Project baby care: a parental training program for students with Emotional and Behavioral Disorders (EBD).

The rate of reported child abuse fatalities has risen annually, with an estimated 1,400 child fatalities from abuse occurring in 2002 alone; even so, recent studies estimate that 50-60 percent of deaths from child abuse are not recorded (National Clearinghouse on Child Abuse and Neglect Information [NCCANI], 2004). Whiplash and other symptoms of shaken baby syndrome (SBS) were reported as the cause of death in 17 percent of fatal child abuse cases (Irazuzta, McJunken, Danadian, Arnold, & Zhang, 1997).

Statistics indicate that many victims of such abuse are children of teenage parents. Parenting classes could lessen the prevalence of the problem, but such classes are under-utilized in this era of high-stakes testing. In particular, school curricula in special education do not adequately prepare students with special needs, particularly those with the most violent behaviors, for their most demanding job--parenting. Profiles of typical abuse perpetrators match the characteristics of many students with emotional and behavioral disorders (EBD) and place them at higher risk of acting impulsively and using violent and abusive behaviors (Kaplan, Posey, & Cornell, 2003; NCCANI, 2004); also, aggressive at-risk young men are more likely than other men to use harmful parenting strategies with their children (Capaldi & Clark, 1998). Newspapers continue to report child fatalities from SBS and other abuses by teenagers with EBD (Darby, 2000; Robles, 1998).

Teaching students parenting skills may be the most cost-effective way to reduce violent and abusive behaviors and prevent the transfer of violent behaviors from generation to generation. For less than $1,000, Project Baby Care, a parental training program developed and adapted for adolescents with EBD, proved successful in increasing their parental knowledge and skills and improving their attitudes toward caring for an infant. The curriculum used in this project included two main components: 1) a practical component of hand s-on experiences involving the interaction of students with computerized doll-babies, and 2) a traditional component of reading, writing, and watching films.

Thirty-seven adolescents with emotional and behavioral disorders (EBD) participated in this project. These students had been assessed by a multidisciplinary committee as having emotional and behavioral problems that were severe enough to warrant placement in four self-contained classes in an urban educational center in southeast Florida. The participants included 24 males and 13 females, roughly evenly divided between Hispanic and black students (African Americans and Haitians). The ages of the students in each class ranged from 14 to 20 years. Fifty-four percent of the students (n = 20) were known to the courts, including 50 percent of all participating males (n = 12) and 62 percent of all participating females (n = 8). Seventy percent of all the participants (n = 26) had been victims of recorded child abuse and/ or neglect. Of the total number of participants, 63 percent of the males (n = 15) and 85 percent of the females (n = 11) had suffered child abuse and/or neglect. Seven female students (54 percent) who attended this program were mothers or pregnant at the time of data collection; two of these students were already mothers for the second time, and a third student with one child was pregnant with her second. Only four of the 24 boys had admitted fathering babies. This population is consistent with the data indicating that early onset of psychiatric disorders is associated with subsequent teen pregnancy among both males and females at a 33 percent greater rate than for other teens (National Comorbidity Study, 1994).

The curriculum included both practical and traditional reading and writing components.

1) Practical Component: The interactive program in this project used two computerized life-size doll-babies that realistically simulated infant behavior (purchased from Baby Think It Over, Inc.) The two doll-babies used in this project were a light-skinned African American boy baby, and a Hispanic girl baby. Each doll-baby has a realistic head that requires support. The lifelike baby has a 21-inch long vinyl body, weighs approximately 67 pounds, and is anatomically correct. Each doll needs to be cared for by the student in very realistic, concrete ways: through feeding, burping, cuddling, and diapering. Each doll-baby has an internal computer that is programmed to cry at random intervals and/or when the doll's head is not being properly supported. As positive feedback, the baby coos and burps when the student provides proper handling.

On average, each session of actual class instruction with a doll-baby lasted over 60 minutes, four times per week. The lifelike baby was used in various hands-on activities (e.g., changing the diaper). For added realism, participants were required to care for the baby while completing their class work. The internal computer was programmed to affect the baby's behavior (e.g., simulating a calm baby or a fussy baby). This feature allowed the teachers and counselors to adjust and tailor stressors in the environment, and to observe the students' reactions and strategies used in response. Students who mishandled the doll-baby were readily identified by the doll's loud, continuous cry. The internal computers detected and signaled the doll to cry if students failed to support the doll's head, neglected the doll, and/or roughly handled the doll. The computers produced perceptually louder and longer crying if the baby was shaken.

Students interacted with the doll-babies only in the controlled setting of the classroom, and only when under observation by a counselor and at least one teacher during each session. The limitation of having only one doll-baby per session for the 10 or 11 students in each class placed some time limitations on total parenting time with the doll-babies.

2) Reading and Writing (Traditional) Component: The curriculum was adapted from a project called the Nurturing Program for Teenage Parents and Their Families (Bavolek & Bavolek, 1988). This project also used a series of paperback books called The Parent Guidebooks for Growing Families (Dalzell & Kanzki, 1999). The latter were particularly useful in teaching students who were nonreaders or very low readers the appropriate expectations for the stages of infant development; the series has excellent graphics that facilitated reading. Films also were used.

The researchers adapted both components of the program to better serve the EBD population. The program was written on a 5th- and 6th-grade reading level, although the content interest was geared for adolescent/young adult interests. Modeled behaviors included: additional, repetitive activities, such as rocking the baby when it continued to cry; proper car-seat positioning; increased use of discussions and group counseling sessions (e.g., strategies to prevent frustration when the baby continued to cry); proactive methods of discipline (e.g., re-direction techniques, time-outs); creative role-playing (e.g., telling your parent you are going to be a parent, scenarios on being a single parent); and preparation of materials at a lower reading level, when needed.

Project Baby Care was included as part of the required Life Skills Management course. Each student received a grade for the 20-session course. Six current teachers at the center provided major support for this project. At the conclusion of the project, students in all four classes attended an awards ceremony and pizza party in recognition of their efforts to become better parents.

The researchers provided the curriculum to teachers in the program. Two overriding concepts were integral to all aspects of the curriculum: 1) discipline, don't hit the child, and 2) talk to and play with the child. One meeting was held with the teachers to review the program, stress the program's two main concepts, and discuss instructional strategies and their implementation. Training was not necessary, as the curriculum was self-explanatory and the teachers were already trained and competent in working with this special needs population. All program materials (e.g., films, lessons, books, pamphlets) were located in the office and available to the staff.

The efforts of three counselors associated with the program greatly enhanced its effectiveness. As part of their general duties, counselors were encouraged to observe the students in their assigned classes and initiate group activities. Their presence and the varied roles they played during the intervention increased its effectiveness. They were present in the classes during each scheduled lesson to encourage class discussions, field questions, observe inappropriate or abusive behaviors, and provide psychological support. Many of the topics led the students to recall past experiences that, in some instances, were upsetting; the counselors provided a comfort zone for the students. Requests for private counseling sessions were immediately honored.

During the sessions, counselors and staff noted certain anomalies. A few students refused to touch the doll-baby at all, and showed either total disregard or outright hatred for the baby, especially when it cried. All but one of these students were male. More important, two of these students resided in homes with younger siblings; one of these students resided with a sibling under 5 years old. A few other students appeared to abuse the doll-babies (i.e., tossing the baby, pulling the baby, twisting the skin of the baby, and shaking the baby) or tried to ignore it (refusing to hold the baby). In all but one instance, these abusive behaviors appeared when the students were unable to stop the doll-babies from crying. Only once did a male student initiate aggression against a quiet doll-baby. It is important to note that other students in the class immediately showed indignation and reported the incident to the counselor, teachers, and other students. On two occasions, this type of incident almost caused a fight as a student went to protect the doll-baby from another student's inappropriate behavior. Counselors added additional sessions of private counseling for those participants who exhibited abusive and/or neglectful behaviors. Also, they spoke with parents, guardians, and foster parents about participants' exhibited inappropriate behaviors. In two instances, a family social worker was assigned to the home.

A more serious incident occurred with one of the students who already had a baby. Apparently, the student was leaving her 2-year-old at the homes of various people (not family) for weeks at a time so she could continue her social life. Counselors had to intervene when one of the people who was caring for the baby refused to release the baby to the student. The baby was finally released and the counselor contacted Family Services; a social worker was assigned to the case to monitor the household to ensure that the 2-yearold was being properly cared for. In addition, the student was required by the court to place the child in child care.

Before and after the project (pre- and posttest), students were administered two questionnaires: The Adult Adolescent Parenting Inventory and Test Your Nurturing Knowledge. The results showed that this program was very effective in three areas:

* Knowledge About Parenting and Parenting Skills. This construct on knowledge about parenting reflects an understanding of the different stages of growth and development of a child, and the skills needed in the care and nurturing of a child. Comparison of pre- and posttest scores showed a strong increase in knowledge about parenting and parenting skills, t(6.54) = p < .001. Participants who were already parents were more knowledgeable than others before the project started but still gained additional knowledge from the curriculum intervention on parenting.

* Beliefs About [Not] Using Corporal Punishment With Children. The students' beliefs about [not] using corporal punishment with children showed the greatest positive change as a result of this project, t(6.67) = p < .001. High post-intervention scores on this belief indicate that participants value alternatives to corporal punishment, refute the need for physical force, consider democratic rule-making that includes all family members, and respect children's needs as part of a mutual parent-child relationship. Success in reducing the belief of an at-risk EBD population in the necessity of using corporal punishment to discipline children was a primary goal of this study.

* Empathy for the Child's Needs. Empathy refers to the ability of a person to be concerned about the needs and feelings of another. Empathic parents are sensitive to the needs of their children and create nurturing environments conducive to the intellectual, emotional, and social growth of their children. The authors observed increases from pre- to posttest scores in the students' empathy, t(2.90) = p < .01. This significant growth in awareness of children's needs indicated that the techniques used in the curriculum to increase empathic attitudes were effective.

This study demonstrated that students with EBD can be successfully trained in appropriate parenting skills. Sixty-eight percent of the surveyed students stated that the Project Baby Care program had helped them to recognize that "parenthood brought dramatic life changes" and were now aware of how unrealistic their expectations about their abilities to parent had been.

Most important, this program significantly reduced students' beliefs in the need for corporal punishment. During the program, they learned more effective and humane ways to discipline a child.

A parenting curriculum aimed at strengthening competencies and coping resources in an EBD population can provide a proactive approach to successful transition into adulthood and promote positive life skills.

References and Resources

Baby Think It Over, Inc. What is the baby think it over program ? Available online, http:/ /btio.com/btioprov.htm

Bavolek, S., & Bavolek, J. (1988). Nurturing program for teenage parents and their families. Park City, UT: Family Development.

Capaldi, D., & Clark, S. (1998). Prospective family predictors of aggression toward female partners for at-risk young men. Developmental Psychology, 34(6), 1175-1188.

Dalzell, J., & Kanzki, R. (1999). Parent guide books for growing families. Miami, FL: South Florida Perinatal Network, Inc.

Darby, J. (2000, March 21). Boyfriend to get life in baby's death. Shaking blamed for fatal injuries. Times Picayune (New Orleans, LA), p. B1.

Irazuzta, J., McJunken, J., Danadian, K., Arnold, F., & Zhang, J. (1997). Outcome and cost of child abuse. Elsevier Science Ltd., 21(8), 751-757.

Kaplan, S., Posey, J., & Cornell, D. (2003, August). Threats by students in special education. Paper presented at the meeting of the American Psychological Association, Toronto, Canada.

National Clearinghouse on Child Abuse and Neglect Information. (2004). Child abuse and neglect fatalities: Statistics and interventions. Available on line. http:// nccanch.acf.hhs.gov/pubs/factsheets/ fatality.cfm

National Comorbidity Study. (1994). Washington, DC: U.S. Government Press. Available online, www.umich.edu/-ncsum/

Robles, F. (1998a, September 7). Man nearly kills child over food, police say. Girl critical; morn, boyfriend charged. Miami Herald, p. 1B.

Robles, F. (1998b, October 23). Dad charged with beating baby to death. Miami Herald, p. 1B.

Catherine Roberts, Clara Wolman, and Judy Harris-Looby are full-time faculty in the Graduate Exceptional Education Program, Barry University, Miami Shores, Florida.