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KAY TAYLOR has been accepted towards fulfillment of the requirements for MASTERS degree“, PSYCHOLOGY ”57% Major professor Date November 15, 1985 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution Illllll‘lllllllllllll L 3 1293 00989 9539 RETURNING MATERIALS: 1V1531_} Place in book drop to LIBRARJES remove this checkout from n your record. FINES will ' be charged if book is returned after the date stamped below. 53-“ "2 1995 HOSPITAL-BASED PRIMARY PREVENTION PRACTICES IN CHILD MALTREATMENT: THE PROMOTION OF POSITIVE PARENT-INFANT RELATIONS BY D. Kay Taylor A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER or ARTS Department of Psychology 1985 ABSTRACT HOSPITAL-BASED PRIMARY PREVENTION PRACTICES IN CHILD MALTREATMENT: THE PROMOTION OF POSITIVE PARENT-INFANT RELATIONS BY D. Kay Taylor The purpose of this study was to evaluate a primary prevention effort in child maltreatment--the focus of which was a community-wide endeavor (i.e., subjects were not prescreened for risk potential). Specific components of the planned intervention addressed four causal levels of maltreatment (individual, family, community, and cultural factors). That addressment was intended to build strengths in those parenting areas which are predictive of abusive or neglectful outcomes. Target areas included: knowledge of child development, child-rearing attitudes, mother-infant interaction patterns, and parenting skills. A posttest-only control group design was employed. The control postpartum mothers received traditional/routine hospital services; experimental mothers received special in-hospital and aftercare services by trained student nurse volunteers. These volunteers functioned in a dual educative/supportive role. Experimental mothers reported more realistic expectations of behavior, embraced more democratic child- rearing principles, provided more verbal stimulation to their infants (reflecting an increased sensitivity), and displayed increased problem-solving abilities. To the memory of my grandparents ii ACKNOWLEDGEMENTS I wish to thank the postpartum nursing staff of Hurley Medical Center, and the instructors and student nurses of the School of Nursing. I would also like to thank the families who participated in this study. I wish to acknowledge the aid provided by my committee: William Davidson, George Fairweather, and Elizabeth Gordon. The day-to-day assistance offered by Elizabeth contributed significantly to the success of the study. Special thanks to the student interns who assisted me in numerous ways: Tim Waskerwitz, Carol Beauchamp, Susan Wolf, and Maria Ragonese. Heartfelt thanks to my family for their love and encouragement. Thank you Mom, Dad, Linda, Ed, John, Jamie, Vicki and Jenny. And to my husband, Jay, and son, Josh, thank you for your endless support and patience. iii TABLE OF CONTENTS Page LIST OF TABLES. O O O O O O O O O O O O O O I O O O O 0 vii CHAPTER I I NTRODUCTI ON C O O O O O O O O O O O O O O O O O 1 Statement of the Problem . . . . . . . . . . 2 Definition . . . . . . . . . . . . . . . . 2 Incidence . . . . . . . . . . . . . . . . 3 Causal factors . . . . . . . . . . . . . 5 Individual level . . . . . . . . . . . 5 Family level . . . . . . . . . . . . . 6 Community level . . . . . . . . . . . . 7 Cultural level . . . . . . . . . . . . 8 Treatment . . . . . . . . . . . . . . . . 10 Prevention . . . . . . . . . . . . . . . . 11 Review . . . . . . . . . . . . . . . . . . . 12 Larson study . . . . . . . . . . . . . . . 12 Metzl study . . . . . . . . . . . . . . . 15 Field study . . . . . . . . . . . . . . . 18 Dickie study . . . . . . . . . . . . . . . 20 Kagey study . . . . . . . . . . . . . . . 23 Myers study . . . . . . . . . . . . . . . 25 Cooper study . . . . . . . . . . . . . . . 28 Summary . . . . . . . . . . . . . . . . . 30 Rationale for the Current Research . . . . . 33 I I METHOD 0 O O O O O O O O O O O O O O O O O O O O 3 5 Setting . . . . Subjects . . . . . . . . . . . . . . . . . . 36 Restrictions . . . . . . . . . . . . . . . 36 Number . . . . . . . . . . . . . . . . . . 38 Demographics . . . . . . . . . . . . . . . 39 Equivalency . . . . . . . . . . . . . . . 41 Design . . . . . . . . . . . . . . . . . . . 41 Procedures . . . . . . . . . . . . . . . . . 42 Recruitment . . . . . . . . . . . . . 42 Intake and informed consent . . . . . . . 42 Assignment to conditions . . . . . . . . . 43 Data collection . . . . . . . . . . . . . 43 Conditions . . . . . . . . . . . . . . . . . 43 Control condition . . . . . . . . . . . . 44 Experimental condition . . . . . . . . . . 46 iv Training of student nurses In-hospital services . . Aftercare services . Ecological focus . . Measures . . . . . . . . . Scale construction . . . Parental expectations qu on1 0 00-1-00. est Rationale for use . . Measure development . . Development of scale score Reliability . . . . . . n 5 Parental attitude research inst s e s C ('1' coo-“Hoooorfoooo50.00.100.000 n 0000000003.... Rationale for use . . . . Measure development . . . Development of scale score Reliability . . . . . . . Mother-infant interaction obs r Rationale for use . . . . Measure development . . . Development of scale score Reliability . . . . . . . . Competency open- ended questionn Rationale for use . . . . . Measure development . . . . Development of scale scores Reliability . . . . . . . . Ho :1 a 1 e oooomfloooo .05). The proportion of variance accounted for was 10%. Time two. The mean score for the experimental group was 8.80 with a standard deviation of 3.28; the mean score for the control 79 Table 14 Analysis of Variance Social/Pegsonal Development Knowledge by Expé?imenta1 Condition Time One Source Df Ms F Sign. wz Between conditions 1 159.77 10.37 .003 .28 Within conditions 26 400.66 Table 15 Analysis of Variance Social/Personal Development Knowledge by Eiperimental Condition Time Two Source Df Ms F Sign. w Between conditions 1 100.84 14.88 .0006 .36 Within conditions 26 176.16 80 Table 16 Analysis of Variance Physical/Motor Development Knowledge by'Experimental Condition Time One , 2 Source Df Ms F Sign. W Between conditions 1 20.68 2.84 ' .10 .10 Within conditions 26 189.32 Table 17 Analysis of Variance Physical/Motor Development Knowledge by Experimental Condition Time Two Source Df Ms F Sign. wz Between conditions 1 70.63 7.87 .009 .23 Within conditions 26 233.48 81 group was 5.62 with a standard deviation of 2.63. At Time Two, the analysis of variance did reveal significant condition effects (see Table 17). Experimental subjects displayed a greater knowledge about the physical/motor aspects of development in children (F = 7.87, p < .01). The proportion of variance explained by this factor was 23%. Attitude Scales Nurture Time one. The mean score for the experimental group was 11.33 with a standard deviation of 2.29; the mean score for the control group was 8.85 with a standard deviation of 2.04. An analysis of variance yielded significant condition effects (see Table 18). Experimental subjects reported a more liberal or democratic viewpoint on nuturing issues (F = 9.10, p < .005). The proportion of variance accounted for was 26%. Time two. The mean score for the experimental group was 29.80 with a standard deviation of 4.14; the mean score for the control group was 26.54 with a standard deviation of 4.98. An analysis of variance did not yield significant condition effects (see Table 19). At Time Two, group assignment did not impact on the degree of liberality expressed regarding 82 Table 18 Analysis of Variance Nurture Attitude by Experimental Condition Time One Source Df Ms F Sign. wz Between conditions 1 43.08 9.10 .005 .26 Within conditions 26 123.03 Table 19 Analysis of Variance Nurture Attitude by Experimental Condition Time Two Source Df Ms F Sign. w2 Between conditions 1 74.08 3.58 .06 .13 Within conditions 26 537.63 83 nurturing issues in child-rearing (F = 3.58, p > .05). The proportion of variance explained by this factor was 13%. Discipline Time one. The mean score for the experimental group was 33.53 with a standard deviation of 5.49; the mean score for the control group was 28.85 with a standard deviation of 4.63. An analysis of variance yielded siginificant condition effects (see Table 20). Experimental subjects reported a more liberal or democratic viewpoint on child discipline issues (F = 5.86, p < .05). The proportion of variance accounted for was 18%. Time two. The mean score for the experimental group was 17.40 with a standard deviation of 3.29; the mean score for the control group was 14.31 with a standard deviation of 2.78. Again, the analysis of variance revealed significant condition effects (see Table 21). The experimental subjects expressed a higher degree of liberality regarding disciplinary aspects of child-rearing (F = 7.09, p < .01). The proportion of variance explained by this factor was 24%. Behavior Observation Verbal Scale The mean score for the experimental group was 61.27 84 Table 20 Analysis of Variance Discipline Attitude bnyxperimental Condition Time One Source Df Ms F Sign. wz Between conditions 1 153.00 5.86 .02 .18 Within conditions 26 679.43 Table 21 Analysis of Variance Discipline Attitude by Experimental Attitude Time Two Source Df Ms F Sign. wz Between conditions 1 66.60 7.09 .01 .24 Within conditions 26 244.37 85 with a standard deviation of 40.76; the mean score for the control group was 23.46 with a standard deviation of 15.62. An analysis of variance yielded significant condition effects (see Table 22). Experimental subjects provided their infants with a greater amount of verbal stimulation (F = 9.88, p < .01). The proportion of variance accounted for was 28%. Open-ended Questionnaire Problem-Solving Ability The mean score for the experimental group was 21.93 with a standard deviation of 4.42; the mean score for the control group was 17.00 with a standard deviation of 3.39. An analysis of variance yielded significant condition effects (see Table 23). Experimental subjects provided a greater number of options to posed child-rearing problems (F = 10.72, p < .01). The proportion of variance explained by this factor was 32%. 86 Table 22 Analysis of Variance Verbal Interaction by Experimental Condition Source Df Ms F Sign. wz Between conditions 1 9953.55 9.88 .004 .28 Within conditions 26 26186.16 Table 23 Analysis of Variance Problem-Solving by Experimental Condition Source Df Ms F Sign. w2 Between conditions 1 169.50 10.72 .002 .32 Within conditions 26 410.93 CHAPTER IV DISCUSSION The purpose of this study was to evaluate a primary prevention effort in child maltreatment--the focus of which was a community-wide endeavor (i.e., subjects were not pre- screened for risk potential). Specific components of the planned intervention addressed four causal levels of maltreatment (individual, family, commmunity, and cultural factors). That addressment was intended to build strengths or competencies in parenting areas which are predictive of abusive/neglectful parenting outcomes. Target areas included: knowledge of child development; child-rearing attitudes; parent-infant interaction patterns; parental competencies/skills. Knowledge of Child Development Social/Personal At both time periods (one-month and three-months postpartum), experimental subjects exhibited a greater understanding or knowledge of the social/personal aspects of child development. This adoption of more realistic expectations was seen as crucial to the promotion of positive parenting functioning. The literature confirms 87 88 that a lack of knowledge of developmental principles endangers the parent-child relationship (Azar, Robinson, Hekimian, & Twentyman, 1984; Breton, 1981; Burch & Mohr, 1980; Egeland, Breitenbucher, & Rosenberg, 1980; Tracy, Ballard, & Clark, 1975; Twentyman & Plotkin, 1982; Wolfe, Sandler, & Kaufman, 1981; Wuerger, 1976). A failure to recognize typical age-related behaviors can be a source of anger and frustration--producing conflict in that relationship. The potential for conflict is present in two ways. First, parents may harbor misconceptions regarding the appropriateness of certain behaviors at a developmental stage--such as the negative, uncooperative stance of the two-year old (item Q12) or the silly, boastful disposition of the four-year old (item Q18). Without the knowledge of the "normality" of these behaviors, an interpretation of "misbehavior" seems likely. Second, parents may harbor misconceptions regarding the approximate age at which they expect their child to perform particular behaviors-~such as understanding adult commands (item Q1) or learning to share toys (item Q2). Control subjects' expectations were accelerative--believing that their child would be capable of these behaviors at an earlier date. This acceleration is a probable source of conflict. When the six-month old infant does not respond to adult commands, or the two-year old toddler does not engage in sharing behaviors. how will that 89 parent react? Will they interpret the failure to comply with adult instructions as "disobedience", and the refusal to share as ”selfishness”? It seems 1ikely--at the very 1east--that this parent will experience confusion or disappointment. Motor/Physical With respect to knowledge about the physical/motor development in children, experimental subjects did not fare better than the control subjects at Time One. However, there were significant differences at Time Two--with experimental subjects reporting more realistic expectations. It seems apparent that during the time between these two data collection dates the experimental subjects reviewed the printed materials left by the student nurses. (What prompted this "review" can only be speculated.) Again, control subjects' expectations were accelerative--predicting that their children would accomplish developmental tasks at an earlier date. And again there is the potential for conflict. The parent who believes that their one-year old is capable of running (item Q16) or should be skillful with a cup and spoon (item Q8) must eventually deal with the reality of the one-year old's capabilities. In summary, the literature on abusive/neglectful families reveals that a lack of understanding of developmental principles produces greater frustration in behavior management. Consequently, the adoption of more 9O realistic expectations was an intervention goal. An entire home visit was devoted to instruction and discussion of child development issues (thereby targeting the individual causal factor of childcare experience). The teaching efforts by the student nurses were successful. Experimental mothers expressed a higher degree of knowledge with respect to both social/personal and motor/physical aSpects of child development. Child-Rearing Attitudes Nurture At Time One, experimental subjects expressed a more democratic viewpoint with respect to nurturing issues in child-rearing. (Statistical significance was nearly achieved at Time Two--with a .06 level attained.) This democratic expression was seen as beneficial to the development of a more harmonious parent-child relationship. In promoting the growth/development of a child, it is hoped that parents will view this promotion as a "shared” process-~one in which the child's role is regarded as significant, and the parental role less ”powerful". Control subjects expressed more traditional views of the child's role--stating that children do not have the right to question their parents' opinions (item Q3), but should remain ”loyal" to them regardless of circumstances (item 91 Q22). Experimental subjects expressed a greater acceptance of controversy--stating that when a child thinks the parent is wrong they should be permitted to say so (item Q2), and that when a parent is wrong he should admit this to the child (item Q27). Experimental subjects also expressed a greater respect for the child's needs and preferences-- stating that a child should take all the time he wants to before he learns to walk (item Q16), and that toilet training should be put off until the child shows that he is ready (item Q23). Discipline At both Time One and Time Two, experimental subjects reported a more liberal or democratic viewpoint on child discipline issues. Again, this democratic expression was seen as beneficial to the development of a more harmonious parent-child relationship. In assuming the task of correcting or controlling a child's behavior, it is hoped that a parent will utilize tools of understanding and fairness as opposed to fear and coercion. Control subjects' responses, however, reflected the belief that children should be taught to fear adults (item Q2), and that degree of strictness would assure parental success (item Q25). Experimental subjects rejected such notions--stating that children should never be taught to fear adults (item Q12), and that strict training may make a child unhappy (item Q11) or resentful (item Q21). Experimental subjects also 92 anticipated fewer problems--agreeing that most parents never get to the point where they can't stand their children (item Q21, T2), and that most parents can spend all day with their children and remain calm and pleasant (item Q30). In summary, parental attitude appears to have causal relevance to the occurrence of child maltreatment (Belsky, 1980; Gershenson, 1977; Marion, 1982; Olds, 1984; Starr, 1979). The literature suggests two forces that work to shape our attitudes concerning children and child-rearing: the individual's socialization history (or childhood experiences), and the influence of cultural values (or belief systems). Thus an intervention strategy was to jointly address/target these individual and cultural factors through a critical examination of both childhood and societal influences on parenting practices, and to offer other options/philosophies in child management. Experimental subjects--assisted by the student nurses-- explored child and parent roles, learned of numerous behavior management techniques, and engaged in active decision-making regarding the adoption and rejection of parental practices. And consequently the goal of impacting on child-rearing attitudes was achieved. Experimental subjects embraced more democratic principles with respect to nurture and discipline-related issues in child-rearing. 93 Parent-Infant Interaction Verbal Stimulation Experimental subjects provided their infants with a significantly greater amount of verbal stimulation. This increased communication between mother and infant was seen as beneficial to the promotion of positive parenting functioning. Through an examination of this verbal communication, it was possible to detect the mother's recognition of--or sensitivity to--the infant's behaviors (both action and feeling states). Experimental mothers more frequently verbalized their infant's physical activities (item #1) and defined/interpreted their moods #2). The following are examples of this action/feeling state recognition: "Is that a new world out there? What you see? Say mama leave me alone. I'm trying to look. That's a smile. You see something you like out there don't ya?" "What are you doing? Kicking your leg now. Is that pretty funny? Say you don't like getting your clothes off.” "Gonna grab on that bear? You like this bear? You're smiling at me." "You're such a tired baby. You gonna go to sleep? Those eyes are getting awful heavy." In addition to a recognition of their infant's behavior states, experimental mothers were also more likely to comment favorably on these behaviors--offering praise (item 94 #11) or laughter (item #6) to express their admiration or appreciation. The following are examples of such approval statements: "There we go. Her's a pretty girl.” (mother has finished dressing infant) "You a big boy. Big? Yeah.” (infant has finished water bottle) "A very good job she did. Yeah. .Clean baby, pretty baby she is." (mother has finished bathing infant) "Are you good girl? Good girl, yeah. Let's look at you smile." (infant smiled for mother) As stated previously, an examination of the verbal communication permitted an evaluation of the mother's sensitivity to the infant's behavior states (both action and feelings). But also discernible was the mother's wish to express her "action” and "feeling" states to her infant-- reflecting her need to establish a certain reciprocality in their interactions. Such reciprocalness is indicative or characteristic of healthy communication patterns. Experimental mothers were more likely to express their needs or desires (item #15)) and to describe or detail their caretaking activities (item #8). The following are examples of these behaviors: "Can you smile for mama? You can smile. Come on." (mother wants infant to smile) "Can you burp for mama? Care to burp for me? Yeah." (mother needs infant to burp) 95 "Let's put your other shirt on. Let's do it up in the back. Mama gotta pull 'em down.“ (mother dressing infant) "Get under that double chin. In between her fingers. These little toes is gotta be washed." (mother bathing infant) In summary, the literature testifies to the severe interactional and communication difficulties that characterize abusive/neglectful families (Anderson, 1979; Bousha & Twentyman, 1984; Burgess & Conger, 1978; Egeland et at., 1980; Wells, 1981). Thus an intervention goal was to promote or strengthen the quality of mother-infant interaction/communication patterns (thereby targeting the family causal factor of parent-child interaction). When providing instruction on child development, student nurses encouraged mothers to communicate with their infants through the provision of stimulation. Also important to the promotion of healthier interaction patterns was the instruction given in stress management techniques. Finally, it was hoped that the student nurses' efforts to enhance the mother's feelings of her own worth and of the value of her infant (through an intense focus on each of their feelings and needs) would serve to strengthen the parent-infant relationship. Experimental mothers did provide greater amounts of verbal stimulation to their infants--and an examination of this communication revealed that these mothers displayed an increased sensitivity to their infant's behavioral states (and an increased appreciation or 96 admiration of these states)--as well as an increased sensitivity to their own feelings and actions. This sensitivity and reciprocality are regarded as strong indicators of both parental risk condition and the quality of mother-infant interaction (Crittenden & Bonvillian, 1984; Egeland & Farber; Giblin, Starr, & Agronow, 1984; Nover, Shore, Timberlake, & Greenspan, 1984; Van ka, Eloff, & Heyns, 1983). Parental Competency Problem-Solving Ability Experimental subjects were able to provide a greater number of options to posed child-rearing problems. This display of competency was seen as beneficial to the establishment of more positive parenting functioning. The experimental mothers not only revealed a "versatility” with respect to current parenting concerns--such as what they generally check for when their infant awakes crying (item Q1), or comforting techniques to be employed to soothe a crying infant (item Q2)--but these mothers were also able to project solutions to future concerns--such as changes they would make in their homes to create a safer environment for the mobile infant (item Q5), or ways to handle feeding problems when solid foods are introduced into their infant's diet (item Q8). Control mothers not only provided fewer 97 options or solutions, but also recognized fewer sources of assistance when asked which person or persons they might contact if they were uncertain about how to handle a problem with their infant‘s care (item Q4). In summary, the literature contends that parents who possess a wider range (or ”repertoire") of childcare skills can more easily address the difficulties or demands involved in parenting (Azar, Robinson, Hekimian, a Twentyman, 1984; Boger, 1983; Dickie & Gerber, 1980; Marion, 1982; Olds, 1982; Rosenberg & Reppucci, 1983; Starr, 1979; Wolfe, Sandler, & Kaufman, 1981; Zussman, 1980). Thus an intervention strategy was to promote such skills (thereby targeting the individual causal factor of childcare experience). Student nurses provided information and printed materials on child development and management. They problem-solved with the mothers utilizing the various learning exercises in the home materials (none of these sample problem exercises were included in the competency measure administered at three-months postpartum). And when providing information on stress management techniques and community resources, they urged mothers to widen or strengthen their support networks (this emphasis was intended to address the community causal factor of social isolation). And again, such efforts were successful. Experimental mothers showed increased problem-solving abilities, including a recognition of a greater number of 98 potential ”helpers" when seeking guidance. Implications and Conclusions Study Weaknesses The subjects/participants were primarily of two mutually exclusive subclasses: white, married, high education and high income; black, single, low education and low income. The researcher had intended to study a sample of parents of varying life circumstances--wishing to assess the impact of intervention on a general population rather than a sub-population of parents. However--with the relatively low subject number--such an assessment was not possible. This barrier (i.e., the low subject number) represented the major weakness of the study. ‘In designing the intervention, a minimum number of fifty subjects was planned. The problem encountered was not the availability of potential subjects, or the willingness of parents to participate--but rather the recruitment of student nurse volunteers. This problem was unexpected. Research team members and nursing school staff personnel had met on numerous occasions to plan/structure the student nurse involvement. However, inspite of careful planning, the team experienced difficulty in attracting students to the project. There were only eight students who screened as e1igible/appropriate--resulting in a total possible subject number of 32. (School officials limited students to an 99 assignment of two project families-~feeling that any additional work load might jeopardize their class work.) In summary, because the study is based on a small number of subjects--and given the number of variables involved--the power and durability of the results may suffer. A second weakness centers on repetition of measures. Specifically, the researcher would have preferred to have conducted an additional behavior observation (i.e., the ten- minute videotape of mother-infant interaction). Such action was not feasible due to a shortage of both human (manpower) and financial resources. Finally, it was not possible to measure the social change outcome criterion of abusive/neglectful behavior (due to ethical/legal objections to the self-report measure). However, with respect to the relationship between the outcome measures of knowledge of development, child-rearing attitudes, parental competency, and interactional behavior, an examination of correlations suggested a common trait. The social/personal and motor/physical expectancy scales, the nurture and discipline attitude scales, and the verbal behavior scales were all strongly related to the problem- solving scale of the competency measure. Strengths Decisions in design regarding entry point and scope of the intervention served to strengthen the experimental 100 model. Regarding the latter, multiple causal levels (individual, family, community, and cultural factors) were targeted. This recognition of the complexity of maltreatment--and the subsequent tailoring of specific components of the intervention--had not been evident in prior studies. With respect to entry point, the early postpartum period was ideal. Mothers were attentive, cooperative, and appreciative. And the potential for impact was realized. Experimental mothers exhibited a greater understanding of the social/personal and motor/physical aspects of child development, embraced more democratic principles with respect to nurture and discipline-related issues in child-rearing, provided more verbal stimulation to their infants (reflecting an increased sensitivity/responsiveness), and displayed increased problem-solving abilities. Thus the intervention goal of building strengths or competencies in parenting areas which are predictive of abusive/neglectful parenting outcomes was achieved. Future Directions for Research Although the intervention did impact on the targeted areas of‘knowledge of child development, child-rearing attitudes, parent-infant interaction patterns, and parental competencies/skills, this impact can only be thought of as a "temporary" success. The long-term effects of such intervention is an unknown. Longitudinal research is 101 required. 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APPENDI CES APPENDIX A Purpose of Project: Participation: What is involved? 109 Request for Participation To develop and refine educational/ supportive services for first- time parents and their infants. (These services are offered to you in hopes of making this early parenting experience as rewarding as possible.) The research is being conducted by a graduate student in Psychology from Michigan State University. Participation in the project is voluntary. (If at any time you wish to withdraw from the project you may do so.) Your decision to participate or not to participate will in no way affect the care that you receive at Hurley Medical Center. If you decide to participate, you will be randomly assigned to one of two service groups. Depending on which group you fall in, you may receive home visits (at one, two and three weeks postpartum) by a Hurley Student Nurse Volunteer. She will share with you materials of interest to the new parent. (These visits will be scheduled at your convenience.) Length of home visits would be approximately sixty minutes. In-hospital activities may possibly include a visit from the Pediatric Nurse Practitioner, an infant bath demonstration, and/or attendance at a mother's breakfast discussion. All participants (regardless of group assignment) will be requested to complete questionnaires at four and twelve weeks postpartum. Also, at four weeks postpartum the project director would record a ten-minute videotape of you and your infant. 110 Confidentiality: You are extended a complete guarantee of confidentiality regarding all aspects of this research project (e.g., information you provide on questionnaires, ideas you discuss with nurses, etc.). All results will be treated with strict confidence and participants will remain anonymous. Upon request, results of the project will be made available to you. If you wish to participate, please sign below on this form: I have read this explanatory sheet, and discussed my involvement in the program with the project director. I understand and wish to participate in the program. Parent Signature Project Director Signature Date APPENDIX B 111 Research Team Director of Pediatric Research Dr. Gordon served in a supervisory role (she provided critical guidance/instruction in all research operations). As a member of the Master's Thesis Committee, she had thoroughly reviewed the proposal, and was active in the planning/revision of its design. Weekly meetings were scheduled to assess the progress of the research project. Director of Student Nursing Ms. Smith functioned in an advisory role with respect to the student nurse involvement. She offered assistance in the practical matters of the training/scheduling of the students (specifically, the incorporation of research tasks into their school curriculum) and was available to discuss any issues/concerns about student performance. Nursing Instructor Ms. Henige aided the project director in presenting/introducing the program to prospective student nurse volunteers. She, too, offered assistance in the training/scheduling of students (dealing with the specifics of assigning project students to project participants). Head Nurse (Post Partum) Ms. Trickey offered assistance in the recruitment of project participants. She helped screen prospective (to 112 determine eligibility status) and provided this information to the project director on designated intake-days. Head Nurse (Newborn Nursery) Ms. Mudar aided Ms. Trickey--providing the necessary information about the infant of prospective participants (which in part determined the eligibility status of the parent). Clinical Specialist Ms. Hershberger functioned in a consulting role. She was available to the student nurse volunteers as a 'reference' person (offering guidance regarding involvement with project families). AsSistant Director of Nursing/Maternal and Child Health Ms. Dawson served in a consulting role. She was available to the Project Director for discussion/direction regarding implementation/progress of the project. Student Nurse Volunteer After successfully completing additional classroom training, the student nurse provided both in-hospital and at-home educational/supportive services for the experimental project participants. Project Director Ms. Taylor was active in all areas of the research-- (training/supervision of students, recruitment of subjects, 113 delivery of services, and administration of post and follow- up measures)--being responsible for insuring the fidelity of the proposed model. The following individuals composed the training staff for the student nurse volunteers: Director of Behavioral Services/Mott Children's Health Center Dr. Rutledge presented educational material on child management--detailing philosophy/systems and methods/techniques. Program Director: 4-C's (Community Coordinated Child Care) Ms. Nieuwenhuis offered information regarding available resources in the community for children and families-- focusing on utilization. Pediatric Home Care Nurse Ms. Roberts instructed in home visitation--with emphasis on arrangement, time management, and personal safety guidelines. Parent Education Nurse Ms. Fortino explored issues of family adjustment (focusing on the physical and psychological stressors of the early postpartum period). 114 Program Director: Warmline (Family Support Center) Ms. Matthews offered instruction in child development (emphasis on realistic expectations) and parenting patterns (focus on active decision-making). Project Director/Michigan State University Ms. Taylor presented specifics of the project (theoretical background, rationale, method, measures)--and the mechanics of the project (instruction in the execution of intervention components). APPENDIX C 115 Training Schedule 1'st Session: "Introduction to Project” D. Kay Taylor Project Director Michigan State University "Home Visitation” Jan Roberts Pediatric Home Care Nurse Hurley Medical Center "Family Adjustment/Stress Management" Judi Fortino Parent Education Nurse Hurley Medical Center ”Community Resources" Jan Nieuwenhuis Program Director Community Coordinated Child Care 2'nd Session: "Child Development/Parenting Patterns" Jerilyn Matthews Program Director-Warmline Family Support Center ”Child Management" Tom Rutledge Director of Behavioral Services Mott Children's Health Center "Mechanics of Project/Role Rehearsals" D. Kay Taylor Project Director Michigan State University Length of Sessions: 4 Hours Total Training Time: 8 Hours 116 Training Presentation Outlines 1'st Session: "Introduction to Project” I. II. III. "Home II. III. IV. Child maltreatment A. Definition B. Incidence ' C. Multi-level analysis of causal factors D. Treatment vs. Prevention Research to be conducted A. Primary prevention effort B. Strategy: multi-level needs addressment C. Hypotheses D. Subjects E. Design F. Procedures G. Measures H. Analyses Student nurse volunteer role (components) A. Support B. Education Visitation" Arrangement A. Reminder call/card Time management A. Controlling interference B. Use of manual Supportive climate A. Empathic/active listening B. Nonpossessive warmth C. Genuineness D. Problems/barriers Safety guidelines "Family Adjustments/Stress Management" I. Introduction A. Definition of postpartum period B. General aspedts of postpartum period II. III. IV. 117 C. Optimal functioning=gaining knowledge D. Integration of knowledge E. Model motherhood experience Changes A. Development of maternal attachment B. Physiological adjustments C. Emotional adjustments Effectively coping with stress A. Utilizing communication B. Effective decision-making C. Role of support D. Stress management techniques Variations on the model motherhood experience A. Single mother . High school not completed . Income dependent on relative/State . Living with another family constellation Previous pregnancies Other 'IJMUOIII "Community Resources" I. II. III. IV. Introduction A. Overview of 4C and its services to the community Defintion of community resources A. Overview of resources in the immediate area B. Specific community resources for children and families C. Importance of referral as support to children and families Problem solving activities A. Practical exercises in referral process . Group discussion on resources . Relationship of health care professionals to resources . Relationship of health care professionals to referred persons U0!!! Materials A. What Can 4C Do For You? B. Parents' Guide to Child Care C. Phone Guide to Children's Community Services in Genesee County 118 2'nd Session: "Child Development/Parenting Patterns" I. II. III. II. III. Development Importance of knowledge A. Realistic expectations Components A. Motor/physical B. Personal/social C. Intellectual Stimulation A. Advances/growth B. Interaction opportunity Parenting patterns Influence of childhood experiences A. Adult relationships B. Functioning as a parent Learning exercise Active decision-making A. Critical examination B. Exploring alternatives C. Adoption/rejection of practices "Child Management” I. II. III. IV. Discipline A. Definition B. Purpose C. Highest goal Focus on change A. Autocratic vs. democratic A system A. Target behaviors/consequences B. One warning Learning exercise Methods of management A. Good B. Not-so-good VI. 119 Learning exercise "Mechanics of Project/Role Rehearsals" I. II. III. IV. IV. Intervention components (SNV) A. Introductory meeting (resolution of labor/birth experience) B. Bath demonstration C. Breakfast discussion (accompaniment) D. Home visit (one-week postpartum) E. Home visit (two-weeks postpartum) F. Home visit (three-weeks postpartum) Management of dual roles (student/volunteer) A. Assignment process B. Incorporation of research tasks Aids A. Access to research staff members B. SNV manual Model fidelity A. Audiotaping B. Completion of forms C. Research journals Ethical issues A. Confidentiality B. Compensatory time Rehearsals APPENDIX D 120 [Introduce Topic] Adjustments/Stress Management AWill you share with me what this first week of being a mother has been like? [If coaching is necessary: "the ups and downs".] [Lead to discussion --] Postpartum Blues/Depression Definition: Mood changes which typically begin a few days after childbirth (although in some instances may set in as late as several weeks or months after). The 'baby blues' have been identified in 50-60% of all term deliveries. It is usually not serious, and in most cases it is short-lived. Characteristics: Tearfulness (some new mothers suddenly Causes: overcome by periods of weeping for no apparent reason), restlessness, easily irritated, sadness, anger, anxiety, fearfulness (feeling uncertain about how to care for the baby),forgetfulness. Many stressors working on or against the new mother. Some physical/physiological stressors include: [Stress] -Hormona1 (drastic reduction in progesterone and estrogen from high pregnancy levels) -Blood volume (immediate drop of about 10-12 lb at delivery) -Internal organs (replaced to prepregnancy locations) -Engorgement of breasts/Sore nipples -Episiotomy pain -Involution of uterus, contraction of cervix, decreasing vaginal size -Fatigue: a major stressor (demands of newborn/loss of sleep 121 Some psychological stressors include: -The birth experience (discrepancy between expected and actual labor/delivery experience) -Body image (stretch marks, leaking breasts, still have 'pregnant belly', etc.) -Addition of new family member (changes in career, time schedules, life style, etc.) -Adaptation to infant (learning about his/ her temperament; responding to cues of the newborn; perhaps feeling awkward in giving care) -Changes in partner relationship (less time for talking, quiet moments, sex/ possible conflicts--criticism, jealousy) -Role transition (before: wife - daughter - employee - etc./ now: additional role of mother) Some environmental stressors: -Financial problems or concerns (additional expenses with baby) -Limited living space (perhaps more crowded than before) -Problems with 'extended' family members (e.g., pershps mother or mother-in-law seem to be interfering/offering unwanted advice or even criticism) Some social/cultural stressors: -"Perfect Home” expectations from TV/magazines -Mobility of society (sometimes there are few family members or close friends nearby to offer advice or help with child care when needed) Suggestions for coping with stressors: -Recognizing changes (it is important to understand what is happening to you physically, emotionally, and socially) 122 -Promoting recovery *Diet/Nutrition [Refer to handouts 'Four Food Groups', 'Caffeine Content' and 'Food Habits Questionnaire'] Must consult *Exercise [Refer to handouts 'Essential physician Exercises for the Childbearng Year' and 'Fitness for New Mothers'] ' *Rest -Uti1izing stress management techniques *Conscious relaxation [Refer to handout] *Exercise (helps restore your energy) *Time-out (staying alone with an infant all of the time isn't good for you-- arrange for someone you trust to take over for a while--you need time for yourself, and the companionship of other adults) -Examining role of total life style/Making adjustments or changes to reduce stress [Refer to handout 'Stress Control Test'-- emphasize to parent that no one is expected to answer all statements with "Yes"--concern is warranted only if there are many "No's"] -Identifying support system (people generally have others near them (e.g., spouse, family members, neighbors, friends, co-workers) or available to them (e.g., doctor, minister) who will listen and share problems) [Stress] Identifying and building these helping relationships with other people can be a source of great personal strength. (Special -Infant soothing techniques (talking to baby, measures singing, swaddling, rocking, music, baby just for carrier, car ride, bath/massage, pacifier, baby) warmth, time-out) References .Hazle, N. R. Postpartum B1ues--Assessment and Intervention. Journal of Nurse-Midwifery, Vol. 27, No. 6, 21-25, 1982. Fortino, J. Personal communication (Parent Education, Hurley Medical Center). . 123 [Introduce Topic] Child Development [Stress] All infants are individuals and will develop at their own individual pace. This information is intended only as a guideline to the motor, social, and intellectual development of your child. Suggestions for the stimulation of that development are included. [Provide definition] Stimulation: To rouse to activity; to increase action; to influence growth. (The suggestions offered here should not be thought of as 'guarantees' regarding the progress of your child's development.) Stages of development which concern us: Infancy: 0-12 months (which will be our major focus) Toddlerhood: 13-30 months Preschool or early childhood: 31-60 months 0-3 Months MOTOR/PHYSICAL DEVELOPMENT *Consists largely of reflex movements during the first 2 months. We will not read through this list since the PNP demonstrated these reflexes for you while you were in the hospital. ADid you find that demonstration helpful or enjoyable? [Go to Head Control] Reflex: An involuntary action or response; an automatic reaction (present at birth). Sucking Reflex: Initiated by stroking baby's lips or placing object in mouth. Allows your baby to obtain nutriment. Rooting Reflex: Initiated by touching the cheek. Allows your baby to find the source of food. Grasp Reflex: Stroke the palm of hand or sole of foot with your finger. Your baby will attempt to grab finger. Push Reflex: Stepping Reflex: Startle Reflex: Moro Reflex: Tonic Neck Reflex: 124 Place baby on back and push on feet so that the legs bend at the knees. Your baby will attempt to push you away with his/her legs. Hold your baby in a standing position. Move him/her forward, and he/she will appear to walk (moving feet heel to toe). Occurs when baby is startled by a sound, bright light, or sudden change in temperature. However, may also occur while sleeping. You will see a jerking or twitching of the arms and legs. Triggered by a sudden change in position (if handled too roughly). Arches back and throws head back-- arms and legs fling upward, then rapidly close to the center of the body. On back--lays head to one side, with arm and leg on that side extended. The other arm and leg are slightly bent. *Head Control: Is steadily improving. [Refer to box area.] 1 month: Raises head slightly off floor or bed. 2 months:Holds head erect, bobbing, when supported in sitting position. 3 months:Lifts head and chest when lying on stomach. Suggestions for stimulating motor development: Provide the chance or opportunity for your baby to practice these abilities. 125 -Play with your baby by eliciting the grasp, push, and stepping reflex. -Hold interesting (bright, colorful) objects near baby so he/she will focus on them; slowly move objects (will help strengthen head and eye control). -Offer praise, encouragement. 0-3 Months PERSONAL/SOCIAL DEVELOPMENT *Rapid emotional shifts (intense crying one moment and quite content the next). Requires a great deal of patience on the parent's part. ' *Periods of crankiness--colic may cause a great deal of crying during the first few months--should end at around 3 months (cause is somewhat of a mystery; apparently digestive system not working smoothly--swallowing a lot of air . ' *Bonding: Emotional attachment between parent and child (established through close physical contact). Touch is very important (skin-to-skin contact). -Wi11 recognize mother's voice as early as 1 week. -Will recognize mother's face at around 1 month (sense of hearing functions better). *Social smile appears (2-3 months). Responds to familiar faces. *Development of trust (responding to needs as quickly as possible is recommended). Cannot spoil an infant under the age of one year. If their cries are answered quickly and consistently in the first year, studies show they will cry less later on. AHas anyone--perhaps a friend or family member--advised you not to pick up your baby too often when he/she is crying? [If parent responds ”Yes" -- comment that that is a very common belief about spoiling.] 126 *Language: crying (baby's first way of communicating). -"I'm hungry" (most frequently needs to be fed). -"I'm frightened" (loud or sudden noises, bright lights, being handled too actively). -”I'm in pain"(sensitive to variations in room temperature such as at bath time or when diaper/clothing is changed; diaper pins or tags on clothing are irritating; stomach gas-need to be burped; wet or soiled--needs [Stress] diaper change). §;;;;;;£ie-:"1'm lonely" (need for physical contact). demands -"I'm bored" (needs change in position, room ------------ area, to be played with). Sometimes it seems that everything you try just doesn't work. Soothing techniques: -A gentle massage. -Talk quietly to baby. -Sing to baby. -P1ay soft music. -Use motion (rocking, walking). AIs there anything you have found to be helpful? When all fails, place baby on stomach in crib and let him/her cry. If possible, have someone you trust 'take over' for a while. You would probably appreciate a 'break'! [Refer to box area.] 127 Suggestions for stimulating personal/social development: Provide baby with pleasureable experiences. -Enjoys human face (8-12 inches),cuddling,being held. -Again, offer praise, encouragement. 0-3 Months INTELLECTUAL DEVELOPMENT *Can see, hear, feel, smell, and taste at birth. Through these 5 senses begins to learn about the world (taking in information from birth). *At 3 months may begin grasping for objects within reach. [Refer to box area.] Suggestions for stimulating intellecutal development: Maximize opportunities to learn. -Needs must be met (if crying or uncomfortable, not as alert or able to become interested in outside things). -Provide additional stimulation. [Review ILP/at conclusion] -Reaching games (hold favored objects close to baby). -Again, offer praise, encouragement. 4-6 Months MOTOR/PHYSICAL DEVELOPMENT *Rolls from side to side (4 months). *Rolls from back to stomach (6 months). *Sits with minimal support (6 months). 128 *First tooth generally appears (6 months). [Refer to box area.] Suggestions for stimulating motor development: -Make sure that baby has space to safely practice new 'mobile' skills (do not leave unattended on sofa, adult bed, changing table, etc.). -Again, offer praise, encouragement. 4-6 Months PERSONAL/SOCIAL DEVELOPMENT *Laughs aloud (4 months). *Self-awareness. Recognizes his/her image in a mirror at about 6 months. Develops a sense of 'separateness'. *Stranger anxiety--may cry or act fearful (6 months). *Language: babbling (intentional repetition of sounds) and cooing (vowel sounds) at around 6 months. [Refer to box area.] Suggestions for stimulating personal/social development: -Continue with Infant Language Program. [Remind of conclusion] -Mirror play (baby should have access to unbreakable hand mirror). -Enjoys social games such as peek-a-boo. -Again, offer praise, encouragement. 129 4-6 Months INTELLECTUAL DEVELOPMENT *Eye-hand co-ordination (6 months) -Fascinated with his/her hands and fingers. Wishes to explore objects by touching. Passes objects from hand to hand. -Learns to drop (release) and throw objects (is learning space perception; cause and efect; developing finger, hand, and arm skills). -Use of hand as reaching tool under guidance of eyes. (Previously just 'random' grasping.) [Refer to box area.] Suggestions for stimulating intellectual development: -Disappearing game (while baby is watching, hide toy or small object under blanket or cloth for baby to discover --learns that objects remain or are 'permanent' even when not in visual range). -Dropping game (hand baby objects for dropping/pick up dropped objects and repeat). -Again, offer praise, encouragement. [Refer parent to outline.] “For the 4-6 month period, which new skill or accomplishment of your baby do you most anticipate or look forward to? “What do you feel might be the most difficult part of this time period for you as a parent? 130 7-9 Months MOTOR/PHYSICAL DEVELOPMENT *Crawling (9 months). *Pulls self up to a standing position (9 months). [Refer to box area.] Suggestions for stimulating motor development: -Retrieving objects (roll ball a few feet from baby to encourage him/her to crawl to toy). -Again, offer praise, encouragement. - 7-9 Months PERSONAL/SOCIAL DEVELOPMENT *Mobility gives a greater sense of 'curiosity' (will most likely react negatively when you must restrict his/her activities). *Achieving greater 'individuality' (shows strong preference in foods). *May have periods of crankiness due to teething irritation. *Language: imitates your sounds--begins to make sounds like "mama" and "dada" (9 months). [Refer to box area.] Suggestions for stimulating personal/social development: -Naming game (saying/repeating names of objects or people while baby is looking at or touching them). -Again, offer praise, encouragement. 131 7-9 Months I NTELLECTUAL DEVELOPMENT *Greater concentration or determination in behavior(may work longer at some particular task--appear less distractible). *Learns more about space as he/she 'travels' (learning distances between rooms; how to crawl around obstacles). *Better sense of spatial relationships (will alter position of hands according to size and shape of object he/she reaches for--using thumb and forefinger for small objects and both hands for large objects). *Can pick up small objects between finger and thumb (9 months). [Refer to box area.] Suggestions for stimulating intellectual development: -Filling & emptying a container (collect a wide variety of objects for baby to place in a container and them dump onto floor). -Provide plenty of space for exploration. [Refer to suggestion 'sheet for babyproofing' home]. -Again, offer praise, encouragement. [Refer parent to outline.] “For the 7-9 month period, which new skill or accomplishment of your baby do you most anticipate or look forward to? “What do you feel might be the most difficult part of this time period for you as a parent? Suggestions for 'babyproofing' home: -Insert safety plugs into unused electrical sockets. 132 -Install gates or childproof latches to control access to dangerous areas (e.g., the basement or any Stairways). -Move small valuables like glass or ceramic knickknacks. -Remove poisons from kitchen, bath. -Beware of unstable furniture that could tip. -Pet food and pet dishes should be out of reach. -Potentially dangerous items should not be left lying around(sewing kits, tools, silverware, smoking equipment) -Remove or cover control knobs on stove when not in use; keep pot handles turned inward; beware of appliance cords (e.g., could tug on cord of coffee pot and pull off counter spilling hot liquid). -Do not leave small objects about when you are not in room playing with baby (may place in mouth and choke). -Tape padding on sharp edges of furniture. -Do not leave plastic clothing bags out (may suffocate). -Keep all doors and drawers closed. 10-12 Months MOTOR/PHYSICAL DEVELOPMENT *May step with support (12 months). *Cruising--supports self with hands while sliding feet-- stepping 'sideward' (12 months). *May stand unaided (12 months). [Refer to box area.] 133 Suggestions for stimulating motor/physical development: -Again, provide hazzard-free environment. -Again, offer praise, encouragement. 10-12 Months PERSONAL/SOCIAL DEVELOPMENT *Greater mobility increases sense of 'independence' (will again react negatively as you place limits on behavior). *Period of extreme messiness as he/she begins finger feeding. *Separation Anxiety--afraid that you will disappear and not return. *Attachment--wants mother around all of the time(may be very demanding of your time). *Genuine feelings of affection--you are no longer just the one who meets or cares for physical needs (wants to sit on your lap, cling to your legs, pat your body, stick fingers in your eyes, mouth and ears). -May kiss on request (12 months). *Language: First words appear (12 months). [Refer to box area.] Suggestions for stimulating personal/social development: -Be patient when he/she is demanding. -Respect your child's fears--continually offer reassurance. -Return signs of affection. -Again, offer praise, encouragement. 134 10-12 Months INTELLECTUAL DEVELOPMENT *Understands that words represents objects. *Comprehends many words (although cannot speak them). *Associates certain sounds with objects (may try to bark when you point at a dog). *Follows simple directions-~understands some adult commands such as "No!" or “Sit down." (12 months). *Memory improving. *Experiments with properties of objects--wants to know what makes it 'tick' (engages in banging, shaking, pushing and so forth). *Masters stacking--2 blocks (12 months). [Refer to box area.] Suggestions for stimulating intellectual development: -Repeat words (not using baby talk or slang). -Labe1ing games (ask child, "Point to ...”). -Provide objects for stacking (develops coordination). -Nesting toys (learns that two objects can 'occupy' same space). -Again, offer praise, encouragement. [Refer parent to outline.] “For the 10-12 month period,which new skill or accomplishment of your baby do you most anticipate or look forward to? “What do you feel might be the most difficult part of this time period for you as a parent? 135 LOOKING FURTHER AHEAD 'WHAT TO EXPECT- (We will just look briefly at some of the toddler and early childhood development.) MOTOR DEVELOPMENT 5 yrs First attempts at skipping/ Jumping rope Laces shoes 5 yrs Shows respect for group property and rights of 2 yrs 3 yrs 4 yrs Kicks ball Throws ball over head/ Catches ball bounced to him/her * Climbs up/ Walks up/ Capable of down stairs down stairs running/ with ease Hops in place Circular Copies scribble circle PERSONAL/SOCIAL DEVELOPMENT 2 yrs 3 yrs 4 yrs Beginning Agreeable, Begins to negative stage Friendly/ develop Shows Shares toys friendships temper with other children * Parallel play (next to children) Fears are chiefly auditory (animal noises,etc.) Cooperative play with others Visual fears predominate (the dark, masks, etc.) Small group play Auditory fears again surface Tendency to tattle, tall tell tales, boast, show- off,act silly others Plays well in large group Spatial fears (of being lost; being only one on a floor of house) Listens and takes turns in group discussions 136 2 yrs 3 yrs 4 yrs 5 yrs Toilet Verbalizes training may toilet needs be completed Achieving Feeds self Cuts food skill with cup with little with knife and spoon mess Still needs Has poise and help in dressing control (but can undress self) Asks for item Correct by name/Uses 2 grammar or 3 words together INTELLECTUAL DEVELOPMENT 2 yrs 3 yrs 4 yrs 5 yrs * . Begins to Asks questions Asks for Asks meaning reason (What is ...) explanations of abstract (Why is ...) words Cannot Can sort out distinguish 'fact' from fantasy from 'fancy' reality Carries out Carries out 2 directions/ 3 directions/ commands commands *[Point out progression.] There are, of course, many more changes you will witness in your child's motor, social, and intellectual growth. Only a few examples are listed here. We encourage you to read over this material again, or visit your public library and check out additional materials on children. By learning about your child's development, you will be better prepared to 'parent' --for you will gain a greater understanding of your child's needs, potential, and characteristic behaviors. 137 References Barber, L. W. and Williams H. Your Baby's First 30 Months. Tucson, Arizona: H.P. Books, 1981. DeLorenzo, L. and DeLorenzo, R. Total Child Care. Garden City, New York: Doubleday & Company, Inc., 1982. I19, F., Ames, L. and Baker, S. Child Behavior. New York, New York: Barnes & Noble Books, 1982. 138 [Introduce Topic] Child Management [Provide definition] Discipline: To educate or teach socially acceptable ways of [Focus on change] The---parent feels that-- behaving. Purpose--To enable a child to function in society (to get along with other people). Involves training or guiding your child in the direction you feel is right or proper. Includes setting limits. (Does not have to include the use of physical force--although discipline is commonly thought of as involving force or some sort of 'punishment'.) Highest Goa1--To instill values (so that one day your child will choose to do the right things by acting on his/her own thoughts or ideas). Through the years,there have been changes in our ideas or attitudes about discipline and raising children. There has been a shift in our society from an autocratic attitude (which stressed complete parental power or dominance) to a democratic attitude (which stresses fairness and cooperation within the family unit). To better understand the difference between these two viewpoints, we will compare autocratic and democratic beliefs. Autocratic Democratic I must control. I need to offer guidance. I am superior. *I am equal. I must be perfect I am human ('good' parents (it is a sign of do make mistakes, and weakness to make can feel secure in mistakes, or to apologizing to their admit to your child when they were in child that you the wrong). were wrong in something). You owe me. The love and respect we feel for each other is freely expressed. 139 i: *(Equal does not refer to 'sameness' (e.g.,that children and adults should have the same responsibilities or powers in decision-making), but rather that children and adults are equal in terms of human worth and dignity.) In line with the democratic viewpoint, we'd like to present a new way of viewing discipline--where the word 'punishment' is missing (for the word PUNISHMENT seems to suggest that some sort of CRIME has taken place). [Explain Rather than thinking of discipline as involving new view] 'Crime and Punishment'--1et us understand disci- pline as a matter of 'Behavior and Consequences'. Regarding behaviors that you wish to eliminate, the following chart may be helpful to you: TARGET BEHAVIORS CONSEQUENCES [read thru this list lst] [read thru this list 2nd] Target behaviors should be--- Consequences should be--- CLEAR--to both parties 0 LOGICAL (that is--re1ated to (e.g., if you say "Stay N the misbehavior--if your close to home." instruct E child rides his/her bike in your child in the exact the street, then the bike boundaries that concern W will be put away for the you--then there is no A remainder of the afternoon-- room for any misunder- R this sort of action helps the standing). N child learn). I AGE APPROPRIATE--you must N CONSISTENT (If you say ”No" ask yourself if your do not change your position-- child's actions are really S if you change your mind misbehavior or are they Y because your child begins to normal/typical for their S cry,you are teaching him/her stage of development T that they can have their way (e.g.,it is not reasonable E if they behave badly enough. to expect a two-year-old M To avoid this, ask yourself to share his/her toys, or if each "No” is really for a three-year-old to necessary. If it is, then play well in a group-- let it remain a ”No”). refer to ch/dev material). FAIR--you should not expect SHORT IN DURATION (e.g., if more from your child than you were to remove the you do from yourself (e.g., child's bike for a week-- if you want your child to rather than an afternoon-- pick up his/her toys, then he/she would most likely you must pick up those forget what they had done things which belong to you). 'wrong', and thus the purpose of discipline is lost--which is to learn). 140 TARGET BEHAVIORS Target behaviors should be--- FEW AS POSSIBLE (the fewer the number of rules, the more likely it is that you will obtain obedience from your child)--select those behaviors which are most important! (e.g., a clean bedroom may not really matter all that much to you, but you want your child in the house before dark). Learning Exercise: CONSEQUENCES Consequences should be--- INDEPENDENT OF YOUR MOOD -- nagging, yelling, or hitting require that you be upset or angry.You are likely to give a consequence that you will later change(e.g.,When angry: ”No TV for a week!["; after calming down:"No TV tonight!" --thus you are more apt to be CONSISTENT if you are calm! CONVENIENT for you (e.g., to tell your child that he/she cannot leave the yard for a week--entails your watching them every minute in order to enforce this; or cancel- ing a weekend vacation means that you also '1ose out'). “Decide what is wrong with each of the following TARGET BEHAVIORS (Also--how could you correct the problem?) Parent tells child (age 11) that he/she can only watch "a little TV" when they get home from school. When the parent arrives home from work, they find that their child has watched TV all afternoon. Parent tells child (age 8) that he/she cannot eat snacks in the living room--although both mom and dad enjoy eating in front of the TV. Parent tells child (age 5) that all toys must stay inside of the house; that toys cannot be put on the furniture; that only two toys can be taken out of the toy box at one time; and that all toys must be put back in the toy box at the end of the day. Parent tells child (age 2) that he/she cannot spill their milk or get food on their clothing during meal time. 141 Learning Exercise: “Read the following situations. Decide what would be an effective consequence for the child's misbehavior. Rule of House--all children receive an allowance at the end of the week if they do assigned chores. Josh (age 9) is suppose to keep the garage clean. This week he did not do this. Rule of House--no 'rough' play in house (wrestling, playing ball, etc.) Jenny (age 7) jumps rope in the living room (knocking over and breaking a small lamp). Rule of House--bedtime is 8:30 p.m. Mark (age 5) is 'pestering' mom to allow him to stay up later. [Note here that although consistency is important, flexibility is sometimes appropriate (e.g., mom may sometimes allow Mark to stay up later when a special TV show is on.] *Remember that discipline involves teaching! There are many ways to teach children. METHODS OF CHILD MANAGEMENT *COMMUNICATION: Take the time to talk with your child.He/she needs to understand what you expect from them.Whenever possible, explain your reasons for rules. This shows that you respect their feelings. *ATTENTION: Just as you find it necessary to have your child experience the negative consequences of his/her inappropriate behavior (e.g., child's paints are put away for the afternoon because they have left them in the middle of the living room floor), it is just as important for there to be a positive consequence for 'good' or desired behavior (e.g., child helps in cleaning living room, and is told how proud you are of him/her). Remember: give your child attention when he/she behaves correctly! (If a child receives attention only when they are misbehaving--they may misbehave simply to gain attention.) *WITHDRAWING If possible, ignore 'bad' behavior (e.g., ATTENTION: teasing, whining, or temper tantrums). Do not reward a child by giving him/her an audience. " *CHOICES: *CHANGE THE ENVIRONMENT *NATURAL CONSEQUENCES *SET EXAMPLES *EMBARRASS- MENT 142 Whenever possible, allow your child the right to make decisions which concern him/ her. This can help your child develop self- control and a sense of responsibility (e.g., you might ask ”Would you prefer to have your homework sessions before dinner, or before bedtime?"). There are times when you can change something in your child's surroundings that will solve a problem between the two of you (e.g., your child wants the room light left on at night. You purchase a small night-light, and he/she is now satisfied). Requires children to be responsible for their own behavior. They learn from the natural or social order of events (e.g., if a child refuses to eat--do not coax, nag, or scold-- they will discover that they become hungry, but must wait for the next scheduled mealtime; if a child dawdles or wastes time in the morning when preparing for school-- they will be late and experience consequences from the teacher.Avoid pity--protecting your child from making mistakes robs him/her of an important learning experience. Children look toward their parents for guidance. They will watch your behavior very carefully--thus it is important to "Practice what you preach" (e.g.,if you don't want your child to call you or other people "dumb",then you should not call your child 'dumb"). NOT SO GOOD METHODS OF CHILD MANAGEMENT Publicly embarrassing a child is not a good ideaIe.g.,asking a waitress for extra napkins because "Johnny can't seem to get through a meal without spilling his milk--I guess he should go back to a baby bottle"). A child may learn to fear social contact with people-- he/she may have very little self-confidence. 143 *GUILT Telling a child that he or she is ”bad" or INFLICTION "selfish" is not a good idea. In the early years, children believe everything that you say. Such criticism can effect their sense of their own worth (critisize the 'deed' and not the 'doer'). Likewise, telling a child that they ”Should behave for me" or "You owe me this much" can make them feel less worthy. *FORCE Force generally teaches a child to fear you. It is best to reserve this method for those occassions when your child is placing himself/ herself in danger (e.g., toddling toward a busy street). Learning Exercises: AThe following are examples of problems a parent is having with their child's behavior. How might the parent manage that behavior? Barbara (age 4) is angry that she is not allowed to cross the street like her older brother. She thinks that her mom is being unfair. Robert (age 9 months) is crawling now. He has broken some things in the house (by reaching for objects on the coffee table and other furniture). Erica (age 10) has a book report due tomorrow.She didn't get the assignment done--and insists that she be allowed to stay home from school tomorrow to finish working on it. Mark (age 6) does not want to join the Cub Scouts (which his mother feels is a good idea).He states that he wants to play baseball on a Little League team. A Reminder: You might recall from last week's developmental material that a child does not understand what the word "No” means until about 1 year of age. Thus for the infancy stage (0-12 months), distraction or redirection (in addition to changing the environment and offering/withdrawing attention) are suggested for managing behavior.For example,if a 9 month old baby is crying because he/she wants to hold something they should not have (e.g., a cigarette lighter), make the effort to interest them in something else (such as pictures in a magazine or book). 144 [Parenting Patterns] In conclusion, it is important to be aware that our parenting styles or practices (i.e., the way in which we raise our children) are often influenced by many things and people (e.g.,our friends, neighbors, family members, books, TV, magazines, etc.). We feel that it is important for each of us to devote some time to 'examine' these influences so that the choices we make as parents are well thought out. Of special importance--is the influence of our own childhood experiences. Learning Exercise: Think back to your childhood. Think about a specific event or situation when your parents or other adults showed you how much they cared about you. “Can you describe that experience for me? “Is this something that you wish to do for your child? “Can you think of another 'practice' you might want to make use of as a parent with your own child? Now think of an event or situation when you believe that your parent or other adults treated you unfairly, or were wrong in something that they did. “Can you describe that experience for me? “Is this something that you wish to avoid doing while raising your child? “Can you think of another 'practice' you might want to 'drop' from your plan for raising your child? References Dinkmeyer, D. & McKay, G. The Parent's Handbook: Systematic Training for Effective Parenting. Circle Pines, Minnesota: American Guidance Service, 1982. Eddy, J. Child Management for Parents. Flint, Michigan: A Mott Children's Health Center Publication. Jewell, R. Methods of Child Management. Flint, Michigan: A Project LIFE (Living Instruction/Family Education) Publication. Rutledge, T. Personal communication (Behavioral Services, Mott Children's Health Center). - APPENDIX E Name Visit 145 Coding Scheme Volunteer identification Family identification Educational Component: I. II. Follow manual (student nurse copy) while listening to tape to check for any omissions in the four areas listed below: (Record any such omissions.) -Instruction -Questions -Learning Exercises -Handouts If student nurse provided any additional information (e.g., elaborated on a particular item when questioned by the parent) please record below: Support Component: Although for the purposes of this research project support has been operationally defined as the benefit of access to a helping person (i.e., student nurse contact/time with participants), the following information would assist the Project Director in evaluating the quality of that support. I. Length of visit: 146 Coding Scheme cont. II. Student nurses's "responding manner" to questions posed by parent: (Please check one.) Positive: Appeared pleased by parent's interest/ Made attempt to answer question Negative= Gave impression that question was unimportant/ Ignored question Comments: III. Student nurses's "responding manner” to parent's answers/information shared during learning exercises: (Please check one.) Positive= Accepting/Non- judgmental/ Enthusiastic Negative= Critical/ Unconcerned/ Misinterprets Comments: APPENDIX ‘F 147 Student Nurse Volunteer Contract Responsibilities: To preserve the fidelity of the model by carrying out the intervention as presented in training and detailed in the manual. To honor your commitment to the project by attending all training sessions, providing intervention services to a minimum of two experimental families, and maintaining a journal of your activities. To provide an accurate account of time devoted to research tasks (to be used for determination of compensatory time). To abide by the confidentiality code of research (especially in regard to rights of human subjects). Date Student Nurse Rights: To feel secure in the knowledge that your safety and welfare is a chief concern of the Project Director. To receive the necessary preparation for successfully adopting the interventionist role. To have access to research staff for needed or additional support/guidance. To receive all necessary materials for training and service provision (notebooks, datebooks, journals, paper, pen, appointment cards, and education manual). To receive clinical credit (=compensatory time) for your involvement in the project. Date Project Director APPENDIX C 148 PARENTAL EXPECTATIONS QUESTIONNAIRE (Time One) This questionnaire was designed to help us learn at what ages parents expect their children to be able to do certain things. Following each item you will find a choice of ages. Check the age at which you believe that your child will accomplish that task or display that behavior. Please do not skip any items or check more than one age. 1. Babbling and cooing. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 2. Babies' senses are all in operation. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 3. First tooth appears. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 4. Cooperative play with others. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 5. Use of the hand as a reaching tool under guidance of eyes. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 6. Most instances of colic seem to disappear after this month. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 149 7. Begins to recognize mother. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 8. Achieving skill with cup and spoon. At birth 1 mo. 3 1 yr. 2 yrs. 3 mos. 6 mos. yrs. 4 yrs. 9. Starts to develop a sense of separateness. At birth 1 mo. 3 1 yr. 2 yrs. 3 10. Laces shoes. At birth 1 mo. ' 3 1 yr. 2 yrs. 3 11. Toilet training may be At birth 1 mo. 3 1 yr. 2 yrs. 3 12. Throws ball over head, At birth 1 mo. 3 1 yr. 2 yrs. 3 mos. 6 mos. yrs. 4 yrs. mos. 6 mos. yrs. 4 yrs. completed. mos. 6 mos. yrs. 4 yrs. catches ball bounced mos. 6 mos. yrs. 4 yrs. 13. Rolls from back to stomach. At birth 1 mo. 3 1 yr. 2 yrs.___ 3 yrs. 4 yrs. mos. 6 mos. RIOS. yrs. mos. yrs. mos. yrs. mos. yrs. mos. yrs. him/her. mos. yrs. BIOS. yrs. 150 14. Shows respect for group property At birth 1 yr. 1 mo. 3 mos. 2 yrs. 3 yrs. 15. Can make circular scribble. At birth 1 yr. 16. May sleep At birth 1 yr. 17. May begin At birth 1 yr. 1 mo. 3 mos. 2 yrs. 3 yrs. through night. 1 mo. 3 mos. 2 yrs. 3 yrs. to crawl or pull up to 1 mo. 3 mos. 2 yrs. 3 yrs. 18. May step without support. At birth 1 yr. 1 mo. 3 mos. 2 yrs. 3 yrs. and rights of 6 mos. 4 yrs. 6 mos. :9 yrs. 6 mos. 4 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. standing position. 6 mos. 4 yrs. 6 mos. 4 yrs. 19. Climbs up or down stairs with ease. At birth 1 yr. 1 mo. 3 mos. 2 yrs. 3 yrs. 6 mos. 4 yrs. 20. Fears are chiefly auditory (thunder, animal At birth 1 yr. 1 mo. 3-mos. 2 yrs. 3 yrs. 6 mos. 4 yrs. ___ 9 mos. 5 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. noises, 9 mos. 5 yrs. others. 151 21. Follows simple instructions. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 9 mos. ___ 5 yrs. 22. Tendency to tattle, boast, tell tall tales, etc. I At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 9 mos. 5 yrs. 23. Begins to develop friendships with other children. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 24. Can become 'spoiled'. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 25. Rooting reflex observed. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 26. Visual fears predominate (the dark, masks, etc.). At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 27. First words appear. At birth 1 mo. 3 mos. 6 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 152 28. Plays well with others (in a large At birth 1 yr. 1 mo. 2 yrs. 29. Some self-feeding. At birth 1 yr. 1 mo. 2 yrs. 3 mos. 3 yrs. 3 mos. 3 yrs. 30. Begins to show a temper. At birth 1 yr. 1 mo. 2 yrs. 3 mos. 3 yrs. 6 4 group). mos. yrs. mos . yrs. mos. yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 9 mos. 5 yrs. 153 PARENTAL EXPECTATIONS QUESTIONNAIRE (Time Two) This questionnaire was designed to help us learn at what ages parents expect their children to be able to do certain things. Following each item you will find a choice of ages. Check the age at which you believe that your child will accomplish that task or display that behavior. Please do not skip any items or check more than one age. 1. Understands some adult commands ("No." or "Sit down."). At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 2. Learns to share toys. At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 6 mos. 9 mos. 4 yrs. 5 yrs. 6 mos. 9 mos. 4 yrs. 5 yrs. 3. Enjoys being supported in a standing position. At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 6 mos. 9 mos. 4 yrs. 5 yrs. 4. May begin grasping for objects within reach. At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 5. Walks up stairs. At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 6. Babies can pick out their own of other women. At birth 1 mo. 3 mos. 1 yr. 2 yrs. 3 yrs. 6 mos. 9 mos. 4 yrs. 5 yrs. 6 mos. 9 mos. 4 yrs. 5 yrs. mother's voice from those 6 mos. 9 mos. 4 yrs. 5 yrs. 154 7. Hops in place. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 8. Begins to play with other children (in small groups). At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 9. Has mastered partial self-feeding. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 10. Sits up with minimal support. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 11. Piling objects on top of one another. At birth ___ 1 mo. ___ 3 mos. ___ 6 mos. 9 mos. 1 yr. ___ 2 yrs.___ 3 yrs. ___ 4 yrs. 5 yrs. 12. Begins negative stage where it seems every request is met with "No”. At birth ___ 1 mo. ___ 3 mos. ___ 6 mos. 9 mos. 1 yr. 2 yrs. . 3 yrs. 4 yrs. 5 yrs. 13. Social smiling appears. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 14. A startle reaction is observed. At birth 1 mo. 1 yr. 2 yrs. 155 3 mos. 3 yrs. 6 mos. 4 yrs. 15. Feeds self with little or no messing. At birth 1 mo. 1 yr. 2 yrs. 16. Capable of running. At birth 1 mo. 1 yr. 2 yrs. 17. Has poise and control. At birth 1 mo. 1 yr. 2 yrs. 3 mos. 3 yrs. 3 mos. 3 yrs. 3 mos. 3 yrs. 6 mos. 4 yrs. 6 mos. 4 yrs. 6 mos. 4 yrs. 18. Tendency to exaggerate, show off, act silly. At birth 1 mo. 1 yr. 2 yrs. 3 mos. 3 yrs. 6 mos. 4 yrs. 19. Infant can see, hear, smell, and taste. At birth 1 mo. 1 yr. 2 yrs. 3 mos. 3 yrs. 6 mos. 4 yrs. 20. Listens and takes turns in group discussions. At birth 1 mo. 1 yr. 2 yrs. 3 mos. 3 yrs. 6 mos. 4 yrs. mos. yrs. mos. yrs. mos. yrs. mos. yrs. mos. yrs 0 mos . yrs. mos. yrs. 156 21. Teething irritation may become a problem. At birth 1 mo. 3 mos. 6 mos. ' 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 22. Starts to sleep longer at night (more than a 4 hour stretch). At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 23. First attempts at skipping. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 24. 'Stranger anxiety' occurs. At birth 1 mo. 3 mos. 6 mos. 9 mos. 5 yrs. 1 yr. 2 yrs. 3 yrs. 4 yrs. 25. Begins to succeed in grasping very small objects. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 26. May be able to stand unaided. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 27. Still needs help in dressing, but can undress self. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 157 28. Kicks a ball. At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 29. Uses 2 or 3 words together, such as "More juice.". At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 30. Enjoys social games (peek-a-boo, pat-a-cake, etc.). At birth 1 mo. 3 mos. 6 mos. 9 mos. 1 yr. 2 yrs. 3 yrs. 4 yrs. 5 yrs. 158 PARENTAL ATTITUDE RESEARCH INSTRUMENT (Time One) The following questionnaire includes a series of statements. Please read each statement and decide how STRONGLY you AGREE or DISAGREE with the statement on a scale from 1 to 4.Circle the appropriate number. Please read each statement; it is important not to skip any statement. Do not spend too much time with any one statement. Trust your first thought. STRONGLY STRONGLY AGREE DISAGREE l. A child will be glad later on that he 1 2 3 4 had strict training. 2. Some children are just so bad they' 1 2 3 4 must be taught to fear grown-ups for their own good. 3. Children have every right to question 1 2 3 4 their parents' opinions. 4. Children are entitled to keep their 1 2 3 4 own secrets. 5. The sooner a child learns to walk the l 2 3 4 better he's trained. 6. There is no reason why a parent can't I 2 3 4 be happy and make their child happy too. 7 . A good parent lets their child learn 1 2 3 4 the hard way about life. 8. Children bother you with all their 1 2 3 4 little problems if you aren't careful from the first. 9. Raising children is an easy job. 1 2 3 4 10. A young parent feels ”held down” 1 2 3 4 because there are lots of things they want to do while still young. 11. If children are given too many rules 1 2 3 . 4 they will grow up to be unhappy adults. 12. A child should never be taught to l 2 3 4 fear grown-ups. 159 STRONGLY STRONGLY AGREE DISAGREE 13. A parent should never be made to 1 2 3 4 look wrong in a child's eyes. 14. A parent should always be concerned 1 2 3 4 about upset feelings in a child. 15. A child should be taken off the 1 2 3 4 bottle or breast as soon as possible. 16. Children should realize how much 1 2 3 4 parents have to give up for them. 17. Children have to face difficult I 2 3 4 situations on their own. 18. If you let children talk about their 1 2 3 4 troubles they end up complaining. 19. Parents very often feel that they 1 2 3 4 can't stand their children a minute longer. 20. Most young parents are pretty content 1 2 3 4 with home life. 21. Strict training will make a child 1 2 3 4 resent his parents later on. 22. More parents should teach their 1 2 3 4 children to always be loyal to them no matter what. 23. You can't make a child behave by l 2 3 4 cracking down on him. 24. Very few children are trained to use 1 2 3 4 the potty by 15 months of age. 25. It is a parent's duty to make sure 1 2 3 4 they know their child's deepest thoughts. 26. Children don't ”owe" their mothers 1 2 3 4 anything. - 27. A child needs to be emotionally close 1 2 3 4 to its parents for a long time. 28. 29. 30. 160 A mother should do her best to avoid any disappointment for her child. Not many parents can be pleasant and calm with their children all day. One of the worst things about taking care of a home is that a woman feels that she can't get out. STRONGLY AGREE 1 2 STRONGLY DISAGREE 3 4 161 PARENTAL ATTITUDE RESEARCH INSTRUMENT (Time Two) The following questionnaire includes a series of statements. Please read each statement and decide how STRONGLY you AGREE or DISAGREE with the statement on a scale from 1 to 4.Circle the appropriate number. Please read each statement; it is important not to skip any statement. Do not spend too much time with any one statement. Trust your first thought. 10. 11. STRONGLY AGREE Strict discipline develops a strong 1 person who knows right from wrong. When a child thinks his parent is 1 wrong he should say so. A mother should make it her business 1 to know everything her children are thinking. Children have a right to rebel and be 1 stubborn sometimes. Most children are trained to use the l potty by 15 months of age. Parents shouldn't feel they have to 1 give up important things for their children. Children should be encouraged to 1 undertake tough jobs if they want to. The trouble with giving attention to 1 children's problems is they usually just make up a lot of stories to keep you interested. A parent should keep control of their 1 temper even when children are demanding. Having to be with the children all the 1 time gives a woman the feeling she is tied down. Strict training makes children 1 unhappy. " STRONGLY DISAGREE 3 4 3 4 3 4 3 4 3 4 3 4 3 4 3 4 3 4 3 4 3 4 162 STRONGLY STRONGLY 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. AGREE DISAGREE If a child acts mean he needs 1 2 3 4 understanding rather than punishment. A wise parent will teach a child 1 2 3 4 early just who is boss. There is nothing worse than letting a l 2 3 4 child hear criticisms of his parents. A child's thoughts and ideas are his 1 2 3 4 own business. A child should take all the time he 1 2 3 4 wants to before he learns to walk. A parent must expect to give up their 1 2 3 4 own happiness for their child's happiness. A child should learn that he has to l 2 3 4 be disappointed sometimes. A child should never keep a secret I 2 3 4 from his parents. A parent should be concerned with any 1 2 3 4 problem of a child no matter how small. Most parents never get to the point 1 2 3 4 where they can't stand their children. Most young mothers are upset more by 1 2 3 4 the feeling of being shut up in the home than by anything else. Toilet training should be put off I 2 3 4 until the child shows that he is ready. Almost any problem can be settled by l 2 3 4 quietly talking it over. Children who are held to strict rules 1 2 3 4. grow up to be the best adults. Taking care of a home doesn't have to 1 2 3 4 COOP a woman up. 27. 28. 29. 30. 163 STRONGLY AGREE If a parent is wrong he should admit I 2 it to his child. A good parent should protect their 1 2 child from life's little problems. Few women get enough thanks for all 1 2 they have done for their children. Most parents can spend all day with l 2 their children and remain calm and pleasant. STRONGLY DISAGREE 3 4 3 4 3 4 3 4 164 MOTHER-INFANT INTERACTION OBSERVATION I. Verbal 1. 10. 11. 12. 13. 14. Parallel Talk Mood Expression Explanatory Back Talk Musical Amusement Instruction Informative Personhood Affection Admiration Investigate Responsive Global Mother verbalizes infant's behavior or performance as infant is engaged in activity. Must refer to a specific physical action. Mother defines infant's mood states. May include an estimation of infant's likes/dislikes. Mother offers a causal interpretation of infant's behavior or mood state. Mother attempts to imitate infant's vocalizations. (Immediately follows infant's vocalizations.) Mother sings or hums. Mother engages in laughter. Mother tells the infant the name of some object in a teaching style. Mother describes/details some aspect of her actions. Mother calls child by name. Or uses 'pet' names for infant. Mother expresses fondness or endearment of infant. Mother praises baby's qualities or behaviors. Mother asks question of infant. Mother provides answer to question. Mother makes reference to things other than caretaking activities that are occuring. Apart from immediate time/ setting. 165 Verbal cont. 15. Need Mother makes request of infant. Subscale Total II. Tactile 16. Kiss Mother kisses infant. 17. Rock Mother rocks infant in arms (either while in a standing position or while using a chair). 18. Tickle Mother tickles infant. l9. Cuddle Mother cuddles or hugs infant (exaggerated). 20. Pats Mother pats, strokes, or massages infant. 21. Grasp Mother elicits grasp reflex by strok- ing palm of hand or sole of foot with finger. 22. Stand Mother holds infant in a standing position (feet resting on some surface). 23. Exercise Mother circles his/her arms around or moves legs up and down in an 'exercise' fashion. Subscale Total III. Visual 24. Smile Mother smiles (exaggerated). 25. Surprise Mother's facial expression reflects surprise (eyes widen, mouth opens,etc.) 166 Visual cont. 26. Present Mother presents object for infant's viewing such as diaper, article of clothing, small toy, etc.(must hold in infant's visual range in a display fashion). 27. Movement Mother moves object such that infant practices visual following (movements must be slow, deliberate). 28. Face-to- Mother places infant in a face-to-face face position. 29. Face Near/ Mother brings face near (8 inches) when Hold holding infant. 30. Face Near Mother brings face near (8-12 inches) when infant is not in arms (e.g., when infant is on changing table or in crib). Subscale Total Verbal Tactile Visual Total Enter totals for each category: (l) (2) (3) (4) (5) (6) 167 READ SLOWLY! This questionnaire was designed to help us understand the feelings and experiences of the first-time parent. Please answer the following questions. What do you check for when your baby awakes crying? “Clarification: What kinds of things do you look for? What do you think might be the problem? Is there anything else you might check for? If a baby seems difficult to comfort, what are some suggestions you might offer a new mother returning from the hospital? “Clarification: If a baby is fussy or crying, what ----? Are there any other suggestions you might offer? How confident are you of your ability to care for your baby? “Clarification: How sure of yourself do you feel about--? If you were uncertain about how to handle a problem with your baby's care, which person or persons might you .contact? “Clarification: For example, if you experienced difficulty in feeding the baby--or there was a problem with diaper rash. Is there anyone else you might contact? As your baby becomes more mobile (able to crawl, walk, etc.), what are some changes you might make in your home in order to provide him/her with a safer environment? “Clarification: How might you childproof your home? Are there any other changes you might make? How confident are you that you will know what to do when your baby is ill? “Clarification: How sure of yourself do you feel about--? 168 (7) Under what conditions or circumstances would you contact (8) (9) your baby's doctor? “Clarification: What kinds of changes in your baby's behavior would prompt you to contact the doctor? Is there anything else? Many parents experience difficulty when introducing solid foods into their baby's diet (he/she may resist eating). How might you handle such a problem? “Clarification: What are some things you might do to make the meal time run more smoothly? Is there anything else you might try? Managing the behavior of the 2-3 year old child can become quite a chore. What are some methods of discipline you might 'experiment' with? “Clarification: What are some different ways you might. manage that trying behavior? Is there anything else you might try? (10)Raising a child can be a very demanding job. What suggestions might you share with a new parent about how to reduce the pressures or stresses in parenting? “Clarification: When you were feeling tense or tired, what sort of things did you do that seemed to help? Anything else? THANK YOU!