Program Goals

The goals of Building Healthy Children (BHC) are:

For parents:

• Reduce maternal depressive symptoms
• Enhance parenting sensitivity
• Reduce parenting stress
• Improve interactions with child
• Reduce maltreatment of child
• Increase family functioning
• Reduce likelihood of child being placed in out-of-home care
• Enhance parental knowledge of child development
• Increase self-sufficiency of access to education, employment, & stable housing

For children:

• Improve physical, social, emotional, and cognitive health
• Increase timely achievement of developmental milestones
• Improve interactions with parent
• Improve emotional security

Logic Model

View the Logic Model for Building Healthy Children (BHC).

Essential Components

The essential components of Building Healthy Children (BHC) include:

• Comprised of three treatments (Child-Parent Psychotherapy (CPP), Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), and Parents as Teachers (PAT)), combined with a community health worker (CHW) support to address concrete service needs
• Team approach to supporting the family, consisting of mental health therapists trained in CPP, IPT-A, and PAT partnering with CHWs:
• Therapists:
• Assess the parent
• Provide the appropriate manualized treatment:
• CPP:
• Used when traumatic experiences have occurred for parents and/or children
• Assessment of parents and children
• Intervention with parents and children designed to:
• Help parent acknowledge what child has witnessed and remembered
• Help parent and child understand each other's reality with regards to the trauma
• Provide developmental guidance acknowledging response to trauma
• Make linkages between past experiences and current thoughts, feelings, and behaviors
• Help parent understand link between her own experiences and current feelings and parenting practices
• Highlight the difference between past and present circumstances
• Support parent and child in creating a joint narrative
• Reinforce behaviors that help parent and child master the trauma
• Gain a new perspective
• In fidelity with model
• IPT-A:
• Assessment of parental depression
• Treatment of parental depression including postpartum depression
• In fidelity with model
• PAT:
• Promotion of developmentally appropriate parenting practices
• Group connections that facilitate social connectedness
• Used when it is the focus of the treatment plan, and if other models (CPP, IPT-A) are not needed or prioritized at that time.
• Utilizes the 4 PAT Components:
• Personal/Home visits which focus on:
• Parent-Child Interaction
• Development-Centered Parenting
• Family Well-Being
• Group connections
• Screening
• Resource network
• CHWs:
• Address concrete service needs such as:
• Housing
• Food
• Medical appointments
• Employment
• Education
• Strive to connect families with resources and support the family to prevent crisis situations that may increase stress and interfere with mental health treatment
• Treatment models flexibly applied to family needs and preferences, which may change over time.
• Overall focus on safety by therapists and CHWs:
• Focus on safety issues in the environment as needed
• Promote safe behavior
• Legitimize feelings while highlighting the need for safe/appropriate behavior
• Foster appropriate limit setting
• Help establish appropriate parent-child roles.
• Embed treatment within the child’s pediatric or family medicine practice through a partnership:
• Some practices may qualify as a federally qualified health center or may follow a medical home approach as recommended by the American Academy of Pediatrics
• Partnerships with the medical practice can include having a dedicated staff person who can do any or all of the following:
• Screen for eligibility
• Provide outreach to families
• Receive referrals from obstetric and pediatric practices
• Exchange notes for communication in the electronic medical records
• Transport families for medical appointments
• Assisting with follow-up around medical appointments and recommendations, or all of the above.
• This access to the medical provider’s records allows the BHC program to:
• Facilitate timely completion of well-child visits
• Ensure up-to-date immunizations
• Adhere with medical recommendations
• BHC services that emanate from the assessments that therapists and CHWs conduct can be entered into the electronic medical record to facilitate communication with the medical team.
• Facilitate connections with resources to meet concrete services needs and ensure timely well-child pediatric care
• Group connections events to reduce social isolation and build social supports and behavioral activation.

Program Delivery

Child/Adolescent Services

Building Healthy Children (BHC) directly provides services to children/adolescents and addresses the following:

• Cared for by parents who are possibly not knowledgeable about typical child development
• Possible limited family understanding of and support for:
• Socioemotional development
• Mental and physical health
• Well-being may be limited
• Possible exposure to trauma
• Possible internalizing and externalizing symptoms
• Possible symptoms of posttraumatic stress disorder (PTSD)

Parent/Caregiver Services

Building Healthy Children (BHC) directly provides services to parents/caregivers and addresses the following:

• Possible lack of parental knowledge of child development
• Parental limited understanding of how to support developmental competencies
• Parental symptoms of depression
• Parental negative perceptions or attributions about the child
• Problems in the parent-child relationship
• Maladaptive parenting strategies
• Possible PTSD symptoms (avoidance, intrusion, and hyperarousal)
• Possible challenges with housing, limited education or employment, or other social determinants of health that may increase stress for the family

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Siblings, partners, and grandparents may be involved, depending on the family circumstances. CPP has a family perspective and incorporates perspectives of other family members who may play a role in the children’s lives.

Recommended Intensity:

Weekly hour-long sessions plus Community Health Worker support that varies in frequency and duration, according to family need

Recommended Duration:

Up to 3 to 3.5 years (from pregnancy to child’s age of 3 years)

Delivery Settings

This program is typically conducted in a(n):

• Birth Family Home
• Community Daily Living Setting
• Outpatient Clinic
• Community-based Agency / Organization / Provider
• Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

This program does not include a homework component.

Languages

Building Healthy Children (BHC) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

• Transportation for home visitation and supporting families’ access to medical care
• Interactive toys
• Assessment tools
• Computers and internet access
• Interface with electronic medical records (if the BHC program is not implemented at a hospital, agencies may need to develop a business partner agreement to align with HIPAA and ensure communication via electronic medical records)

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Therapists are Master-level mental health clinicians. CHWs are paraprofessionals. The need for other types of staff (e.g., resource specialists in pediatric offices or pediatric social workers to work with CHWs) will be determined based on the implementing agency.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2015). Don’t hit my mommy: A manual for Child-Parent Psychotherapy with young children exposed to violence and other trauma (2nd ed.). Zero to Three.
• Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004). Interpersonal Psychotherapy for Depressed Adolescents. Guilford Press.
• Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2017). The guide to Interpersonal Psychotherapy: Updated and expanded edition. Oxford Press.
• Parents as Teachers National Center, Inc. (2023). Parents as Teachers Foundational Curriculum: Prenatal to 3. Author.

Each manual is provided during training though many of them are available for purchase from booksellers online.

Training Information

There is training available for this program.

Training Contacts:

• Jody Manly
  jody_manly@urmc.rochester.edu
  phone: (585) 275-2991
• Robin Sturm
  robin_sturm@urmc.rochester.edu
  phone: (585) 275-2991

Training Type/Location:

Training can be provided at our organization, onsite at the trainee organization, virtually, or a combination of in-person and remote

Number of days/hours:

Training is provided in a Learning Collaborative format for teams within an organization. Ideally, the Learning Collaborative would include a team with Master-level therapists, paraprofessional CHWs, supervisors, and senior leaders who could address issues such as access to electronic medical records, funding and billing issues, partnerships with referral sources and medical providers, etc. The Learning Collaborative occurs over approximately 18 months with didactics during Learning Sessions and consultation calls that include case presentations and implementation discussions. However, the length and type of involvement would differ according to role. The therapists would need more extensive training to implement all 3 intervention models. The CHWs and senior leaders would need some familiarity with the models but would not be implementing them. The medical office staff would not attend the training, but senior leaders could develop materials to share with partners about the services provided. The training does include written materials on weaving together the three practices and CHW component parts. An agency that wants to implement BHC would need to have readiness to implement the model with the infrastructure support that could facilitate sustainability. Prior implementation experience (e.g., clinicians who have been trained in CPP or IPT-A) would be an asset but is not required. The agency would need to commit to allocating staff time for training, have supervisory structures in place to support the model, have partnership(s) with medical practices, and have funding mechanisms that could support sustainability.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Building Healthy Children (BHC).

Formal Support for Implementation

There is formal support available for implementation of Building Healthy Children (BHC) as listed below:

Didactics and consultation in fidelity with CPP and IPT-A component models are provided during the 18-month Learning Collaborative. If an organization was interested in implementing the full BHC model, technical assistance could be made available via teleconferencing, perhaps combined with in-person training, as well as leadership coaching and program evaluation.

Fidelity Measures

There are fidelity measures for Building Healthy Children (BHC) as listed below:

Fidelity measures are utilized within each BHC component (e.g., CPP, IPT-A, PAT). These measures are completed by therapists.

Implementation Guides or Manuals

There are no implementation guides or manuals for Building Healthy Children (BHC).

Implementation Cost

There are no studies of the costs of Building Healthy Children (BHC).

Research on How to Implement the Program

Research has not been conducted on how to implement Building Healthy Children (BHC).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References