Essentials for Childhood: Steps to Create Safe, Stable and Nurturing Relationships

The CDC’s National Centre for Injury Prevention and Control’s Division of Violence Prevention has produced a new resource: Essentials for Childhood:  Steps to Create Safe, Stable and Nurturing Relationships (SSNRs).  The resource document “proposes strategies that communities can consider to promote the types of relationships and environments that help children grow up to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children.”

Child Maltreatment (CM) has been identified as a significant worldwide health problem. It includes all types of maltreatment of a child, including physical abuse, sexual abuse, emotional abuse and neglect, which results in harm, potential harm, or threat of harm to a child.

“Safety, stability and nurturing are three critical qualities of relationships that make a difference for children as they grow and develop.  They can be defined as follows:

• Safety:  The extent to which a child is free from fear and secure from physical or psychological harm within their social and physical environment.
• Stability:  The degree of predictability and consistency in a child’s social, emotional, and physical environment.
• Nurturing:  The extent to which a parent or caregiver is available and able to sensitively and consistently respond to and meet the needs of their child.”

The resource is organized into four sections, each section identifying a goal and strategies for moving towards that goal.

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Goal 1:  Raise awareness and commitment to promote SSNRS and prevent Child Maltreatment.

Goal 2:  Use data to inform actions.

Goal 3:  Create the context for healthy children and families through norms, change and programs.

Goal 4:  Create the context for healthy children and families through policies.

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A consistent effort has been made to base the steps in the document on the best evidence available.  In Goal 3, for example—the goal with most direct application for our programs—Step 3 refers to a rich scientific literature, including several strategies that have been rigorously evaluated and shown to prevent or reduce CM.  However, the evidence base is constantly evolving.  Today’s practices must be based on current best evidence, realizing that this understanding may evolve and change over time.

In Goal 3, three steps are suggested to support parents and caregivers in providing SSNRs.

Step 1:  Promote the community norm that we all share responsibility for the well being of children.

Supporting families in providing SSNRs is a shared responsibility; “everyone in your community …can champion or contribute to efforts to develop safe places or neighbourhood activities where children are watched and supervised, and families can gather, interact and get to know each other.  Neighbourhood associations can link families and other neighourhood adults together to help with household tasks and to watch out for each other’s children in the neighbourhood.

This step can also tie into raising awareness and enlisting partners when building commitment   For example, people may have influence in a particular sector (e.g. business, social services, education) where they can promote family-friendly policies or activities.

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Step 2:  Promote positive community norms about parenting programs and acceptable parenting behaviours.

To offset fears caregivers may have of being unable to cope if they ask for help, one suggestion is to identify local parents to serve as mentors who promote positive parenting in order to help change norms about parenting behaviours in your community.

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Step 3:  Implement evidence-based programs for parents and caregivers.

“Programs that teach caregivers positive child-rearing and child management skills are the most basic approach to facilitating SSNRs.  Your community can support all caregivers by providing access to evidence-based parent training.  A lot is known about how to foster caregiver skills that promote positive child development, prevent child behavior problems, and prevent CM.”  The resource stresses the importance of making programs accessible to caregivers: offering low-cost or free-at-the-point-of-use programs, implementing programming at convenient times and in accessible locations, providing childcare and transportation options such as transit vouchers, van pools, etc.

Recommended programs that have been shown to prevent CM include:

• Parent-Child Interaction Therapy (PCIT), where coaches work directly with parent-child pairs to help them learn specific skills to build a nurturing and secure relationship with their children while increasing their children’s desirable behaviors and decreasing negative behaviours.  www.pcit.org
• Triple P (Positive Parenting Program) is a system of parenting and family support offering five levels of intervention, ranging from media strategies to increase awareness and acceptance, to brief consultations on common development issues, to intensive one-on-one approaches.  www.triplep-america.com
• Nurse-Family Partnership (NFP) involves ongoing home visits by health nurses that focus on improving maternal and child health, maternal life skills, and parenting skills  www.nursefamilypartnership.org
• Hospital-based abusive head trauma prevention approaches offer anti-shaking information to parents of newborns before parents take the baby home from hospital.
• Multi-component programs (Child-Parent Centers)  “Center-based multi-component programs provide comprehensive educational and family support to low-income children and their parents.  The approach is child-centered and individualized, with an emphasis on enhancing the child’s social and cognitive development in a stable, enriched learning environment.  Parent-focused activities include enhancing parents’ personal development; promoting positive parent-child interactions; providing information on nutrition, health and safety; and providing referrals to appropriate services.”

Some programs that do not have evidence of changing CM outcomes, but do demonstrate improvements in parenting behavior and child behavior problems include:

• Incredible Years, a training program for parents, teachers and children promoting emotional and social competence with the goal to prevent, reduce and treat aggression and emotional problems in children 0-12.  www.incredibleyears.com
• Strengthening Families for Parents and Youth is an education and support program focusing on increasing family skills to support health child development, including communication skills, family functioning, social-emotional development, and healthy behavior.  www.extension.iastate.edu/sfp
• Early Head Start is a child-development and parenting-education program delivered through centre-based services and/or home visits, designed to develop attachment and developmental skills.  It assists with transition to Head Start programs at 3, and offers family advocacy, resources and referrals.  www.ehsnrc.org

The resource emphasizes that; “Creating a community context that supports effective parenting is critical to children experiencing SSNRs.”

Current research shows that effective parenting programs typically:

• “Provide opportunities for caregivers to actively practice and receive feedback as they learn and apply the new parenting behaviours….  Having parents practice the skills with their own children during program sessions is particularly effective.”
• Teach parents the correct use of time outs as an alternative to physical discipline.
• Emphasize positive and nurturing relationships and interactions and teach effective communication and play skills.
• Promote consistency of response, both individually and across all of a child’s caregivers.

Considerations for implementing programs to promote SSNRs include:

• Delivery options:  e.g. the media, in primary health care, through schools, and in faith communities, as well as formal programs.  Parents need to see and practice the new behaviours.
• Developmentally-appropriate programming:  Different parenting behaviours are required at different stages of a child’s development.  A child’s entry into a new developmental stage may be a point at which parents reach out for advice and support.
• Involvement of the child’s extended circle of caregivers:  Extending learning opportunities to grandparents, family, friends and neighbours involved in the child’s care encourages consistency of care.
• Consistency of information:  It is valuable to review and update existing programs to identify inconsistencies or conflicting messages.  Receiving the same messages from multiple sources reinforces the information, so it is more likely to be integrated and applied.

http://www.cdc.gov/violenceprevention/pdf/efc-01-03-2013-a.pdf