These materials, developed by the Family Connections Project at Children’s Hospital Boston, describe a comprehensive approach to strengthen the capacity of Early Head Start and Head Start staff in dealing with parental depression.
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Introduction to the Family Connection Materials
Over the past five years, we, the Family Connections team and our community partners have worked together to develop an approach to strengthen the capacity of Early Head Start and Head Start staff in dealing with parental depression and related adversities. Our work with Early Head Start and Head Start programs has allowed us to acknowledge three key assumptions that have grounded all of our efforts:
- Early Head Start/Head Start families and staff are often in chronically adverse situations, including poverty, exposure to violence, and social isolation.
- Depression is a common response to such adversity.
- These adversities and depression affect the ability of parents and staff to relate effectively with other adults, with their children or the children in their care, and with the Early Head Start/Head Start community.
From the beginning, the goal of Family Connections has been to develop training approaches and consultation strategies that could be made available to all Early Head Start and Head Start centers. In that effort, our first objective was to develop the approach and then test it in several Early Head Start and Head Start programs in the greater Boston area over several years. In those partnerships, we provided trainings, mental health consultations, observations, classroom interventions, and ongoing supervision to the mental health consultants who collaborated with us in implementing the program. The results of those experiences are captured here in the Family Connections materials. These materials include information on depression and related adversities, detailed workshops, strategies for working effectively with children, families, and other staff, and a guide to assess a program's readiness to take full advantage of this resource.
Why is depression a relevant topic for Early Head Start and Head Start?
Members of the Early Head Start and the Head Start community recognize that being involved in one of these two federal programs means being involved with parents. Parent involvement in Head Start is related to a wealth of positive outcomes for children, including improved early literacy, more positive social behavior, and fewer behavioral problems overall (FACES, 2000). While parent outreach is a foundation of the Early Head Start/Head Start professional’s experience, trying to engage parents can be challenging under the best circumstances. One factor that can provide such a challenge is parental depression, because the isolating effects of depression can prevent individuals from accessing the very resources that could ease their suffering. Recent research and public discussion have brought new attention to adult depression, its risk factors and successes in treatment. A recent study found that 48% of Early Head Start mothers were found to be suffering from depression (ACF, 2002), bringing with it a heightened awareness to the relevance of the topic to the Head Start community.
The purpose of Early Head Start/Head Start staff gaining information about the topic of depression and strategies for addressing the needs of families facing adversity is to strengthen their knowledge base in effective parent engagement. The goal is to build capacity for reaching out to depressed parents within the Early Head Start/Head Start community, so that the staff and families they serve might benefit from the many resources these programs provide.
How do these materials help build our capacity to engage all parents?
The Family Connections training approach provides workshops designed to strengthen Head Start staff’s knowledge base regarding the signs and symptoms of depression, healthy social emotional development, and the importance of self-care and reflection. We have found that the combination of these topic areas provides a powerful foundation for understanding the effects of depression, the importance of nurturing resilience in ourselves and others, and the development of strategies for staff members to engage families that are coping with the risk factors and experience of depression.
The materials are also designed to build on Head Start staff’s skills by providing strategies and learning opportunities designed to do the following:
- Practice of reflection and perspective-taking as professional skills.
- Positive engagement of all parents in order to reach those affected by depression.
- Positive attachment with children as a foundation for the promotion of social-emotional growth and positive relation-ship-building with parents. Children of depressed parents are at increased risk for language and cognitive problems, insecure attachments, difficulties with emotional regulation, social competence and behavioral problems.
- Active participation in effective information-sharing and communication practices.
- Understanding of the crucial role each Head Start staff member plays in effective parent outreach.
As you consider embracing this new direction, we encourage you to access the support of a mental health consultant who knows your program. Such a relationship can provide support during many aspects of this new initiative, from conducting a needs assessment to planning specific new interventions, and can assist in understanding the training needs of the staff. In our experiences with our test programs, we have found mental health consultants to be key partners for the Head Start program in taking on the Family Connections approach.
Why focus on supporting Early Head Start/Head Start staff?
Our goal is to maintain a focus on building capacity within one’s program, leaving the professionals of that program better able to respond to the challenges they face in effectively engaging all the families they seek to serve.
Working with young children and their families is a highly demanding job. Staff working in an early childhood setting, serving families, negotiating the effects of poverty, community violence, social spending cuts, and a shortage of affordable housing are at risk of experiencing a significant degree of stress and professional “burn-out.” Our approach acknowledges this stress openly, and as a result the promotion of mental health and emotional support for staff is presented as a priority.
We also acknowledge that a unique aspect of the culture of Head Start is that many Head Start professionals were once Head Start parents. In other words, Head Start staff may be feeling the effects of the stress coming from their experience in the community as well as in the role of a professional trying to support other members of that community. Because of this unique characteristic of Head Start, the goal of engaging and supporting parents and the goal of providing support for staff are intertwined.
How can supporting staff affect their work with parents?
It is essential to provide good information about depression and resilience, and to support parents struggling with depression and related adversities. But it is important to keep in mind that information alone does not automatically lead to change in behavior or skill. Factual knowledge must be made personally relevant and meaningful for practitioners in order to change professional skills and behaviors. The content and progression of the Family Connections trainings for staff and parents focus not only on important information and concrete skills, but also upon the personal meaning of the topics for the participants. Reflecting the philosophy that meaning provides the essential link between thought and action (Selman, 1997), all training efforts seek to encourage "meaning making" by:
- Linking topics to practical knowledge identified as relevant by staff or parents.
- Engaging staff and parents in exercises that challenge them to connect training themes with the real-life situations they encounter in their work and home.
- Incorporating practice of self reflection and perspective taking into training experiences as important tools in ongoing personal and professional growth.
- Advocating for other elements of engagement by supervisors and Workshop Leaders. For instance, classroom observation can provide opportunities for modeling the new child interaction skills described in training.
- Encouraging an emphasis on self-care and the support of the ongoing mental health of the EHS/HS staff.
Staff members are encouraged to reflect on their values, expectations and attitudes about parenting, mental health and depression in order to consider how those views affect their ability to build a supportive alliance with the families they serve. The emphasis on self care has provided the opportunity to acknowledge the incidence of depression among Early Head Start/Head Start staff and how it can be a factor that may limit these professionals in fulfilling their responsibilities as well as their potential.
A Description of the Family Connections Materials
The Family Connections materials provide staff with information, learning opportunities, and a description of the crucial ways programs can better understand and respond to the needs of children and families. These resources are designed to promote the professional skills of Self Reflection, Self Care, and Perspective Taking.
The Family Connections Readiness Guide
 This guide presents information and processes focused on assessing a program's level of "readiness" to engage in the kind of work involved in reaching out to families facing adversity. Rather than judge whether a program is or isn't ready, this guide provides a method for self-reflection designed to suggest levels of readiness and then recommends which of the Family Connections materials might be most effective according to the level. Full text» [PDF, 127KB]
The short papers are designed to share information on topics that are central to understanding depression, resilience and best practice in engaging parents facing adversities. They are intended to work as stand-alone items for parents and staff as well as materials used in training workshops and parent groups. The following list includes the title and a short description of content for each short paper.
The Challenges and Benefits of Making Parent Connections
Includes strategies for effective parent outreach. Full text» [PDF, 138KB]
 Parenting, Depression, and Hope: Reaching out to families facing adversity
Includes a discussion of the signs of depression and strategies for reaching out to parents struggling with depression. Full text» [PDF, 165KB]
 Fostering Resilience in Families Coping with Depression: Practical ways Head Start staff can help families build on their power to cope
Includes a discussion of what resilience is and why fostering resilience in families is a powerful way to promote mental health. Full text» [PDF, 175KB]
Understanding Depression across Cultures
Includes a discussion on the range of responses to mental health issues, including depression across cultures, and the importance of cultural sensitivity in mental health outreach. Full text» [PDF, 295KB]
 Self Reflection and Shared Reflection as Professional Tools
Includes a discussion of the benefits in using self reflection and shared reflection as tools that can enhance communication and service delivery. Introduction to the Family Connections Materials. Full text» [PDF, 141KB]
 Better Communication with Children: Responding to challenging subjects
Includes strategies for responding effectively to children and the difficult topics they can bring to Head Start staff. Full text» [PDF, 129KB]
Better Parent Communication: What do I say when a parent tells me something difficult?
Includes strategies for responding effectively to parents and the difficult topics they can bring to Head Start staff. Full text» [PDF, 143KB]
 Encouraging an Expressive Environment: Supportive communication from the inside out
Includes a discussion concerning the benefits of having a program with an expressive environment and strategies for supporting such a program climate. Full text» [PDF, 329KB]
 Supportive Supervision: Promoting staff and family growth through positive relationships
Includes a discussion of how supervision can benefit from a relational approach that includes strategies for both the supervisor and supervisee in making supervision an effective professional experience. Full text» [PDF, 175KB]
 Parenting through Tough Times: Coping with Depression
A discussion of the signs of depression and strategies for coping with depression.
Full text» [PDF, 134KB]
 The Ability to Cope: Building Resilience in You and Your Child
Includes a discussion of what resilience is and why fostering resilience in oneself and children can promote mental health. Full text» [PDF, 123KB]
 Self Reflection in Parenting: Help for Getting Through Stressful Times
A discussion about the benefits of using self-reflection as a parent, especially when facing stressful times, as well as strategies for practicing self-reflection. Full text» [PDF, 114KB]
This section includes an extensive group of training materials organized into modules and infused with guidance for the person designated as the Workshop Leader. The modules themselves will contain directions for presenting the specific trainings in each group, the handout information required for those trainings, and the questionnaires designed to receive feedback on each training effort. The modules include:
 Module One:
The Benefits and Challenges of Engaging Parents
Perspective Taking
What Is Depression? Full text» [PDF, 602KB]
Module Two:
The Program Climate and You
Accentuate the Positive
What Is Depression? Full text» [PDF, 604KB]
 Module Three:
Supporting Social/Emotional Growth
Strategies for Talking to Children about Difficult Issues
Using Reading and Circle Time to Promote an
Expressive Environment Full text» [PDF, 548KB]
 Module Four:
Better Communication
Developing a Resource and Referral Process
Getting the Most from the Home Visit Full text» [PDF, 466KB]
In closing, we would like to emphasize the importance of making a careful assessment of the readiness of a program interested in getting the most from these materials, the availability of mental health consultation during the use of these materials, and ongoing training and support for those who will implement the program. At the same time, we recognize that different programs will use these materials in different ways and hope it is helpful to programs, staff, families and children in dealing with the adversities faced by families with young children. Introduction to the Family Connections Materials Introduction to the Family Connections Materials
For more information about the family connections materials please visit:
http://www.childrenshospital.org/familyconnections
Administration for Children and Families. (2002). Making a difference in the lives of children and families: The impacts of Early Head Start programs on infants and toddlers and their families. Washington, DC: U.S. Department of Health and Human Services.
United States Department of Health and Human Services. Administration for Children and Families (ACF). Office of Planning, Research, and Evaluation (OPRE). Head Start Family and Child Experiences Survey (FACES): 2000 Cohort [United States][Computer file]. ICPSR04149-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2008-09-10. doi:10.3886/ICPSR04149.
Selman, R.L. Watts, C.L., and Schultz, L.H. (Eds.) (1997). Fostering Friendship: Pair therapy for treatment and prevention. Aldine DeGruyter/Transaction Press.
Beardslee, William. When a Parent is Depressed: How to Protect Your Children from the Effects of Depression in the Family. Boston: Little, Brown, and Company, 2003. Originally published in hardcover under the title When a Parent is Depressed: Protecting the Children and Strengthening the Family. Boston: Little, Brown, and Company, 2002.
Knitzer, Jane, Suzanne Theberge, and Kay Johnson. "Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework." Project Thrive Issue Brief No. 2. New York: Columbia University, National Center for Children in Poverty, 2008. http://www.nccp.org/publications/pdf/text_791.pdf [PDF, 261KB].
Center on the Developing Child at Harvard University. "Advancing the Scientific Foundations of Health, Learning, and Community Well-Being." http://www.developingchild.harvard.edu.
The Family Connections materials were developed by the Family Connections Project at Children's Hospital Boston, under the Innovation and Improvement Project grant from the Office of Head Start, Administration for Children and Families, U.S. Department of Health and Human Services, and through local partnerships with ABCD. Primary authors are Mary Watson Avery, William R. Beardslee, Catherine C. Ayoub, and Caroline L. Watts. Copyright Children’s Hospital Boston, November 2008. Contributing authors and editors include Family Connections consultants Kristin Stephenson, Melissa Ryan, Emily Callejas, Alissa Coggins, Andie Hernandez, Linda Howes, Kim Knowlton-Young, and Kristen Shealy; Brazelton Touchpoints faculty and staff John Hornstein, Elisa Vele-Tabaddor, and Lisa Desrocher; ABCD staff members Barbara Jacobs, Carolyn Boehne, and Joyce Tanner; clinicians Nadja Reilly, Juan Sosa, and Ane Marinez Lora; editorial evaluation team members Kelly O’Carroll, Maureen Brinkworth, Jennifer DiBara and Susanna Andrew. Advice and consultation were received from Amy Hunter, Zero to Three, and Jim O'Brien, Office for Head Start.
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Family Connections Materials: A Comprehensive Approach in Dealing with Parental Depression and Related Adversities. Family Connections Project at Children's Hospital Boston. HHS/ACF/OHS. 2008. English.
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