Outline for 10-Week Intervention (3rd Edition handouts)

© 2018 Promoting First Relationships®

6 month – 5 year outline, 3rd Edition Handouts

®

Outline for 10-Week Intervention (3rd Edition handouts) *Use with children 6 months to 5 years

Week 1

1. Introduce PFR – HANDOUT #1 CHILDREN’S SOCIAL AND EMOTIONAL HEALTH, emphasizing the

importance of the parent-child relationship.

2. Begin JOINING PROCESS with parent (please see sample Joining Questions).

3. Show and discuss HANDOUT #4 DEVELOPING TRUST

Emphasize that a child develops trust in his/her parent through these repeated, daily interactions

Show and discuss HANDOUT #8 SUPPORTING TRUST AND EXPLORATION.

What is like for you when your child needs you to be close to give love, comfort, and help?

What is it like for you when your child moves out to explore?

4. Dicsuss purpose of our visits:

1. Sometimes parenting can be difficult or confusing, and parents may have questions and

concerns. We are here to support you as you work through some of these common challenges.

2. Our second purpose is to explore with you how you can help your child when he needs your

protection, help and attention. Responding with understanding and nurturance increases his

feelings of trust that the world is a good place and that he will be taken care of.

3. Invite parent to share what she is hoping to get from these visits.

5. VIDEOTAPE parent and child interaction for 5 to 10 minutes. Ask parent to PLAY with child as

they normally would. It is important to help parent feel as comfortable as possible. Discontinue

recording if parent is too uncomfortable.

6. Watch PFR parent/caregiver introductory video or leave with parent to watch during the week

(or watch together during session 2)

7. Give Thoughts for Week 1:

Notice how your child may need you this week:

When were times he or she needed to stay close to you?

When were times he or she felt safe and secure enough to move away from you to explore?

During times she or he is exploring, notice how she or he might still let you know:

I need you to watch over and enjoy me

I need you to protect, comfort, or help me understand my feelings

I need to refuel on your love



Week 2

1. Check in, continue joining, and review thoughts from the past week:

Notice how your child may need you this week:

When were times he or she needed to stay close to you?

When were times he or she felt safe and secure enough to move away from you to explore?

During times she or he is exploring, notice how she or he might still let you know:

I need you to watch over and enjoy me

I need you to protect, comfort, or help me understand my feelings

I need to refuel on your love

2. Discuss parent’s thoughts about the PFR video, and then discuss HANDOUT #2 ELEMENTS OF A

HEALTHY RELATIONSHIP.

3. Introduce HANDOUT #3 MEETING THE SOCIAL AND EMOTIONAL NEEDS OF INFANTS AND TODDLERS.

Look together at the 10 social and emotional needs and help the caregiver understand what each of

these means, as well as some ways to meet these needs. Also, take the time to reflect on which ones of

these needs seem especially important for their child right now; or which of these needs seem easier or

more difficult for the parent/caregiver to meet.

4. REFLECTIVE OBSERVATION: Show videotape from previous week and reflect on it together.

Invite parent to comment on what she is noticing; and let her know that you will do the same. Look for

opportunities to highlight times when parent is supporting child’s social and emotional needs.


Look through the list of Social-Emotional needs. Choose 2 that make you think of your child and focus

on them for the next week. For each Social-Emotional need you chose:

Think about ways you were able to meet those needs.

What, if anything, feels hard or challenging about meeting those needs?

Also, think about your own Social-Emotional needs as a parent, and how you are able to have those

needs met.



Week 3

1. Check in, continue joining, and review thoughts from the past week: Look through the list of Social-Emotional needs. Choose 2 that make you think of your child and focus

on them for the next week. For each Social-Emotional need you chose:

Think about ways you were able to meet those needs.

What, if anything, feels hard or challenging about meeting those needs?

Also, think about your own Social-Emotional needs as a parent, and how you are able to have those

needs met

2. INTRODUCE HANDOUTS #12 PLAYTIME WITH YOUR CHILD and #13 TEACHING THROUGH PLAY.

Here are some ideas to think about when playing with your child. Emphasize importance of

child taking the lead in play. Playtime is a great time to give children some control.

What activities do you do together that you both especially enjoy? What are some ways that

your child lets you know he is enjoying the play?

3. VIDEOTAPE parent and child interaction: 10 minutes PLAYING; then stop and introduce a

TEACHING activity (record teaching activity for 5 minutes or LESS).

First, ask parent to play with her child as she normally would and videotape for about 10 minutes.

After parent and child have played, then tell parent about the teaching activity and have her choose

from 2 to 3 tasks that she would like to teach her child; or she can also offer a developmentally

appropriate task that she would like to teach her child. Record for up to 5 minutes max.

4. Look at BABYCUES CARDS AND/OR SHOW BABYCUES VIDEO and discuss which cues the caregiver

sees her own child doing.

Each of us has a unique temperament and way of experiencing the world. Children, from the time they

are born, give us information about who they are and how they are experiencing the world. If we watch

these cues carefully, we can learn how to respond sensitively and also we can learn about our child and

her special and unique qualities or make-up. When a child feels understood, he learns that he can trust

the ones closest to him to meet his/her needs. This sets the stage for the future relationships your child

will have with other people in her life.

Also discuss the importance of responding sensitively to child’s subtle or milder YELLOW cues to

help maintain a calm, comfortable state for both parent and child.

Discuss the idea of Serve & Return – that parent can watch for cues that child sends that he wants to

interact (Serves); and that parent can respond sensitively to communicate that she sees (Returns).

5. If child is less than one year, give and discuss HANDOUT #6 BUILDING CONNECTIONS

Helps identify ways that caregiver can respond to her baby during calm and upset moments.


In thinking about BabyCues, notice cues your child uses to signal “I’m interested in interacting” and

cues that signal “I need a change or break.” What are some cues that are easy to read, harder to read?



Week 4


In thinking about BabyCues, notice cues your child uses to signal “I’m interested in interacting” or

“I need a change or break.” What are some cues that are easy to read? Harder to read?


3. If child is a baby, explain HANDOUT #5 ON THE PATH TO TRUST AND SECURITY, OR

If child is a toddler, explain HANDOUT #9 ON THE PATH TO A POSITIVE SENSE OF SELF

Relate to child’s Temperament; and emphasize the qualities and information most beneficial to dyad.

4. HANDOUT #15 CHALLENGING BEHAVIORS OF INFANTS &TODDLERS: NEEDS, FEELINGS, BEHAVIORS

All behavior has meaning. Internal world of feelings, desires, and motivations drive behavior.

Support a wondering stance in parents so they can understand what their child is feeling/needing

5. Discussion on Crying and Attachment:

Crying in Infancy: When children are hurt, upset, scared, cold, hungry, or lonely, they naturally seek

their parents or caregivers for comfort and safety (safe haven). Children often signal their need for

comfort or safety by crying. Their crying means something and is one way they communicate their

needs. Picking up and consoling a crying baby helps the baby develop trust in his caregiver. This way

of thinking about crying may be different from what we’ve been told in the past. Some of us might

have been told that picking up a baby when he cries might spoil the baby, and that a baby will want to

be held all the time or will cry more if a parent responds to their crying with cuddling and holding.

What have you been told about this? What is your experience of your baby crying? Can you think of

a time that your baby was crying and it was easy to give what he needed? A time that was difficult?

Limits in Toddlerhood: Babies want what they need. For example, a baby who wants to be held has

a natural instinct to seek this kind of comfort in order to survive and grow. There is no need to worry

about spoiling a baby. This is not the case with toddlers. Their needs and wants are not always the

same. For example, a toddler who is crying because he wants candy that he cannot have is very

different than a time that he is crying because he is sad, scared, sick, or upset and needs protection and

comfort. The crying child who wants candy still needs to feel understood, but the child also needs the

boundary of the limit.(i.e. I understand you want the candy, but you can have it after dinner.)

Can you think of a time when your child’s crying was a signal that he needed you for comfort or

protection? How did you respond? How did it feel to you? To your child?

Can you think of a time that your child cried because he could not have something he wanted and

you needed to set a limit? How did that crying feel different? What was it like to set a limit?


Which qualities on the Path feel easier for you to provide; which qualities feel more challenging? What

makes these qualities easier or harder? Look for ways to meet these for your child this week.

When your child is upset this week,

Notice your child’s behavior: What do you see and hear your child doing to communicate?

What emotion might your child be feeling?

What social and emotional need might your child be telling you about with his or her behavior?

How do you show your child that you are trying to understand? What can you do to help your child



Week 5


Which qualities on the Path feel easier for you to provide; which qualities feel more challenging?

What makes these qualities easier or harder? Look for ways to meet these for your child this week.

When your child is upset this week,

Notice your child’s behavior: What do you see and hear your child doing to communicate?

What emotion might your child be feeling?

What social and emotional need might your child be telling you about with his or her behavior?

How do you show your child that you are trying to understand? What can you do to help your child

2. Memory of an Emotion: “We are switching gears a little now and will talk more about you and

your own childhood in this next exercise. Reflecting on your own childhood and how you were

parented can help parents respond sensitively vs. just reacting to their child’s behaviors and needs.”

Ask parent to remember a time from their childhood when they experienced an emotion, either

happy or upset. (Consult Trainer/Supervisor if you have concerns about asking caregiver to remember

a specific event from the past – you may do one of the optional replacement exercise below if you

choose).

What were you feeling?

What were you needing?

How do you think your caregiver was feeling?

What was your caregiver needing?

Did you get what you needed?

How did you feel about yourself?

How did you feel about your caregiver?

How did you handle all those feelings?

Bring discussion to the present: How did that feel to discuss? Was this typical of how you were

parented? How does this influence, or how do you want it to influence, how you parent?

[Optional replacement exercises for above:

Option 1. Tell me a little about your childhood experience and how you were parented. How was that

for you? How does this influence or how do you want this to influence how you parent?

Option 2. Memory of a Time you felt Cared for: Provider asks relevant questions from the list above

about a time when the caregiver felt loved or cared for by a parent or someone close to them.

Conclude by asking how caregiver wants this to influence how s/he parents.]

3. Show and Discuss HANDOUT #10 STAYING CONNECTED DURING DIFFICULT MOMENTS

Here are some ways to help your child during an upset moment so that he learns he can count on you

to help him manage strong feelings, instead of sending him away to do that difficult job on his own.

How does it feel to work to stay connected with your child when he/she is upset instead of focusing

only on stopping the crying or the behavior? How do you think your child feels?

4. Show and Discuss HANDOUT #11 ON THE PATH TO SUCCESSFUL SEPARATIONS AND TRANSITIONS

Being thoughtful about your child’s feelings and needs during separations and transitions, which can

be scary and unpredictable for your child, helps you and your child feel more secure and comfortable.



5. If child is 12 months or older, VIDEOTAPE parent and child brief Separation-Reunion, if child is

less than 12 months, videotape parent and child play interaction for 10 to 15 minutes.

“Now I’d like to film a brief separation and reunion between you and your child. [If parent seems

worried or if it seems important to add this, you can acknowledge that this may feel difficult/hard and

that as parents we don’t want to cause our child to be sad, but that separations and reunions happen

naturally in real world moments and that this exercise gives us some really helpful information for

dealing with these times.] This experience helps parents understand what their child may need when

they are separating; observe how their child acts and feels when they are gone, including learning

about their child’s strong and mild cues; and understand what helps their child when they return. All

of this information can be really helpful in supporting a strong, positive relationship with your child.

We will watch the video at the next session, and we will get a chance to discuss all of this together.

For this exercise, please say good-bye to your child, and then to leave the home so that your child

cannot see you (if leaving the home is not possible, ask parent to leave the room so that child feels that

parent is briefly unavailable). I’d like you to be gone for three minutes (make sure parent has a way to

track the time). However, if you hear your child crying, please come back into the room right away.

When you return, please greet your child. I will continue to videotape you and your child for another 3

to 5 minutes, so you can have some time together. Do you have any questions about this?

Is there anything you would like to do to the space (setting up baby gates, putting away unsafe items or

other items out of reach) before you say good-bye to your child?


Notice two times when your child was upset.

How were you able to stay connected?

How does focusing on how to help feel different from focusing on stopping the whining, crying, or

other upset behavior?

How do you think your child felt when you tried to help her or him through the difficult situation?

Also, please think about one time when you felt upset.

Was there someone you could trust with your feelings?

If yes, what makes it possible for you to trust that person?

If no, what did you do with your feelings?



Week 6


Notice two times when your child was upset. How were you able to stay connected? How does

focusing on how to help feel different from focusing on stopping the whining, crying, or upset

behavior? How do you think [child] felt when you tried to help him through the difficult situation?

When you felt upset, was there someone you could trust with your feelings? If yes, what makes it

possible for you to trust that person? If no, what did you do with your feelings?

2. Show and Discuss Separation-Reunion Video: (Or Parent-Child Play video, if child < 12 mos)

The focus is on helping the parent interpret the child’s behavior and developing nurturing ways to

respond. If the child showed secure behaviors, the provider points out how clearly the child showed

his/her needs and discusses what this behavior elicits from the parent. If the child showed avoidant or

resistant behaviors, the provider talks about the parent’s & child’s feelings and needs in more detail.

In both cases (secure/non-secure), provider talks about secure base behavior. For insecure:

“Sometimes children don’t always give clear cues about what they need, but we could see [name of

child]’s distress (point out subtle and potent cues) when you were gone. Examples of questions to use

to help parents focus on their own and their children’s feelings and needs: How do you think [name of

child] was feeling when you were out of the room. How did you feel when you came back? How did

your child feel? What do you think your child needed? What did you need?” Reflect with parent about

what child may be needing from her and ways to meet this need.

3. Look together at SOCIAL AND EMOTIONAL NEEDS (H/O #3) & relate to parent’s childhood Looking specifically at each need, how were your needs met or not met as a child?

How do you think this affects you now? How do you think it affects your parenting?

4. Safe and Scary: Most of us have times when we view our world as safe and comfortable: As a world that we can trust.

Other times, the same world feels not so safe; it feels pretty uncomfortable. We might feel afraid,

worried, stressed or angry. At these times, it might be hard for us to trust others. It might also be hard

to help ourselves feel calm again.

Can you think of an example in your life when you might feel afraid, worried, stressed, angry or

distrustful? What helps you when you feel like this? Is there a person you can trust with hard

feelings, and that helps you feel better?

Children are just like us. Sometimes their world feels safe and comfortable. And sometimes it feels

scary, stressful, worrisome or upsetting. It can feel like this for children even when it seems safe and

fine to us. Even if we can’t always understand why our child is upset, worried or scared, providing

comfort and trying to help him or her feel understood is how we help our child feel safe and secure,

especially when the world is starting to feel out of control. It is hard for children to feel better without

help from someone they trust.

Can you think of a time when your child was feeling upset like this, and needed you to feel better?

How did you help your child feel better?

5. Give Thoughts for Week 6: During the next week, try to notice a time when your child was scared

or upset and it was hard to understand why. How did you show your child that you cared? How did it

feel? How do you think your child felt? Also during the next week, try to notice when you felt

safe/comfortable vs. scared, anxious or angry. What was that like for you? Was there someone that

helped you feel understood? How did that make you feel?



Week 7


During the next week, try to notice a time when your child was scared or upset and it was hard to

understand why. How did you show your child that you cared? How did it feel? How do you think

your child felt?

Also during the next week, try to notice when you felt safe/comfortable vs. scared, anxious or angry.

What was that like for you? Was there someone that helped you feel understood? How did that make

you feel?

2. VIDEOTAPE parent and child interaction— 10 to 15 minutes PLAYING.

3. Discuss HANDOUT #7 THE POWER OF REPAIR…BECAUSE NO ONE GETS IT RIGHT ALL OF THE TIME

All parents have difficult times with their child. Repair allows parent and child to make things right

again.

4. Discuss HANDOUT #10B CALMING MYSELF, CALMING MY CHILD

These are strategies that parents can use in the moment to remain calm enough to stay connected to

their child and help him or her through upset feelings and behaviors.

1. Noticing – I notice my bodily reactions and how I am feeling. Are my muscles tight/ neck or

shoulders hunched? Stomach aching? Shallow breathing? Is my voice louder (am I yelling?)

Am I feeling stressed, nervous, anxious, frustrated, angry, or overwhelmed?

2. Accepting – I acknowledge the situation. “This is hard”, “I’m feeling rushed”, “I’m

embarrassed”

3. Calming – I use one of my established calming strategies to help me calm down

Count to 10

Breathe deeply and slowly – try breathing through nose and out mouth

Tense/relax muscles

Repeat a key word that cues body to calm down

Put on soothing music

Use positive Self-talk (Affirmations): I can handle this; This will pass; I am a good

mom; Nobody’s perfect.

*When I am calmer, I am more able to help my child calm

Then, discuss Calming My Child section and think with parent about what will help their child.


When you and your child are having a difficult moment, try using the calming steps we have talked

about today. How did it feel to you? How did your child respond?



Week 8


When you and your child were having a difficult moment, were you able to use the calming steps that

we talked about. How did it feel to you? How did your child respond?


3. Show and discuss HANDOUT #14 – ENCOURAGING COOPERATION IN EVERYDAY MOMENTS.

We all want our children to share and cooperate. The strategies in this handout build cooperation

because they help children feel happy, safe, and understood. When children feel good about

themselves and their caregivers, they are more willing to cooperate.

4. Discuss HANDOUT #14B – BALANCED PARENTING: GUIDANCE THROUGH LIMITS AND CHOICES

We define discipline as the process of teaching and helping children learn expectations, control their

behavior, and handle their emotions so they can cooperate with others. We do this by providing limits,

choices and responsive guidance, all with an empathetic attitude.

Looking at the handout, explain that all parents tend to lean to one side of the balance beam or the

other. Ask parent which side they naturally lean towards. Understanding our natural tendency can help

us reflect on how we are reacting in the moment to a situation with our child.

Then discuss:

Limits: Limits help children feel safe and secure, learn to manage their emotions, and learn

socially acceptable behavior.

*What are one or two important limits or rules that you are working on right now with your

child?

Choices: When children are provided an appropriate level of choices in their day, as well as

some choices involving a particular limit or rule, they can experience the feelings of control

and competence they need, and this helps them more willingly cooperate.

*What are some choices you can offer your child?

Responsive Guidance: As parents, we can help guide our children to make good choices by

taking a moment to self-calm; being near our child (vs. across the room); using a gentle, non-

threatening tone of voice, empathizing with and labeling our child’s underlying feelings and

motivations, making suggestions for what is okay to do and redirecting, stating clearly what is

not okay and giving a simple reason; and providing the opportunity for our child to try again or

practice.

*What are some ways that you can help guide your child to cooperate?

5. Give Thoughts for the Week:

In reviewing the “Encouraging Cooperation” handout, which two strategies feel easiest for you?

Which strategies feel more difficult?

Thinking about discipline, what limits/rules are you working on? Given the specific limit or rule,

what choices are important for your child right now? How can you use guidance to help your child

cooperate?



Week 9


In reviewing the “Encouraging Cooperation” handout, which two strategies feel easiest for you?

Which strategies feel more difficult?

Thinking about discipline, what limits/rules are you working on? Given the specific limit or rule,

what choices are important for your child right now? How can you use guidance to help your

child cooperate?

2. VIDEOTAPE parent and child interaction: 10 minutes PLAYING; then stop and introduce a

TEACHING activity (record teaching activity for 5 minutes or LESS).

3. Discuss HANDOUT #16 – UNDERSTANDING CHILDREN’S BEHAVIOR.

This handout explains five possible reasons for a child’s difficult behavior and ways that caregivers

can deal with the behavior.

4. HANDOUT #17 – BEHAVIORS, FEELINGS, AND NEEDS: AN INTERVENTION WORKSHEET. Fill out the

Intervention Worksheet together.

When completing the worksheet together, prompt parent to discuss a specific interaction that was

difficult. Also, make sure to have the parent identify the relevant social and emotional needs for

column #3. Use these identified social and emotional needs, to help problem solve in the 4th column.

5. Give Thoughts for the Week:

Think of a couple of challenging interactions that took place between you and your child this week.

For at least one challenging interaction, refer to the BEHAVIORS, FEELINGS AND NEEDS INTERVENTION

WORKSHEET (Handout #17). After thinking about your and your child’s interaction in this way, do you

feel any differently about the interaction?



Week 10

1. Check-in and discuss thoughts from last week:

Think of a couple of challenging interactions that took place between you and your child this week.

For at least one challenging interaction, refer to the BEHAVIORS, FEELINGS AND NEEDS INTERVENTION

WORKSHEET (Handout #17). After thinking about your and your child’s interaction in this way, do you

feel any differently about the interaction?


3. OPTIONAL, review any handouts or concepts that would be helpful to discuss further.

4. CLOSING ACTIVITY to honor the time you have spent together.

1. Acknowledge a specific quality in the caregiver that you have observed and reflected on

together that contributes positively to her healthy relationship with her child.

2. Ask Caregiver to reflect on the following:

What has stood out or been important to you as you’ve gone through this program?

What do you want to remember to keep in mind in regards to you and your child?

Do you have any last thoughts as we finish our time together?

Outline for 10-Week Intervention (3rd Edition handouts)

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Transcript of Outline for 10-Week Intervention (3rd Edition handouts)