goals? Is it important for the family to know about the home visitor extended family? Is the home visitor comfortable sharing that information?
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 6-3
PERSONALITY DEVELOPMENT (eRIKSON, 1968) STAGE 1: TRUST VS. MISTRUST (Birth to 15 months) The developmental crisis centers around the babys need to perceive the world as basically friendly and comfortable. Parents and caregivers foster an infants sense of trust by providing responsive care based on observation of the infants behavior, making an effort to make the baby feel loved, respected and capable of eliciting responses from adults. In addition, the baby gains a feeling of well-being because his or her basic physiological and emotional needs are met. Mistrust occurs when the infant feels abandoned, threatened, or uncared for in a hostile, nonresponsive environment. Thus babies left to cry for long periods in their cribs or fed and played with only on overly strict schedules may grow to feel that the adults in their lives are harsh and powerful, indifferent to the needs of a helpless child. STAGE 2: AUTONOMY VS. SHAME AND DOUBT (15 months to 2 1/2 years) The crisis of autonomy occurs when a child perceives his or her separateness from parents and acts to test or gain personal independence. Auto means self. Toddlers try to develop a sense of self by experimenting, challenging, and exploring. Part of their discovery involves pushing away from the people who so far have controlled them. Thus much of their behavior appears to be negative. Me do it, Mine, and No are often heard toddler words which indicate that a child is trying hard to be a person in his or her own right. Toddlers need help in the task of becoming independent. Parents and caregivers who remember that a toddler is trying to develop self-control will understand the childs need for an ally someone who will help him or her develop autonomy. Children who are made to feel that they are bad for trying to stand on their own feet or who are severely punished for saying no or mine or for refusing to share can develop a lasting sense of shame and self doubt. Toddlers need safe limits and wise adult supervision but they also need many opportunities to test themselves. Adults need a strong sense of humor, a lot of patience, and determination to help toddlers develop the inner controls they need so desperately. STAGE 3: INITIATIVE VS. GUILT (2 1/2 TO 5 years) For children in this stage, the developmental task or crisis is to establish a sense of initiativethe courage to have ideas and try them out. This is the stage of I can do it. Like toddlers, preschoolers are intensely self-centered, but often their behavior is more positive, more active, and more adventuresome. The toddler practices walking, carrying, filling containers and dumping them, going up and down steps, and beginning climbing. Preschoolers can run, hop (sometimes skip), may climb higher than adults would wish, and explore over a wide territory. Most preschoolers have an extensive vocabulary and, in addition to using words they know, experiment with nonsense words or swearing. They enjoy being with children their own age but still require careful supervision because they are quick to insult, hit, bite, or kick their friends and do not always remember rules that are designed to keep them safe. Being able to develop initiative depends on having many opportunities to explore, to create, and to play in ways that engage every one of the five senses. Adults foster childrens initiative when they provide opportunities for play with unstructured materials like boxes, blocks, blank paper and crayons, clay and miniature housekeeping equipment. Preschoolers can also learn through books, but books can never substitute for firsthand experience with real people and objects.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 7-1
PERSONALITY DEVELOPMENT (eRIKSON, 1968) STAGE 4: INDUSTRY VS. INFERIORITY (6 to 12 years) School age children address the crisis of industry versus inferiority. Children in this age group need to be productive and succeed in their activities. In addition to play, a major focus of their lives is school. Therefore, mastering academic skills and material is important. Those who do learn to be industrious by expending energy master activities. Comparison with peers becomes exceptionally important. Children who experience failure in school, or even in peer relations, may develop a sense of inferiority. STAGE 5: IDENTITY VS. ROLE CONFUSION (Adolescence) Adolescence is a time when young people explore who they are and establish their identity. It is the transition period from childhood to adulthood when people examine the various roles they play (i.e., child, sibling, student, catholic, native American, basketball star, or whatever), and integrate these roles into a perception of self, an identity. Some people are unable to integrate their many roles and have difficulty coping with conflicting roles; they are said to suffer from role confusion. Such persons are confused; their identity is uncertain and unclear. STAGE 6: INTIMACY VS. ISOLATION (Young Adulthood) Young adulthood is characterized by a quest for intimacy and involves more than the establishment of a sexual relationship. Intimacy includes the ability to share with and give to another person without being afraid of sacrificing ones own identity. People who do not attain intimacy are likely to suffer isolation. These people have often been unable to resolve some of the crises of earlier psychosocial development. STAGE 7: GENERATIVITY VS. STAGNATION (Mature Adulthood) Mature adulthood is characterized by the crisis of generativity versus stagnation. During this time of life, people become concerned with helping, producing for, or guiding the following generation. In a way, generativity is unselfish. It involves a genuine concern for the future beyond ones own life track. Generativity does not necessarily involve procreating ones own children. Rather, it concerns a drive to be creative and productive in a way that will aid people in the future. Adults who lack generativity become self absorbed and inward. They tend to focus primarily on their own concerns and needs rather than on those of others. The result is stagnation, that is, a fixed, discouraging lack of progress and productivity. STAGE 8: INTEGRITY VS. DESPAIR (Old Age) The crisis of ego integrity versus despair characterizes old age. During this time of life, people tend to look back over their years and reflect on them. If they appreciate their life and are content with their accomplishments, they are said to have ego integrity, that is, the ultimate form of identity integration. Such people enjoy a sense of peace and accept the fact that life will soon be over. Others, who have failed to cope successfully with past life crises and have many regrets, experience despair.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 7-2
The Family Life Cycle (Duvall & Miller)
(Adapted from The Marriage and Family Experience. Strong, B. and DeVault C. 5th ed. West Publishing Company, 1992) STAGE I: BEGINNING FAMILIES • Married couple with no children • Average length of stafe is 2 to 3 years • Greatest marital satisfaction experienced STAGE II: CHILDBEARING FAMILIES • Childbearing about 30 months apart • Childrearing • Average 2 children/family • Half of women work outside of the home • Average length of stage is 2 years • Marital satisfaction begins to lessen (continues to decline through stage IV or V) STAGE III: FAMILIES WITH PRESCHOOL CHILDREN • This familys oldest child is 30 months to 6 years. • Deeply involved in childrearing • Average length of stage is 3 years STAGE IV: FAMILIES WITH SCHOOL CHILDREN • Familys oldest child is between six and 13 years old. • With children in school, mom has more free time and most enter work force • Average length of stage is 7 years STAGE V: FAMILIES WITH ADOLESCENTS • Oldest child is 13 to 20 years old • Marital satisfaction reaches its lowest point • Average length of stage is 7 years STAGE VI: FAMILIES AS LAUNCHING CENTERS • The first chld has been launches into the adult world • The stages lasts until the last child leaves home, average 8 years • Marital satisfaction begins to rise STAGE VII: FAMILIES IN THE MIDDLE YEARS • This stage lasts from the time the last child has left home to retirement • Commonly referred to as the empty nest stage • Sometimes adult children return home • Begin caretaking activities for elderly relatives, especially parents and parents-in-law STAGE VIII: AGING FAMILIES • Working members of the family have retired • Chronic illnesses begin to take effect • Eventually one of the spouses dies • The surviving spouse may move in with other family members or be cared for by them. UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 8
stages of parenthood (gALINSKY, 1987) Image Making Stage (pregnancy to birth of child) Parents prepare for changes in themselves, their significant relationships and their environments. They form and reform images of what is to come and of the parents that they want to be. This stage becomes a base for comparing these expectations, seeded and consolidated during pregnancy, with the reality of experience. Nurturing Stage (birth until the child begins saying no, around 18 months to 2 years) Parents compare images and expectations of themselves and of their child with their actual experience. They are developing an attachment with their baby and learning how much and when to give. Authority Stage (2 years to around the 4th or 5th birthday) Parents have the task of deciding what kind of authority to be in guiding their childs behavior. Interpretive Stage (beginning of school years to the approach of adolescence) Entrance of the child into Kindergarten or first grade prompts parents to review the images of parenthood. The major task is interpreting how well they are doing and how they have influenced the development of their childs self-concept. Interdependent Stage (teenage years) Issues similar to those in the authority stage reemerge. However, they require different solutions. Parents redefine their relationships with their almost adult child. Departure Stage (occurs when children leave home) This stage is characterized by evaluation. Parents evaluate images of departure, the parent-grown child relationship, and overall successes and failures. Discussion Questions: What images or expectations did you have of how things would go at this stageof how you would be as a parent and of how your child would be? What polar conflicts do you experience (i.e. wanting to let go and wanting to hold on at the same time?) What issues or perspectives might be especially important for fathers at this stage? UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 9
Ways to Provide Support 1. Identify the familys needs and priorities. A need is a resource that the family desires but lacks. Needs are to be identified by the family, not the home visitor. (e.g. information, food shelter, vocational opportunities, emotional security, financial security, etc.). Priorities are the things families say they need most. When home visitors listen and respond to those priorities, this lays the groundwork for giving helpful help and building trusting relationships. Family needs change frequently. An important part of your job as a home visitor is monitoring changes in family concerns, priorities, and resources to promote their babys development. As you work with your families, listen to them and be aware of the problems that are creating the most stress in their lives. 2. Discover the familys resources and capabilities. Family resources are their familys abilities to find and use support systems inside and outside of the family that can create a sense of well-being for the family as a group and the individual members of the family. (e.g. being motivated to help the child, having close emotional bond with extended family members or friends, resourceful, being able to budget wisely, reading to your child or knowing how to play with the child in a way that promotes learning). Emphasizing and expanding the familys abilities are likely to increase the confidence and self-esteem of individual family members. 3. Map the familys social support network. Identifying the resources and social support that the family already has available. Sources of support may be either informal or formal. The home visitor tries to strengthen each familys informal support network by identifying additional sources of information support and then helping the family access that support. If family needs cannot be met through informal supports, the home visitor helps the family access formal supports. 4. Mobilize the familys resources. Home visitors review their familys concerns, priorities, and resources, and then assist family members in developing plans to get the help they want. A rule of thumb to follow is: Never supply help that the family can get on its own. A major goal of home visitors is to encourage families to use members of their informal support network as resources. Doing so empowers families because they learn to meet their own needs. When the informal support network is functioning, the familys dependence on professionals is lessened. It is very easy to rush in and try to fix all the familys problems. For example, you could offer a ride to the clinic when mom says she doesnt have a car. The consequences of doing so is that in the future mom will probably call you whenever she needs a ride to an appointment. This creates a self-defeating dependency on you and prevents their family from gaining self-sufficiency. The fix it approach contradicts the enable and empowering philosophy and may lead to burnout of the home visitor. Adapted from Baird, S. (1994). Preparing paraprofessional early interventionists (PPEI). Communication Skill Builders.
UNDERSTANDING FAMILY SYSTEMS & fAMILY dEVELOPMENT
HANDOUT 10
Chapter 7:
EARLY PARENTING: A focus on mothering
Overview ........................................................................... 83 LEarning objectives ........................................................ 83 Preparation Checklist .................................................. 83 Outline ..............................................................................84 Learning Activities .........................................................84 Overheads 1. 2.
Maternal Tasks of Pregnancy Maternal Tasks of Early Postpartum
Handouts 1. 2. 3.
4. 5. 6.
Maternal Tasks of Pregnancy Maternal Tasks of Early Postpartum (2-1 & 2-2) Approaches for Assessment and Support of Mothering Strengths and Capacities (3-1) - (3-3) Scenario One Scenario Two Scenario Three
Chapter 3. Strength Based Chapter 7. Early Parenting: a focus on mothering Overview
Notes
A babys early care has long lasting effects on how the baby develops and learns as well as how she copes with stress in later life. Recent research shows that a strong, secure attachment to a loving adult can have a protective effect on a growing child. Many factors influence a parents ability to provide the warm, sensitive and responsive care that fosters secure parent/infant attachment. Early competence in the parenting role is one factor that has been positively associated with the development of maternal affectional behaviors (Walker, Crain, and Thompson, 1986) and positive attachment to the baby. The pregnancy and birth experiences, as well as the early days and weeks following birth offer unique opportunities to promote maternal self- confidence, competence and pleasure in caring for a baby. This module provides information on the development of maternal behaviors, maternal tasks of the postpartum and activities that can help new mothers discover their inner capacities to parent. In addition, those factors that influence a parents ability to parent including cultural, environmental and psychological factors are examined.
¦LEARNING OBJECTIVES By the end of this SEGMENT, trainees will be able to: 1. List three factors that influence a womans capacity for mothering. 2. List three maternal tasks of the early postpartum. 3. List three home visitor interventions that can promote maternal confidence and competence during the early postpartum. 4. Cite one example in which culture influences the development of maternal behaviors.
þ PREPARATION CHECKLIST In addition to standard training materials, you will need: Baby doll Newsprint and markers Paper clips in a small box
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OUTLINE I. Preparation for Mothering II. Self-Confidence and Mothering Capacity III. Developmental Stages of the Mothering Role IV. Influences on Development of the Mothering Role V. Approaches for Assessment and Support of Mothering Strengths and Capacities VI. Summary
V LEARNING ACTIVITIES I. Preparation for Mothering Mothering is a relationship with a baby or child characterized by a strong, emotional attachment that promotes the infant/childs survival and well being (Barnard, 1995). A womans potential for mothering is influenced by maternal, infant and environmental factors (Mercer, 1981; Rubin, 1984; Koniak-Griffin, 1993) some of which include: Quality of mothering she herself received. Acceptance of her femininity. Personal values and goals. Relationship with the babys father/ partner and degree of security she derives from it. Circumstances surrounding pregnancy and how welcome it is. Physical conditions of pregnancy and delivery.
Exercise: iNFLUENCES ON MOTHERING CAPACITY
Instructor: Ask large group to brainstorm list of additional influences on mothering potential and early experiences with baby. The list should include child and environmental factors as well as maternal factors. Encourage trainees to discuss how these influences affect mothering capabilities.
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!P
Notes OSSIBLE
RESPONSES INCLUDE:
Parenting that both parents received Self-confidence Culture Adjustment to role as parent of baby Babys temperament and special needs Knowledge of infant behaviors Support the parent/s receives Expectations of baby Relationship with partner Health of parents and baby Previous childbirth experience Spacing between births Have group members then sort factors into those that are fixed and those that could be influenced by information, guidance and support from home visitors. II. Self-Confidence and Mothering Capacity Pregnancy, birth and the early postpartum period provide unique opportunities for promoting a mothers competence and self-confidence in her mothering role, characteristics that are linked to the mothers attachment to baby. In a study of maternal role attainment, Mercer, Nichols, and Doyle (1988) suggest that transitions such as childbirth are turning points which result in assumption of new roles and new relationships leading to new self-concept. The transition to a new role, whether it is the mother of one or more than one child, can disrupt the mothers sense of self and lead to feelings of anxiety, uncertainty, and vulnerability (Mercer, Nichols, & Doyle, 1998; Ruble et al., 1990). In order to develop comfort with the new role, a maternal identity, a mother needs to perceive herself as competent so that she becomes confident in her ability to meet babys needs.
Exercises: Memories and fantasies
Instructor: Ask participants to close books, get comfortable and close eyes or daydream. Begin exercise with slowly reading the following statements and questions: “ I would like to take you on a journey. For some of you this will be a memory and for others this will be fantasy. Think about the first time that you held your child.” 1. Where were you? 2. Who was with you? 3. How did you feel? Minnesota Home Visitor Training Manual
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Chapter Based Chapter 3. 7. Strength Early Parenting: a focus on mothering Notes
4. What did your baby look like? 5. What was your birth experience like? Was it what you expected? “Now think back to the first week at home with a new baby.” 1. What was your first week with your new baby like? Was it what you expected? 2. What types of questions did you have? What were your worries? 3. Who helped you? 4. Were there cultural or family traditions that you followed to help you through those first days and weeks? 5. What experience during that first week do you remember most clearly and why? Following a minute of silence, read the following statements and questions: “Some of you had the experiences that you anticipated. Others did not.” 1. Did anyone in the hospital or at home ask you about the birth and how it fit with your expectations? 2. What types of questions did you have and where did you get the answers? 3. What were your worries? With subsequent children, what were the differences in your worries and your experiences? 4. Who helped you during the first two weeks with a new baby? 5. What were the cultural or family traditions that you observed? 6. If your baby wasnt what you expected, was there anyone that you could talk to about this? 7. When did you begin thinking of yourself as mother of the baby that you had? 8. What contributed to your feelings of confidence and competence as mother of this new baby? Ask for volunteers to share experiences and summarize responses. The feedback that a woman receives regarding her performance during childbirth can influence her perception of self as competent (Mercer & Stainton, 1984; Humenick & Bugen, 1981). Her successful performance of mothering tasks also contributes to her perception of self as competent. Her perception of her performance during birth and in caring for baby are influenced by feedback that she receives from her partner, family, friends, nurses and physicians as well as the baby. Promoting the mothers perception that she is competent will help encourage development of confidence in her ability to meet her babys needs.
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Notes Exercises:
Cry Box (See attachment module)
Instructor: For this exercise, you will need a baby bottle, a baby doll, and something small that makes noise, such as a small box with paper clips inside. Hand the box to a trainee and tell the group that this is the babys cry. Instruct the trainee (baby) to shake the box gently if s/he is crying softly and more vigorously to represent crying harder. Play out the following scenarios with the instructor as the mother: Instructor: Scenario One You had a long labor and delivery and have been waking up at night every 2-3 hours to feed the baby. When you burp the baby, s/he vomits most of the feeding and cries. You comfort the baby e.g. speak softly to him/her, hold upright against your chest, and rub babys back gently. Trainee: (Baby) After you have vomited the feeding, you shake the box with paper clips vigorously to represent loud crying. As the mother comforts you, you cry more softly and after a minute you stop crying completely. Instructor: Scenario Two You had a long labor and birth and have been waking up at night every 2-3 hours to feed the baby. When you burp the baby, s/he vomits most of the feeding and cries. You comfort the baby e.g. speak softly to him/her, hold upright against your chest, and rub babys back gently. Baby cries louder and louder and does not respond to your efforts to comfort him/her. After a few minutes of loud crying you give up and put baby in the crib and shut the door. Trainee: (Baby) After you have vomited the feeding, you shake the box with paper clips vigorously to represent loud crying. Have the crying get louder and louder. As the mother comforts you and eventually puts you in the crib, you continue to cry loudly. Process each scene immediately after its completed. Ask the group the following questions: 1. Was the mother successful in her attempts to feed and comfort baby? 2. How did you feel? 3. What would be your feelings as a mother when you are faced with subsequent feeding experiences? Minnesota Home Visitor Training Manual
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Chapter Based Chapter 3. 7. Strength Early Parenting: a focus on mothering Notes
4. What are other stressors that can contribute to a mothers perception of herself as competent? (Examples: Fear, pain, fatigue, sense of helplessness, lack of support, marital stress, threats to mothers health, depression) III. Developmental Stages of the Mothering Role Mercer (1985) defines maternal role attainment as a process in which the mother achieves competence in the role and integrates the mothering behaviors into her established role set, so that she is comfortable with her identity as a mother (p.98). Development of a maternal identity occurs in stages: the anticipatory stage, the formal stage, the informal stage, and the personal, maternal role identity stage. (Mercer 1985). A. The anticipatory stage This stage begins during pregnancy whereby the woman prepares for her new role. The pregnant woman prepares for this new role through completion of four major developmental tasks (Rubin,1984).
¹ OVERHEAD 1 Developmental Tasks of Pregnancy
DEVELOPMENTAL TASKS OF PREGNANCY • Seeking safe passage for herself and her child through pregnancy, labor, and delivery. During the first trimester the pregnant woman concentrates on her own well being and is concerned with what she eats and drinks. Fears about the baby and delivery appear during the second trimester. During the third trimester, the pregnant woman becomes increasingly uncomfortable and looks forward to delivery for relief. •
Ensuring the acceptance by significant persons in her family of the child she bears. Rubin believes that this task is one of the most critical tasks for the pregnant woman. Relationships have to be adjusted and redefined in the family in order to create a place for the new baby. The mother also has to create a new identity for herself and build this identity into her life.
•
Binding-in to her unknown baby. This refers to establishment of a bond between mother and baby.
•
Learning to give of herself. Pregnancy creates physical changes as well as lifestyle changes. This prepares the mother for learning to put babys needs above her own.
HANDOUT 1 Developmental Tasks of Pregnancy
B. The formal stage The formal stage begins at birth. During this stage the new mother needs to complete the following tasks as part of the process for acquiring the mothering role (Mercer, 1981). Page 88
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Chapter 3. Strength Based Chapter 7. Early Parenting: a focus on mothering Maternal Tasks of Early Postpartum •
Reconcile the actual childbirth experience with her prenatal fantasies of birth. As the mother reviews the events of childbirth and reflects on how they differed from what she expected, she begins integrating the experience with her expectation. She evaluates her performance in relation to the experiences of her mother, sisters, and friends. When the actual experience is not what was expected, the mother may feel that her performance was inadequate. Home visitors can involve partners in this discussion so that 1) the mother can receive reassurance and support about her performance or 2) the experience can be reframed so that she and the partner can recognize her strengths and accomplishments.
•
Reconcile pre-birth fantasies of baby with actual infant characteristics. Talking about how her babys characteristics compare with her fantasies of baby during pregnancy helps the mother see babys uniqueness. Through this process the mother begins to claim the baby as hers, a step that is important for sensitive and responsive care. When baby is the desired sex and has the expected size, coloring, and temperament characteristics, then this task takes less effort and time and she can move to other tasks. When there are major gaps between expectations and reality, there is more work for mom. Including the partner in this discussion can help facilitate identity with and attachment to baby for both mother and partner.
•
Reconcile her body image after birth with her expectations. The new mother wants to look and feel feminine again. She is concerned about her appearance. Her partners response can assist with this task or prolong it.
•
Observe the baby’s normal bodily functions. The new mother needs to see baby feed, suck, burp, and cry so that she can be assured that there is nothing wrong with the baby. This is part of the early attachment process.
Notes
¹ OVERHEAD 2 Maternal Tasks of Early Postpartum
HANDOUT 2 Maternal Tasks of Early Postpartum
Perform mothering tasks. During the first two weeks after birth, the first time mother with no experience focuses on learning and performing infant care tasks such a bathing, feeding, burping, and diaper changing. The experienced mother is concerned with how to mother this new baby and how the baby will fit into the family. The experienced, as well as the inexperienced mother may have mood swings, be easily frustrated and critical of herself. Most mothers, regardless of experience, need reassurance that they are capable of caring for the new baby.
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Chapter Based Chapter 3. 7. Strength Early Parenting: a focus on mothering Notes
Redefine partner roles. The new mother and father begin to redefine their roles as partners and as parents to include the new family member. Resume other responsibilities. Following birth the mother begins to anticipate the responsibilities awaiting her at home including meal preparation, care of older children, and laundry. The partner can assist the mother with identifying individuals who can help them during the early weeks following birth. Around two weeks after birth, the mother wants to resume social activities outside the home. Finding her at home for a home visit may be difficult after two weeks as the mother resumes outside activities. C. The informal stage The informal stage begins during the first month. The mother creates her own responses to her babys cues and relies less on the advise of experts. The babys response to her care and comments from family members and friends provide the mother with feedback about her competence as mother of this baby. D. The personal, maternal role identity stage This stage signals the endpoint of maternal role attainment. During this stage the mother: Develops a sense of competence and satisfaction in the role. Attaches to the infant. Is comfortable with her maternal identity. The timing and duration of these stages are influenced by a number of factors including previous mothering experience, culture, support from significant others, the mothers physical recovery, the babys temperament and expectations of baby. IV. Influences on Development of the Maternal Role A. Previous Experience as a Mother It has been assumed that competence and confidence in mothering abilities is developed through caring for the first baby and is subsequently transferred from one birth to the next. In fact, many of the available support services such as public health nurse home visits and parent education home visits, are based on this assumption. Work done by Rubin (1984) and Mercer and Ferketich (1995), however, suggests that a womans maternal identity does not transfer from one birth to the next because each birth experience and each baby are unique. Studies have also shown that conditions which influence a mothers perception of herself as competent are observed in experienced mothers as well as first time mothers. Experienced mothers have reported greater competence
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Chapter 3. Strength Based Chapter 7. Early Parenting: a focus on mothering in mothering behaviors (Rutledge & Pridham,1985), at the same time that they report greater stress from social supports and physical symptoms (Affonso, Mayberry, & Sheptak, 1988) and lower self-esteem (Brouse, 1985) than first time mothers. This is significant when findings from other studies (Walker, Crain, and Thompson (1986a, 1986b) have shown that the mothers attitudes toward themselves (e.g., competent and confident) are significantly related to their attitudes toward their infants. These studies all support the need to offer information, support and reassurance to the new mother that will promote competence, self-confidence and pleasure in their roles as mother regardless of previous mothering experience.
Notes
B. Culture Culture significantly influences the new mothers roles, relationships with partners and family members, daily activities, and responsibilities. It provides mothers with expectations for behaviors and can influence her interpretation of personal experiences.
Exercises: fAMILY rITUALS sURROUNDING CHILDBIRTH AND THE POSTPARTUM PERIOD
Instructor: Ask group participants to think about families they know or have worked with who observed family and/or cultural rituals surrounding childbirth and the postpartum period. Have group members generate a list of behaviors, beliefs, and values that they have observed with families experiencing pregnancy and birth. Discuss how the family and cultural rituals influenced the postpartum experience.
!P • • • • • •
OSSIBLE
RESPONSES INCLUDE:
Clothing Diet Physical assistance and support from extended family members/friends Household responsibilities Partner relationships Infant Care
Home visiting services that offer culturally appropriate information, support and reassurance to all mothers can promote self-confidence and competence as they make the transition to mothering the new baby.
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HANDOUT 3: Approaches for Assessment and Support of Mothering Strengths and Capacities
V.
Approaches for Assessment and Support of Mothering Strengths and Capacities Understanding the developmental sequence for maternal behaviors and those factors which influence maternal capacity and maternal role attainment enable home visitors to provide families with appropriate and timely information and support that can promote maternal confidence and competence. Demonstration interview Instructor: Demonstrate an interview with a new mom in the home or hospital setting. The interview should include the following topic areas for assessment and teaching:
*
Review the Childbirth Experience
Talking about the childbirth experience with the mother enables the home visitor to : • Begin establishing a caring relationship with the mother • Assess her expectations of the birth experience and her perceptions of her performance during birth; her relationships with significant others; her expectations of the baby e.g. sex, physical characteristics • Help the mother integrate her expectations of childbirth and the new baby with reality so that she can begin the process of claiming the baby as her own. Sample questions: How was your labor and delivery? How long was it? Was anyone with you? If so, who was there? Were you hoping for a boy or a girl? Did the babys father want a boy or a girl? 5. Have the babys grandparents gotten to see the baby yet? 1. 2. 3. 4.
*
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Discuss Expectations of First Weeks at Home Talking about her expectations of the first week helps the home visitor gather information about the availability and acceptability of support during these early days and weeks. This also helps the home visitor get a sense of moms perception of her competence in caring for the new baby. Sample questions: How have things been going since youve been home? Minnesota Home Visitor Training Manual
Chapter 3. Strength Based Chapter 7. Early Parenting: a focus on mothering Notes 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Who has been helping you out so that you can get a bit of rest? What questions do you have about taking care of baby? How is the babys feeding going? How has the baby been sleeping at night? Who gives you a break if youre exhausted? How does your baby let you know if he/she needs something? How is everyone adjusting to having a new baby in the house? What kinds of things does the babys dad help with? Who all has been to visit you and the baby? What changes have you made in what you eat and drink since you had the baby? 12. Now that youve been home for ___days/weeks, is having a baby(second, third, etc) what you thought it would be like? How is it different? 13. When are the grandparents coming for a visit? Parents have different experiences with family members. Sometimes they are very helpful and sometimes they arent. What kind of help do you get from them? 14. Are there things that your parents did when you were young that you want to repeat with this baby? What would you do the same? Have you thought about what you would do differently? If so, what would that be?
*
Discuss Capacities of Baby. Review information on newborn capacities, infant states and calming techniques and demonstrate babys capacities and calming techniques. This activity can provide the mother with important feedback about her performance of mothering tasks and the babys response to her efforts.
Sample questions: 1. What have you been told or have read about the kinds of things that babies can do? 2. Do you have an active baby or a quiet baby? 3. What kinds of things do you like to do with baby?(e.g., hold, sing to, breastfeed, talk to, read to baby)
*
Review Information on Postpartum Depression. Sample discussion and questions: Another topic that I talk with all new moms about is the difference between the baby blues and postpartum depression. Studies across the world have shown that anywhere from 50-80% of women experience the baby blues. In the United States, anywhere from 10-20% of women
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Chapter Based Chapter 3. 7. Strength Early Parenting: a focus on mothering Notes experience postpartum depression. We also know that women who have had periods of sadness, previous depression or family members with history of depression have a greater chance of experiencing a postpartum depression. • Have you or any family members had periods of sadness or depression? • During the pregnancy or since youve been home have you noticed
*
Review Safety Tips for Sleep and Car. Sample questions: What information have you been given on sleep safety and car seat safety?
*
Review Plans for Health Care. Review information on immunizations and well-child care. Sample questions: 1. What doctor do you plan to take the baby to for their checkup? 2. When is the babys first checkup? 3. When will you go back to the doctor?
HANDOUT 4: Scenario 1
HANDOUT 5: Scenario 2
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Instructor: Following the interview demonstration, discuss the following questions with the large group of participants: 1. What kind of information and support did the parent/s receive? 2. What kind of information did the visitor receive? 3. What did the visitor do/say to promote the parent/s competence and confidence?
Exercise: rOLE PLAY HOME VISIT TO A FAMILY WITH A NEW BABY
Instructor: Have participants break into small groups of 4. Allow 15 minutes for role play and discussion. Distribute one of three scenarios to each group. Each group member is to role play one of the following: mother, father, home visitor, or Minnesota Home Visitor Training Manual
Chapter 3. Strength Based Chapter 7. Early Parenting: a focus on mothering
observer. Have small group members discuss the following questions: 1. 2. 3.
What kind of information and support did the parent/s receive? What kind of information did the visitor receive? What did the visitor do/say to promote the parent/s competence and confidence?
Notes
HANDOUT 6: Scenario 3
VI. Summary Helping new mothers, experienced and inexperienced alike, adjust to the role as mother of a new baby is important work that can influence their understanding of and responses to their infants. As a home visitor it is important to take advantage of natural life transitions such as childbirth to offer information, reassurance and support to mothers that can promote competence and confidence in the mothering role.
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Developmental Tasks of Pregnancy (Rubin, 1984) 1. Seeking safe passage for herself and her child through pregnancy, labor, and delivery. 2. Ensuring the acceptance by significant persons in her family of the child she ears.
3. Binding-in to her unknown baby.
4. Learning to give of herself.
early parenting: A focus on mothering
Overhead 1
Maternal Tasks of Early Postpartum (Mercer, 1981) 1. Reconcile the actual childbirth experience with her prenatal fantasies of birth. 2. Reconcile pre-birth fantasies of baby with actual infant characteristics. 3. Reconcile her body image after birth with her expectations. 4. Observe the babys normal bodily functions. 5. Perform mothering tasks. 6. Redefine partner roles. 7.
Resume other responsibilities.
early parenting: A focus on mothering
Overhead 2
Developmental Tasks of Pregnancy (RUBIN, 1984)
1. Seeking safe passage for herself and her child through pregnancy, labor, and delivery. During the first trimester the pregnant woman concentrates on her own well being and is concerned with what she eats and drinks. Fears about the baby and delivery becomes increasingly uncomfortable and looks forward to delivery for relief.
2. Ensuring the acceptance by significant persons in her family of the child she bears. Rubin believes that this task is one of the most cortical tasks for the pregnant woman. Relationships have to be adjusted and redefined in the family in order to create a place for the new baby. The mother also has to create a new identity for herself and build this identity into her life.
3. Binding-in to her unknown baby. This refers to establishment of a bond between mother and baby.
4. Learning to give of herself. Pregnancy creates physical changes as well as lifestyle changes. This prepares the mother for learning to put babys needs above her own.
early parenting: A focus on mothering
handout 1
Maternal Tasks of Early Postpartum (Mercer, 1981) 1.
Reconcile the actual childbirth experience with her prenatal fantasies of birth. As the mother reviews the events of childbirth and reflects on how they differed from what she expected, she begins integrating the experience with her expectation. She evaluates her performance in relation to the experiences of her mother, sisters, and friends. When the actual experience is not what was expected, the mother may feel that her performance was inadequate. Home visitors can involve partners in this discussion so that 1) the mother can receive reassurance and support about her performance or 2) the experience can be reframed so that she and the partner can recognize her strengths and accomplishments.
2.
Reconcile pre-birth fantasies of baby with actual infant characteristics. Talking about how her babys characteristics compare with her fantasies of baby during pregnancy helps the mother see babys uniqueness. Through this process the mother begins to claim the baby as hers, a step that is important for sensitive and responsive care. When baby is the desired sex and has the expected size, coloring, and temperament characteristics, then this task takes less effort and time and she can move to other tasks. When there are major gaps between expectations and reality, there is more work for mom. Including the partner in this discussion can help facilitate identity with and attachment to baby for both mother and partner.
3.
Reconcile her body image after birth with her expectations. The new mother wants to look and feel feminine again. She is concerned about her appearance. Her partners response can assist with this task or prolong it.
4.
Observe the baby’s normal bodily functions. The new mother needs to see baby feed, suck, burp, and cry so that she can be assured that there is nothing wrong with the baby. This is part of the early attachment process.
early parenting: A focus on mothering
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5.
Perform mothering tasks. The first time mother with no experience focuses on learning and performing infant care tasks such a bathing, feeding, burping, and diaper changing. The experienced mother is concerned with how to mother this new baby and how the baby will fit into the family. Most mothers, regardless of experience, need reassurance that they are capable of care for the new baby.
6.
Redefine partner roles. The new mother and father begin to redefine their roles as partners and as parents to include the new family member.
7.
Resume other responsibilities. Following birth the mother begins to anticipate the responsibilities awaiting her at home including meal preparation, care of older children, laundry and return to social activities outside the home. The partner can assist the mother with identifying individuals who can help them during the early weeks following birth. Around two weeks after birth, the mother wants to resume social activities outside the home. Finding her at home for a home visit may be difficult after two weeks as the mother resumes outside activites.
early parenting: A focus on mothering
handout 2-2
Approaches for Assessment and Support of Mothering Strengths and Capacities
*
Review the Childbirth Experience. Talking about the childbirth experience with the mother enables the home visitor to: V Begin establishing a caring relationship with the mother. V Assess her expectations of the birth experience and her perceptions of her performance during birth; her relationships with significant others; and her expectations of the baby e.g. sex, physical characteristics. V Helps the mother integrate her expectations of childbirth and the new baby with reality so that she can begin the process of claiming the baby as her own. Sample questions: 1. How was your labor and delivery? How long was it? Was anyone with you? If so, who was there? 2. Were you hoping for a boy or a girl? Did the babys father want a boy or a girl? 3. Have the babys grandparents gotten to see the baby yet?
*
Discuss Expectations of First Weeks at Home. Talking about her expectations of the first week helps the home visitor gather information about the availability and acceptability of support during these early days and weeks. This also helps the home visitor get a sense of moms perception of her competence in caring for the new baby. Sample questions: 1. How have things been going since youve been home? 2. Who has been helping you out so that you can get a bit of rest? 3. What questions do you have about taking care of baby? 4. How is the babys feeding going? 5. How has the baby been sleeping at night? Who gives you a break when youre exhausted? 6. How does your baby let you know if he/she needs something? 7. How is everyone adjusting to having a new baby in the house? 8. What kinds of things does the babys dad help with? 9. Who all has been to visit you and the baby?
early parenting: A focus on mothering
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Approaches for Assessment and Support of Mothering Strengths and Capacities 10. 11. 12. 13.
*
What changes have you made in what you eat and drink since you had the baby? Now that youve been home for ___days/weeks, is having a baby(second, third, etc) what you thought it would be like? How is it different? When are the grandparents coming for a visit? Parents have different experiences with family members. Sometimes they are very helpful and sometimes they arent. What kind of help do you get from them? Are there things that your parents did with you when you were young that you want to repeat with this baby? What would you do the same? Have you thought about what you would do differently? If so, what would that be?
Discuss Capacities of Baby. Review information on newborn capacities, infant states and calming techniques and demonstrate babys capacities and calming techniques. This activity can provide the mother with important feedback about her performance of mothering tasks and the babys response to her efforts. Sample questions: 1. What have you been told or have read about the kinds of things that babies can do? 2. Do you have an active baby or a quiet baby? 3. What kinds of things do you like to do with baby?(e.g., hold, sing to, breastfeed, talk to, read to baby)
*
Review Information on Postpartum Depression. Sample discussion and questions: Another topic that I talk with all new moms about is the difference between the baby blues and postpartum depression. Studies across the world have shown that anywhere from 50-80% of women experience the baby blues. In the United States, anywhere from 10-20% of women experience postpartum depression. We also know that women who have had periods of sadness, previous depression or family members with history of depression have a greater chance of experiencing a postpartum depression. 1. Have you or any family members had periods of sadness or depression? 2. During the pregnancy or since youve been home have you noticed sadness?
early parenting: A focus on mothering
handout 3-2
Approaches for Assessment and Support of Mothering Strengths and Capacities
* *
Review Safety Tips for Sleep and Car. Sample questions: 1. What information have you been given on sleep safety and car seat safety? Review Plans for Health Care. Review information on immunizations and well-child care. Sample questions: 1. What doctor do you plan to take the baby to for their checkup? 2. When is the babys first checkup? 3. When will you go back to the doctor?
early parenting: A focus on mothering
handout 3-3
Scenario One You have a visit scheduled with 16 year old Sarah who delivered a 6.5 pound boy 5 days ago. She had a routine vaginal delivery without complications. The babys father visited frequently in the hospital and was present for the birth. During the hospitalization, Sarahs mom did most of the babys feeding and diaper changing. She was referred by the hospital for a visit because she is a teen. Sarah greets you at the door and invites you inside. She looks tired. Her hair is wet and she is dressed in sweats. The TV is on and the baby is sleeping in the car seat on the living room floor. A bottle of formula is setting on a table near the sofa. The tall teenage male walks inside after you have been visiting with Sarah for about 10 minutes. From your unique discipline or role: •
Establish a beginning relationship with the parent/s.
•
Gather and provide meaningful information to the parent/s.
early parenting: A focus on mothering
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Scenario Two You have making your first visit to Anna, a 23 year old Hispanic woman who gave birth, 9 days ago, to an 8 pound baby gir, her third child. She had routine vaginal delivery without complications. She is breast feeding and at the time of hospital discharge feedings were going well. The hospital referred her to you because she and her family moved to Minnesota from Colorado 6 months ago, and the hospital staff wanted her to get connected with WIC and a health provider for the baby. Anna speaks some English but her husband interprets for her. Her husband, Jose, works from 3-11 pm at a local factory. You scheduled the visit so that Jose would be available to help interpret. When you arrive at the 2nd floor apartment, the 4 year old boy opens the door and lets you inside. Anna is sitting on the sofa breast feeding the baby. Her 4 year old son returns to watching TV with his 13 year old sister. Anna looks happy but tired. There are dishes on the table and the kitchen sink, and toys are scattered around the apartment. Anna calls her husband, Jose, from the back bedroom and he joins you for the visit. From your unique discipline or role: •
Establish a beginning relationship with the parent/s.
•
Gather and provide meaningful information to the parent/s.
early parenting: A focus on mothering
handout 5
Scenario Three It is 9:00 am and you are making your regular rounds on the postpartum unit at one of the local hospitals. You learn of a new delivery, Joann is a 31 year old woman who gave birth yesterday to a 9 pound baby girl, her second child. This was an unexpected C-section. She and the baby are doing well. Joann is an elementary school teacher and her husband is a lawyer. She has a 3 year old son at home who is currently staying with Joanns mother. From your unique discipline or role: •
Establish a beginning relationship with the parent/s.
•
Gather and provide meaningful information to the parent/s.
early parenting: A focus on mothering
handout 6
References and Resources cHAPTER 2: Introduction to Home Visiting Behrman, R. E. (Ed.). (1994). Home visiting: The future of children. Los Altos, CA: The Center for the Future of Children, The David and Lucille Packard Foundation. Olds, D., Henderson, C. R., Cole, R., Eckenrode, J., Kitzman, H., Luckey, D., Pettit, L., Sidora, K., Morris, P. & Powers, J. (1998). Long-term effects of nurse home visitation on childrens criminal antisocial behavior: 15 Year follow-up of a randomized controlled trial. JAMA 280(14), 1238-1244. CHAPTER 3: Strength-Based approach Ahlquist, A. (1995). Strength based interviewing. Minneapolis, MN: University of Minnesota Ahlquist, A. (1997). Resilience: The CRECC model. Minneapolis, MN: University of Minnesota. Bernard, B. (1991). Prevention should emphasize protective factors: Research update. Western Regional Center for Drug Free Schools and Communities. Portland, Or. Bernard, B. (1992). Fostering resiliency in kids: Protective factors in the family, school, and community. Illinois Prevention Forum 122: D: 1-16. Breakey, G., Pratt, B., Morrell-Samuels, S. & Kolholatu, D. (1991). Healthy Start program manual. Honolulu, Hawaii Family Stress Center. Broffrenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22, 723-742. Cochran, M. & Wooler, F. (1985). Beyond the deficit model. Changing Families, 2(3). Dejong, P. & Miller, S. (1995). Interviewing for client strengths. Social Work, 40, 72941. Egeland, B., Carlson, E., & Sroufe, L. (1993). Resilience as process. Development and Psychology, 5, 517-528. Erickson, M. F. (1989). The STEEP program: Helping young families rise above )at risk.( Family Resource Coalition Report, 3, 14-15. References & Resources
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Fetterman, J. (1989). Ethnography: Step by step. Newbury Park, CA: Sage. Guidelines for family support practice. (1996). Family Resource Coalition. Chicago, Illinois. Kamarek, E.C., & Galson, W. A. (1990). Puttiing children first: A progressive family policy of the 1900s. Washington, DC: Progressive Policy Institute. Learning to be partners: An introductory training for family support staff. (1997). Chicago, Illinois: Family Resource Coalition. Masten, A., Best, K., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2, 425-444. Saleeby, D. (1992). Strength perspective. Boston: PA. Longman Publishing. U.S. Congress Office of Technology Assessment. (1988, August). Healthy children: Investing in the future. Washington, D.C.: US Government Printing Office. Weiner, J. M., Engel, J. (1991). Improving health services for children and women. Washington, DC. US Government Printing Office. Werner, E. (1990). Protective factors and early childhood resilience. In Meisel, S. J. & Shonkoff, J. P. (Eds.), Handbook of early childhood intervention. (pp. 97-116). Cambridge, England: Cambridge University Press. CHAPTER 4: Culture and Cultural Context Abney, V.D. & Gunn, K. (1993). A rationale for cultural competency. The APSAC Advisor, 6(3), 19-22 Ahmann, E. (1994). Chunky Stew: Appreciating cultural diversity while providing health care for children. Pediatric Nursing, 20 (3), 320-324. Andrews, M.M. & Boyle, J.S. (1995). Transcultural concepts in nursing care. (2nd ed.). Philadelphia: JB Lippincott Company. Cross, T. (1996, Spring). Developing a knowledge base to support cultural competence. Prevention report of national resource center for family centered practice. (No. 1). Iowa City, IA: University of Iowa. Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York, NY: Noonday Press. Page 2
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Levine, R. & Miller, P. (1990). Commentary on cultural considerations in attachment. Human Development, 33, 73-80. Pianta, R., Egeland, B. & Erickson, M. (1990). The antecedents of maltreatment: Results of the Mother-Child Interaction Research Project. In D. Cicchetti& V. Carlson, (Eds.), Child maltreatment: Theory and research on the causes and consequences of child abuse and neglect. Cambridge, England: Cambridge University Press. Posada, G. et al. (1995). The secure-base phenomenon across cultures; childrens behavior, mothers preferences, and experts concepts. In E. Water. et al, (Eds.), Monographs of the Society for Research in Child Development. 27-48. Sagi, Abraham (1990). Attachment theory and research from a cross-cultural perspective. Human Development, 33, 3-9. Takahashi, Keiko (1990). Are the key assumptions of the Strange Situation procedure universal? A view from Japanese research. Human Development, 33, 23-30. CHAPTER 6: UNDERSTANDING Family Systems and Family Development Baird, S. (1994). Preparing paraprofessional early interventionists (PPEI). Communication Skill Builders. Birckmayer, J., Mabb, K., Westerndorf, B.J., & Wilson, J. (1996). Parents of babies and toddlers: A resource guide for educators. Cornell Cooperative Extension. Cochran, M., Dean, C., Dill, M., & Woolever, F. (1984, January). Empowering families: Home visiting and building clusters. Cornell University Family Matters Project. Duvall, E.& Miller, B. (1985). Marriage and family development, (6th ed.). Harper & Rowe. Erikson, E. (1968). Childhood and society. New York, NY: WW Norton. Family Support Worker Training Materials. (1997). Honolulu, HI: The Family Institute, Hawaii Family Support Center. Galinsky, E. (1987). The six stages of parenthood. Addison-Wesley Publishing Company, Inc. Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge, MA: Harvard University Press. Page 4
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Munsch, R. (1997). Love you forever. Firefly Books, Ltd. Nye, F. I. & Bernardo, F. M. (Eds.). (1981). Emerging conceptual frameworks in family analysis: With a new introduction for the 1980s. New York, NY: Praeger. Office of Maternal and Child Health. Philadelphia Department of Public Health. (1997, June). MCH-Funded paraprofessional and infant and child home visiting programs: A blueprint for program development and implementation. Philadelphia, PA. Olson, D. (1994). The family circumplex model. Minneapolis, Minnesota: Family Information Services. Reiss, A. (1979). Family systems: A training program. Paper presented at the second National Symposium on Home-Based Services for Children and Families, Iowa City, IA. Strong, B. & De Vault, C. (1992). The marriage and family experience. (5th ed.). West Publishing Company. Trainers Manual: Module IV: Culture, Family and Providers (1995). Far West Laboratory for Educational Research and Development and California Department of Education,. Wayman, K.I., Lynch, E.W., & Hanson, M.J. (1990). Home-based early childhood services: Cultural sensitivity in a family system approach. Topics in Early Childhood Special Education, 10 (4), 56-75. Whitchurch, G.G. and Constantine, L.L. (1993). Systems theory. In P.G. Boss, W.J. Doherty, R. LaRossa, W.R. Schumm, and S.K. Steinmetz. Sourcebook of family theories and methods: A contextual approach. New York: Plenum Press. cHAPTER 7: Early Parenting: A Focus on Mothering Affonso, D., Mayberry, L., & Sheptak, S. (1998). Multiparity and stressful events. Journal of Perinatology, 8, 312-317. Barnard, K. & Martell, L. (1995). Mothering. In M. Bornstein (Ed.), Handbook of Parenting, Vol. 3. Status and Social Conditions of Parenting. Hove, UK: National Institute of Child Health and Human Development, Lawrence Erlbaum Associates. Brouse, S.H. (1985). Effect of gender role identity on patterns of feminine and selfconcept scores from late pregnancy to early postpartum. Advances in Nursing Science, 7(3), 32-48.
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Copies of this report are available on the MDH website: www.health.state.mn.us Upon request this material will be made available in an alternative format such as large print, Braille, or cassette tape. Print on recycled paper.
November 2001
