Prevention Theory

Make the Connection (MTC) was designed to be used either “universally” with any parent and infant or “targeted” to at-risk populations. The definitions of the various categories of “preventive intervention” in Mrazek and Haggerty’s (1994) Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research helped clarify that the program could be considered “preventive” even when parent-infant dyads had high-risk factors or minimal signs of impairment in areas of attachment and communication.

In practice, MTC is offered as “universal” parenting education to families attending community-based Ontario Early Years Centres, Family Resource Programs, Community Health Centres and drop-in parenting programs. It is also “targeted” to specific at-risk populations such as teen parents, parents with infants in child welfare custody, parents of children with identified special needs, Aboriginal populations and new immigrant families.
Higher risk infants/parents often continue with other services following an MTC program.

Attachment Theory and Research

Research documents the positive outcomes resulting from a strong parent-child attachment and poorer outcomes for children with some form of insecure attachment. 

The parent-child relationship is linked to the developing structure and function of the brain (Eliot, 1999; Dan Siegel, 1999). Secure attachment is the basis for healthy self-esteem, healthy cognitive and social development, impulse control and general success in school (Levy, 2000; Doherty. 1997; Goldberg, 2000).
Many elements of the program are linked to the “Relationships, not things make brighter babies” belief so clearly stated by Dr. William Sears.

For example, in Make the Connection:

• The majority of sessions focus on “relationship” and “communication” themes, only one is devoted to MTC with “learning”. Parents are inundated today with market-driven products geared to making babies smarter, sooner – turning parents into “teachers” with their own agendas.
• Parents learn that they are “the best toy in the house” and through songs and rhymes with baby, “Magic Moments” (social games with no toys) – they foster their baby’s emotional and cognitive development.
• Parents are reminded throughout each session’s “toy box” activity, to monitor and respond to their baby’s reaction to the toy – e.g. don’t get caught up in watching the bubbles, watch your baby’s reaction to the bubbles!
  
  The intricacies of attachment theory are summarized in the key messages of the program. 

• In the title Make the Connection, is the view that infants experience themselves and the world within the context of relationship. They come to feel loved and secure “in connection”. They learn language “in connection” and they explore their world “in connection.” Within this connection, infants organize their sense of themselves, of others, and develop expectations about how they will be in all future relationships. Moreover, the connection/relationship is two-way. There are two subjectivities – the infant’s and the parent’s –each having an effect on the other. Daniel Stern (1985) talks about how this works in “The Intersubjective World of the Infant”.
• Through the videotaping and feedback element of MTC, parents’ awareness of the bi-directional impact of the parent-infant relationship is raised. It can be a relief to some parents to know that their infant plays a highly active role in developing attachment-related functions such as self-regulation, secure base behaviour, empathy, engagement-disengagement cues, etc. And that their infant’s temperament affects their ‘fit’ with their baby. Knowing that their own nurturing responses (or not) have an impact on their baby’s behaviour, can also be a wake-up call for some parents. All this is good for fostering healthy attachment.
• In MTC with Love, attachment theory is expressed in plain language. The messages on the poster and the guided activities of Sessions 1 to 3 capture key behaviours that foster secure attachment – mutual eye gaze, gentle touch, responding to cues, mirroring affect verbally and nonverbally, responding quickly to cries, talking in an expressive tone, respecting baby’s ‘negative’ feelings, accepting baby for who she is.
  
  Self Psychology, Relational Psychotherapy, Adult Attachment Theory
  
  The field of adult psychotherapy has contributed a great deal to our views about parents’ roles in MTC, how discussion topics are designed and how training is delivered. Some of the key contributions from psychology are:

• All our issues and relationship struggles as adults stem from our primary attachment relationships as infants and young children. We know from the Adult Attachment research that parents’ attachment categories can be deduced from interviews and that their infants’ future attachment category predicted from these findings. 
• Psychodynamic psychotherapies* are premised on the belief that unresolved issues from our earliest attachments become part of our “organizing principles” as adults. Unless we address these issues and ultimately develop new organizing principles, we may be destined to repeat the past. These theories feed into our understanding of what parents need to provide relationally for their infants to help them feel secure and attached. They also play into our belief that we need to help parents reflect on their past during the program. 
  *Self Psychology (Heinz Kohut, 1984, Joseph Lichtenberg, 1992); Relational Psychotherapy (Patricia DeYoung, 2003); Intersubjectivity theory (Stolorow and Atwood 1992); Feminist Psychology (Judith Jordan from The Stone Centre, 1991); and others. 
• Psychologist Donald Winnicott’s well known view that none of us had “perfect” parents, none of us are “perfect” parents and that we just need to strive to be “good enough,” is brought up with parents in Session 3 of MTC.
• The power of parallel process is a phenomenon that is well-documented within psychotherapy and adult learning. MTC uses the parallel process to make sure the same relational values filter all the way through from the way facilitators are trained to the way parents are encouraged to relate to their infants. 
  
  Language Development Research
  
  The main language theory influencing MTC is what Stanley Greenspan calls the Functional/Emotional Interactionist view. His explanation of language acquisition is inextricably tied to an infant’s emotional interaction with primary caregivers. This theory claims that emotion, rather than an innate language mechanism, drives a baby’s desire to communicate. 
  In addition to Greenspan’s model, there is a wealth of research on how early language development predicts later measures of intelligence and success in school (Hart & Risley, 1995; Doherty, 1997). Poor language skills are linked to anti-social behaviour (Cohen et al., 1996; Levy, 2000, Stattin & Klackenerg-Larson, 1993). One of the major recommendations from this research, which is convincingly presented in the “Ontario Early Years Report” (McCain and Mustard, 1999), is to enhance the supports available to parents, particularly around the parent-child relationship.
  
  Infant Development/Early Literacy Research
  
  MTC does not put great emphasis on teaching cognitive aspects of development, although it does direct parents to “Follow your baby’s lead” to encourage exploration.
  
  MTC does not focus on developmental charts and early milestones in order to get away from the current trend to “make your baby smarter.”
  
  Reports that underline MTC:

• The McCain and Mustard Early Years Report (1999) provided a good overview of what infants and young children need to succeed by the time they enter school.
• Gillian Doherty’s review Zero to Six: The Basis for School Readiness (2001) commissioned by Human Resources Development Canada. Her basic findings showed that children’s       development stemmed from three areas:

1. Innate abilities and temperament (genetics)
2. Physiological maturation

• Experience within and outside the home
  Secure attachment and positive interaction with adults and peers was the number one factor in school readiness and is the overarching goal in MTC.
  
  The other two factors which supported the 3-theme breakdown in MTC were:

• Language development – the importance of exposure to language, of being listened to and of being encouraged to use language (i.e. Let your baby know you understand how she feels,     help your baby understand, Help your baby “talk” to you)
• General knowledge and cognitive skills – which are addressed in Session 8 of the program “Helping your baby discover his world”. The four messages are:

1.  Follow your baby’s lead
2. Give your baby safe things to taste and touch
3. Keep your baby’s world interesting

• Stop when your baby’s had enough
  
  Physical well-being and motor development are not addressed within MTC programs although they are a critical part of school readiness. 
  
  Adult Learning Theory
  
  MTC uses a holistic, 4-point approach to adult learning. The four learning essentials and the corresponding MTC activities are:

• Reflection – Reflection answers the learner’s question “How does this relate to me and my baby?” Reflections on adult scenarios such as “How to tell a friend ‘no’ in a way that is good for your relationship” and relating this to how to say “no” to your baby are built into each session. Other questions during discussion times help parents reflect on themselves and their baby and what supports or challenges them. A discussion called “Your parents – yourself” raises parents’ awareness of how their parenting past affects their current parenting.
• Information – Parents/learners need new information to take them forward or to help them look at old beliefs in new ways. Information on attachment, communication and learning is built into the Leader’s Guide in quotes and “nuggets” of information from the “experts.” Information in the form of parenting tips is on the coloured teaching posters/fridge magnets. This information is built into how each week’s guided parent-baby activities are structured and is also used to focus the review of videotapes.
• Practice – Parents practice or apply relational messages with their baby during each session’s guided baby activities. E.g. With the emphasis on “Helping your baby feel good about herself” in Session 3, during the toy box “bubbles” activity, instructions are to pay attention to and talk about your baby’s facial expressions and reactions to the bubbles. Of course, most ‘practice’ goes on during interaction at home.
• Feedback – Learning is only complete when you have feedback on how you’re doing. In MTC we are committed to giving only positive feedback, particularly since it’s done in a group setting. Parents and babies are videotaped twice during an MTC program followed by two opportunities to give and receive positive feedback from facilitators and other parents in the group. One of the primary goals of the facilitator’s feedback in MTC is to help parents connect their relational behaviour to the impact it has on their baby. Parents also receive feedback in their day to day interactions with their baby. When positive, this reinforces their motivation to continue whatever they’re doing.
  
  Best Practices in Parenting Intervention and Education
  
  MTC incorporates the latest findings on what constitutes a well-designed and effective parenting program. 
• From Mrazek and Haggarty (1994) we learned that a rigorous prevention program should have a description of:

1. Goals
2. Content
3. Delivery personnel/qualifications
4. Intervention site
5. Manual/protocol for delivery
6. Special techniques
7. Learning exercises
8. Duration
9. Follow-up/refreshers

• Laurie Gottlieb and colleagues (1995) published a review called Parent Education Programs: Effectiveness in improving child mental health. We took from this that we were on the right track in terms of
  Involving parents early in the first year
• Parameters for a modern parent education program – Invest in Kids website (2004). 

1. Increasing parents’ knowledge, skills and confidence in parenting and child development
2. Promoting sensitive, responsive and warm parent-child relationships
3. Fostering parents’ sense of support for their role 
4. Fostering the parents’ couple relationship 
5. Addressing both the physical/medical concerns and the psycho-social issues
6. Providing hands-on interactive sessions with babies present 
7. Demonstrating the fun and playful side of parenting 
8. Continuing through the baby’s second year 
   
   Other Programs which Influenced the Design of MTC:
   Parent-Child Mother Goose
   You Make the Difference in helping your child learn
   Watch, Wait and Wonder
   Nobody’s Perfect
   Circle of Security