Preventive Intervention Programs for Disadvantaged Children Leonard A. Jason, Ph.D. Lyn De Arnicis, Ph.D. Brent Carter, Ph.D.
ABSTRACT: This paper describes a 6-year effort aimed at developing educational interventions for a group of economically disadvantaged children. The program provided an opportunity for psychologists and student paraprofessionals to join with personnel at urban health carefacilities in responding to a serious identified community problem--disadvantaged youngsters, ages 1 and 2, who are vulnerable to later school and life difficulties. The intervention succeeded in enhancing academic skills among six groups of disadvantaged toddlers. As ongoing research results indicated the needfor new program elements, the university personnel piloted innovations and the health centers gradually incorporated effective components into the existing program.
Much has been written in recent years concerning the plight of economically disadvantaged children. Typically, "deficit" theorists characterize such children as having intellectual lags (Hunt, 1969), below average language abilities (Bereiter & Engelmann, 1966), and motivational difficulties (Zigler & Butterfield, 1968). "Difference" advocates reject descriptions referring to disadvantaged children as having inferior capabilities, and instead emphasize nonstandard, but equivalent cognitive and language abilities (Baratz, 1973). Difference theorists point to environmental hurdles, such as inadequate schools (Clark, 1967) and job discrimination (Williams, 1970), and adverse evaluation procedures to account for the developmental lags found among a high percentage of disadvantaged children. If it is true that disadvantaged children have nonstandard cognitive and language abilities and are not familiar with mainstream skills, serious academic and adjustment problems might arise later in life (Jason, 1975). Traditionally, mental health professionals have taken a passive-receptive stance, extending services to the disadvantaged only after disorders have become patently identifiable. By treating problems after their manifestation, these approaches ignore significant longitudinal and precipitating factors contributing to the formation of the disorder. In contrast, a community model posits a more active person-centered, secondary preventive approach which
*Dr. Jason is connected with the Psychology Department, De Paul University, 2219 North Kenmore Avenue, Chicago, Illinois 60614. Portions of this paper were presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New York, 1976. The authors wish to express their sincere appreciation to Dr. Emory Cowen for his continual support and guidance, and also thank the personnel at Jordan Neighborhood Health Center and Westside Health Services who worked with them in a rewarding collaborative relationship. Community Mental Health Joumal, Vol. 14(4), 1978 0010-3853/78/1600-0272500.95
9 1978 Human Sciences Press
Leonard A. Jason, Lyn De Amicis, and Brent Carter
273
stresses early identification of problem areas and the development of appropriate interventions to alleviate them. More primary approaches attempt to establish environments conducive to sound development from the start (Zax & Cowen, 1976; Cowen, 1973). Over the last few years, various preventive educational programs around the country have indicated that preschool disadvantaged children can learn mainstream cognitive and linguistic skills and thus perform comparably to their more advantaged peers (Hunt, 1971; Horowitz & Paden, 1973). The present paper describes a 6-year research effort directed toward developing innovative educational interventions targeted toward a group of economically disadvantaged children. ROCHESTER PROGRAMS In 1969, during routine well-baby examinations, physicians at Jordan Neighborhood Health Center in Rochester were identifying some inner-city toddlers, ages 10 to 24 months, as evidencing appreciable social and behavioral difficulties. Such problems were in the absence of any neurological or physiological disorders. Many of these children showed marked withdrawal and a lack of interest in environmental stimuli as well as a preference for nonverbal over verbal means of communication. Even though this group of disadvantaged children were readily recognizable, no intervenrive programs existed in Rochester that were aimed at providing early educational opportunities. In an effort to enhance social, behavioral, and academic skills for these children, a joint intervention program was initiated in collaboration with Dr. Emory Cowen, a psychology professor at the University of Rochester. During the first year of the program, trained University of Rochester undergraduate volunteers under the supervision of advanced graduate students worked with the targeted children three times a week over a 3-month period. Help agents were initially encouraged to establish warm and supportive relations with program toddlers which would reduce anxiety and promote receptivity to subsequent educational experiences. As target youngsters became acclimated to their new environment, they were exposed to a stimulating assortment of educational materials. Throughout the sessions, toddlers were encouraged to rely more and more on verbal rather than nonverbal means of communicating. Any social interactions with other children or with adults, as well as appropriate verbal behaviors, were rewarded by help agents. By the end of the program, children were more active, talkative, and interested in their environment. Moreover, on academic measures they scored significantly higher than at prepoint (Specter & Cowen, 1971). Thus at this early point it was quite clear that an early and active interventive program could successively build new skills among targeted children.
Inclusion of Parents As the program developed, parents were actively encouraged to work directly with their children. This was facilitated by conducting
274
Community Mental Health Journal
several sessions in the homes of the children. It was hoped that parents and undergraduates could work together on enhancing skill development among the program youngsters. During the home sessions, parents observed and participated in actual teaching activities with their children. When children were reevaluated at the end of this program, significant improvements were again achieved in academic areas and children were judged to be more cooperative, content, happy, friendly, and less distractible (Jason, Clarfield, & Cowen, 1973). These initial efforts demonstrated the intervention's value and effectiveness in providing measurable growth experience for these children. Also shown was the interest among parents in becoming more directly involved with the program.
Further Program Variations A later intervention investigated the differential effectiveness of two separate interventions, each including considerable parent involvement. The first intervention was based on behavior modification principles. This program has been pilot tested in an intervention the previous year (Jason & Kimbrough, 1974). In this program, trained undergraduates entered homes of targeted children and taught a hierarchical series of lessons that emphasized language skills. The behavioral curriculum of 61 lessons 0ason, 1974) ranged from simple tasks (that is, attending, nonverbal, and verbal imitation) to more complex ones (that is, identifying pictures, answering questions using sentences). Behavioral techniques employed included (1) reinforcing appropriate behaviors by first using social and edible reinforcers and then gradually phasing out the edible reinforcers, (2) physically prompting desired behaviors, (3) rewarding successive approximations of appropriate behaviors, and (4) ignoring disruptive and inappropriate behaviors to decrease the probability of their reoccurrence. Parents observed home teaching sessions and were encouraged to participate actively in administering lessons. This behavioral intervention was compared to a relational one that is, a program similar to those implemented in previous years except for the addition of parent group meetings. Groups met once a week for 2 hours at Westside Health Services. Group leaders included advanced graduate students from the University of Rochester and interested staff members from the health center. Such parent groups represented an innovative approach to providing comprehensive preventive mental health services to disadvantaged parents. The function of the groups was fourfold (1) as an information liaison between help agents and parents; (2) as a propagator of program goals, overall philosophy, and child rearing skills; (3) as a forum for venting personal concerns related to the rearing of their children; and (4) as an ongoing training workshop aimed at sharpening problem-solving skills and enhancing feelings of self-confidence and competence. At postpoint evaluation, both programs effectively enhanced children's academic and motor abilities; however, there were few consistent differences between interventions (Jason, Gesten, & Yock, 1976).
Leonard A. Jason, Lyn De Amicis, and Brent Carter
275
Final Comprehensive Programs The next program in the series combined the effective elements of previous programs by including both relational and behavioral approaches in the center as well as home setting (Jason, 1977). Parents were again included by modeling program elements in the home and providing weekly discussion groups for them. Children were provided three sessions weekly--two at a center and one in the home. Target youngsters were randomly assigned to two groups, the first of which participated in the intervention from September to December and the second group from January to April. Following program participation, targeted children evidenced significant gains. In the absence of the program intervention, abilities remained the same in control children. Moreover, after 3 months follow-up, gains were maintained by program youngsters. Conceivably, extensive parental involvement at both home sessions and parent group meetings provided them with requisite skills and motivations to continue the critical educational elements following the termination of the program. The last intervention included all of the elements previously developed (that is, parent groups, home and center sessions). In this program, the outcomes of two different formats were compared for relative effectiveness (Carter, 1977). In the first program, paraprofessionals worked with children at both the community center and home sessions as was done in the past. In the second program, however, help agents worked only in the home with parents, who in turn worked directly with their own children. Results of this year's efforts showed (1) children in both experimental groups gained significantly more than control children; (2) participants in the center program improved most on motor skills, whereas children in the home program improved most in academic areas; and (3) evaluations of social maturity for both experimental groups remained constant, whereas measures of social development of control subjects declined during the program period. In conclusion, findings from six separate studies indicate that preventive interventions effectively enhance skill development in disadvantaged toddlers. The inclusion of parents in the training programs better enables children to maintain whatever gains they have achieved after the termination of the formal program.
RESULTANT SYSTEM CHANGES During the past 6 years, program modifications and developments have precipitated substantive structural changes within the sponsoring health care facilities. For example, at Jordan Neighborhood Health Center, the site of the first program, a full-time program director and supporting personnel were hired. The health center now recruits and trains all help agents. The initial 3-month program has been expanded to a year-round intervention and a step-up program was developed for graduates of the infant program. Thus Jordan Health Center's 4-year collaboration with the Univer-
276
Community Mental Health Journal
sity of Rochester enabled them to assume fully the University of Rochester's respons~ilities for establishing an effective educational program. Westside Health Services, another health care facility in Rochester, heard about the intervention program at Jordan Health Center and expressed an interest in establishing a similar program at their setting. As a result, during the past 3 years, students and faculty at the University of Rochester have collaborated with Westside Health Services in developing a comprehensive intervention program. The health center has become increasingly invested and committed to the ongoing educational program. This is in part reflected in the program's yearly budget (funded by Westside Health Services), which has increased from about $5,000 during the initial year to over $20,000 for the third-year program. In addition, the health center has created an internship position to enable clinical psychology graduate students from the University of Rochester to gain field experience in preventive educational programs and has also hired a full-time director for the program. Last year's intervention included more than 40 children and parents. Plans are now underway for expanding program length to enable the intervention to operate for the entire year. Parent groups have become an integral component of the program, and former parent group members are currently being trained as co-leaders for the groups. Family health assistants at Westside Health Services have been trained in program procedures and are now devoting one-fourth of their l~ne to the program. They screen all referred children with a comprehensive battery of assessment instruments including the Bayley Scales of Infant Development (Bayley, 1969) as well as socioemotional, behavioral, environmental, and interactional measures. Plans are presently being formulated for mounting a comprehensive and systematic screening program whereby all registered toddlers would be regularly tested for possible inclusion in the infant program or referred to other community-based programs. Such unique developments are enabling Westside Health Services to be truly responsive to the individual needs of all toddlers in their geographic area. FUTURE DIRECTIONS The preventive educational programs described in this paper provided a unique opportunity for research dinicians at a university setting and personnel at community health care facilities to collaborate in meeting a serious, identified community need that is, identification of incipient childhood difficulties and the implementation of preventive services. The university staff contributed expertise in initiating programs, training personnel, and providing feedback from comprehensive evaluations. The health facilities were able to identify a large number of children, establish working liaisons with the children's families, and increasingly allocate finances and personnel to assume responsibilities for operating the program. This unique relationship between university and health care centers highlights potential alternative roles for psychologists. Clinical community psy-
Leonard A. Jason, Lyn De Amicis, and Brent Carter
277
chologists entering into long-term relationships with service-providing agencies could conceptualize issues, formulate interventions, implement programs to meet unmet community needs, mobilize requisite manpower, and evaluate program efficacy (Rotter, 1973). More than likely these new roles for psychologists will be vital ones if the ever-increasing demands and needs for mental health services are to be met (Cowen, 1973). Preventive educational programs, as described above, represent only one type of intervention strategy in helping disadvantaged children. It should be recognized that a multitude of long-term pernicious influences (dilapidated housing, rundown neighborhoods, unemployment, lack of successful adult models, inadequate schools, discrimination) continually confront the disadvantaged. More comprehensive primary preventive approaches might restructure environments to eliminate irritants that predispose individuals to unfortunate later outcomes. More collaborative investigations, both on the early secondary and primary levels, are needed to provide the technology and knowledge for insuring sound, salutary development for all children-whether advantaged or disadvantaged. REFERENCES Baratz, J. C. Language abilities of black Americans. In K. S. Miller and R. M. Dreger (Eds.), Comparative studies of blacks and whites in the United States. New York: Seminar Press, 1973. Bayley, N. Manual for the Bayley Scales of infant development. Berkeley, Calif.: Psychological Corporation, 1969. Bereiter, C., & Engelmann, S. Teaching disadvantaged children in the preschool. Englewood Cliffs, N.J.: Prentice-Hall, 1966. Carter, B. Preschool program for economically disadvantaged children: A comparison of two intervention procedures. Unpublished doctoral dissertation, University of Rochester, 1977. Clark, K. R. Defeatism in ghetto schools. In J. I. Roberts (Ed.), School children in the urban slum. New York: Free Press, 1967. Cowen, E. L. Social and community interventions. Annual Review of Psychology, 1973, 24, 423492. Horowitz, F. D., & Paden, L. Y. The effectiveness of environmental intervention programs. In B. M. Caldweil and H. Riccuti (Eds.), Review of child development research (Vol. 3). New York: Russell Sage Foundation, 1973. Hunt, J. McV. The challenge of incompetence and poverty. Urbana, Ill.: University of Illinois Press, 1969. Hunt, J. McV. Parent and child centers: Their basis in behavioral and educational sciences. American Journal of Orthopsychiatry, 1971, 41, 13-38. Jason, L. Westside Health Services" infant stimulation manual. Unpublished manuscript, 1974. Jason, L. Early secondary prevention with disadvantaged children. American Journal of Community Psychology, 1975, 3, 33-46. Jason, L. A behavioral approach in enhancing disadvantaged children's academic abilities. American Journal of Community Psychology, 1977, 5, 413-421. Jason, L., Clarfield, S., & Cowen, E. L. Preventive intervention with young disadvantaged children. American Journal of Community Psychology, 1973, 1, 50-61. Jason, L., Gesten, E., & Yock, T. Relational and behavioral interventions with economically disadvantaged toddlers. American Journal of Orthopsychiatry, 1976, 46, 270-278. Jason, L., & Kimbrough, C. A preventive educational program for young economically disadvantaged children. Journal of Community Psychology, 1974, 2, 134-139. Rotter, J. The future of clinical psychology. Journal of Consulting and Clinical Psychology, 1973, 40, 313-321. Specter, G. A., & Cowen, E. L. A pilot study in stimulation of culturally deprived infants. Child Psychiatry and Human Development, 1971, 1, 168-177.
278
Community Mental Health Journal
Williams, F. Some preliminaries and prospects. In F. Williams (Ed.), Language and poverty. Chicago: Markham Publishing Company, 1970. Zax, M., & Cowen, E. L. Abnormal psychology: Changing conceptions (2nd ed.). New York: Holt, Rinehart & Winston, 1976. Zigler, E., & gutterfield, E. Motivational aspects of changes in IQ test performance of culturally deprived nursery school children. Child Development, 1968, 39, 1-14.
ABSTRACT: This paper describes a 6-year effort aimed at developing educational interventions for a group of economically disadvantaged children. The program provided an opportunity for psychologists and student paraprofessionals to join with personnel at urban health carefacilities in responding to a serious identified community problem--disadvantaged youngsters, ages 1 and 2, who are vulnerable to later school and life difficulties. The intervention succeeded in enhancing academic skills among six groups of disadvantaged toddlers. As ongoing research results indicated the needfor new program elements, the university personnel piloted innovations and the health centers gradually incorporated effective components into the existing program.
Much has been written in recent years concerning the plight of economically disadvantaged children. Typically, "deficit" theorists characterize such children as having intellectual lags (Hunt, 1969), below average language abilities (Bereiter & Engelmann, 1966), and motivational difficulties (Zigler & Butterfield, 1968). "Difference" advocates reject descriptions referring to disadvantaged children as having inferior capabilities, and instead emphasize nonstandard, but equivalent cognitive and language abilities (Baratz, 1973). Difference theorists point to environmental hurdles, such as inadequate schools (Clark, 1967) and job discrimination (Williams, 1970), and adverse evaluation procedures to account for the developmental lags found among a high percentage of disadvantaged children. If it is true that disadvantaged children have nonstandard cognitive and language abilities and are not familiar with mainstream skills, serious academic and adjustment problems might arise later in life (Jason, 1975). Traditionally, mental health professionals have taken a passive-receptive stance, extending services to the disadvantaged only after disorders have become patently identifiable. By treating problems after their manifestation, these approaches ignore significant longitudinal and precipitating factors contributing to the formation of the disorder. In contrast, a community model posits a more active person-centered, secondary preventive approach which
*Dr. Jason is connected with the Psychology Department, De Paul University, 2219 North Kenmore Avenue, Chicago, Illinois 60614. Portions of this paper were presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New York, 1976. The authors wish to express their sincere appreciation to Dr. Emory Cowen for his continual support and guidance, and also thank the personnel at Jordan Neighborhood Health Center and Westside Health Services who worked with them in a rewarding collaborative relationship. Community Mental Health Joumal, Vol. 14(4), 1978 0010-3853/78/1600-0272500.95
9 1978 Human Sciences Press
Leonard A. Jason, Lyn De Amicis, and Brent Carter
273
stresses early identification of problem areas and the development of appropriate interventions to alleviate them. More primary approaches attempt to establish environments conducive to sound development from the start (Zax & Cowen, 1976; Cowen, 1973). Over the last few years, various preventive educational programs around the country have indicated that preschool disadvantaged children can learn mainstream cognitive and linguistic skills and thus perform comparably to their more advantaged peers (Hunt, 1971; Horowitz & Paden, 1973). The present paper describes a 6-year research effort directed toward developing innovative educational interventions targeted toward a group of economically disadvantaged children. ROCHESTER PROGRAMS In 1969, during routine well-baby examinations, physicians at Jordan Neighborhood Health Center in Rochester were identifying some inner-city toddlers, ages 10 to 24 months, as evidencing appreciable social and behavioral difficulties. Such problems were in the absence of any neurological or physiological disorders. Many of these children showed marked withdrawal and a lack of interest in environmental stimuli as well as a preference for nonverbal over verbal means of communication. Even though this group of disadvantaged children were readily recognizable, no intervenrive programs existed in Rochester that were aimed at providing early educational opportunities. In an effort to enhance social, behavioral, and academic skills for these children, a joint intervention program was initiated in collaboration with Dr. Emory Cowen, a psychology professor at the University of Rochester. During the first year of the program, trained University of Rochester undergraduate volunteers under the supervision of advanced graduate students worked with the targeted children three times a week over a 3-month period. Help agents were initially encouraged to establish warm and supportive relations with program toddlers which would reduce anxiety and promote receptivity to subsequent educational experiences. As target youngsters became acclimated to their new environment, they were exposed to a stimulating assortment of educational materials. Throughout the sessions, toddlers were encouraged to rely more and more on verbal rather than nonverbal means of communicating. Any social interactions with other children or with adults, as well as appropriate verbal behaviors, were rewarded by help agents. By the end of the program, children were more active, talkative, and interested in their environment. Moreover, on academic measures they scored significantly higher than at prepoint (Specter & Cowen, 1971). Thus at this early point it was quite clear that an early and active interventive program could successively build new skills among targeted children.
Inclusion of Parents As the program developed, parents were actively encouraged to work directly with their children. This was facilitated by conducting
274
Community Mental Health Journal
several sessions in the homes of the children. It was hoped that parents and undergraduates could work together on enhancing skill development among the program youngsters. During the home sessions, parents observed and participated in actual teaching activities with their children. When children were reevaluated at the end of this program, significant improvements were again achieved in academic areas and children were judged to be more cooperative, content, happy, friendly, and less distractible (Jason, Clarfield, & Cowen, 1973). These initial efforts demonstrated the intervention's value and effectiveness in providing measurable growth experience for these children. Also shown was the interest among parents in becoming more directly involved with the program.
Further Program Variations A later intervention investigated the differential effectiveness of two separate interventions, each including considerable parent involvement. The first intervention was based on behavior modification principles. This program has been pilot tested in an intervention the previous year (Jason & Kimbrough, 1974). In this program, trained undergraduates entered homes of targeted children and taught a hierarchical series of lessons that emphasized language skills. The behavioral curriculum of 61 lessons 0ason, 1974) ranged from simple tasks (that is, attending, nonverbal, and verbal imitation) to more complex ones (that is, identifying pictures, answering questions using sentences). Behavioral techniques employed included (1) reinforcing appropriate behaviors by first using social and edible reinforcers and then gradually phasing out the edible reinforcers, (2) physically prompting desired behaviors, (3) rewarding successive approximations of appropriate behaviors, and (4) ignoring disruptive and inappropriate behaviors to decrease the probability of their reoccurrence. Parents observed home teaching sessions and were encouraged to participate actively in administering lessons. This behavioral intervention was compared to a relational one that is, a program similar to those implemented in previous years except for the addition of parent group meetings. Groups met once a week for 2 hours at Westside Health Services. Group leaders included advanced graduate students from the University of Rochester and interested staff members from the health center. Such parent groups represented an innovative approach to providing comprehensive preventive mental health services to disadvantaged parents. The function of the groups was fourfold (1) as an information liaison between help agents and parents; (2) as a propagator of program goals, overall philosophy, and child rearing skills; (3) as a forum for venting personal concerns related to the rearing of their children; and (4) as an ongoing training workshop aimed at sharpening problem-solving skills and enhancing feelings of self-confidence and competence. At postpoint evaluation, both programs effectively enhanced children's academic and motor abilities; however, there were few consistent differences between interventions (Jason, Gesten, & Yock, 1976).
Leonard A. Jason, Lyn De Amicis, and Brent Carter
275
Final Comprehensive Programs The next program in the series combined the effective elements of previous programs by including both relational and behavioral approaches in the center as well as home setting (Jason, 1977). Parents were again included by modeling program elements in the home and providing weekly discussion groups for them. Children were provided three sessions weekly--two at a center and one in the home. Target youngsters were randomly assigned to two groups, the first of which participated in the intervention from September to December and the second group from January to April. Following program participation, targeted children evidenced significant gains. In the absence of the program intervention, abilities remained the same in control children. Moreover, after 3 months follow-up, gains were maintained by program youngsters. Conceivably, extensive parental involvement at both home sessions and parent group meetings provided them with requisite skills and motivations to continue the critical educational elements following the termination of the program. The last intervention included all of the elements previously developed (that is, parent groups, home and center sessions). In this program, the outcomes of two different formats were compared for relative effectiveness (Carter, 1977). In the first program, paraprofessionals worked with children at both the community center and home sessions as was done in the past. In the second program, however, help agents worked only in the home with parents, who in turn worked directly with their own children. Results of this year's efforts showed (1) children in both experimental groups gained significantly more than control children; (2) participants in the center program improved most on motor skills, whereas children in the home program improved most in academic areas; and (3) evaluations of social maturity for both experimental groups remained constant, whereas measures of social development of control subjects declined during the program period. In conclusion, findings from six separate studies indicate that preventive interventions effectively enhance skill development in disadvantaged toddlers. The inclusion of parents in the training programs better enables children to maintain whatever gains they have achieved after the termination of the formal program.
RESULTANT SYSTEM CHANGES During the past 6 years, program modifications and developments have precipitated substantive structural changes within the sponsoring health care facilities. For example, at Jordan Neighborhood Health Center, the site of the first program, a full-time program director and supporting personnel were hired. The health center now recruits and trains all help agents. The initial 3-month program has been expanded to a year-round intervention and a step-up program was developed for graduates of the infant program. Thus Jordan Health Center's 4-year collaboration with the Univer-
276
Community Mental Health Journal
sity of Rochester enabled them to assume fully the University of Rochester's respons~ilities for establishing an effective educational program. Westside Health Services, another health care facility in Rochester, heard about the intervention program at Jordan Health Center and expressed an interest in establishing a similar program at their setting. As a result, during the past 3 years, students and faculty at the University of Rochester have collaborated with Westside Health Services in developing a comprehensive intervention program. The health center has become increasingly invested and committed to the ongoing educational program. This is in part reflected in the program's yearly budget (funded by Westside Health Services), which has increased from about $5,000 during the initial year to over $20,000 for the third-year program. In addition, the health center has created an internship position to enable clinical psychology graduate students from the University of Rochester to gain field experience in preventive educational programs and has also hired a full-time director for the program. Last year's intervention included more than 40 children and parents. Plans are now underway for expanding program length to enable the intervention to operate for the entire year. Parent groups have become an integral component of the program, and former parent group members are currently being trained as co-leaders for the groups. Family health assistants at Westside Health Services have been trained in program procedures and are now devoting one-fourth of their l~ne to the program. They screen all referred children with a comprehensive battery of assessment instruments including the Bayley Scales of Infant Development (Bayley, 1969) as well as socioemotional, behavioral, environmental, and interactional measures. Plans are presently being formulated for mounting a comprehensive and systematic screening program whereby all registered toddlers would be regularly tested for possible inclusion in the infant program or referred to other community-based programs. Such unique developments are enabling Westside Health Services to be truly responsive to the individual needs of all toddlers in their geographic area. FUTURE DIRECTIONS The preventive educational programs described in this paper provided a unique opportunity for research dinicians at a university setting and personnel at community health care facilities to collaborate in meeting a serious, identified community need that is, identification of incipient childhood difficulties and the implementation of preventive services. The university staff contributed expertise in initiating programs, training personnel, and providing feedback from comprehensive evaluations. The health facilities were able to identify a large number of children, establish working liaisons with the children's families, and increasingly allocate finances and personnel to assume responsibilities for operating the program. This unique relationship between university and health care centers highlights potential alternative roles for psychologists. Clinical community psy-
Leonard A. Jason, Lyn De Amicis, and Brent Carter
277
chologists entering into long-term relationships with service-providing agencies could conceptualize issues, formulate interventions, implement programs to meet unmet community needs, mobilize requisite manpower, and evaluate program efficacy (Rotter, 1973). More than likely these new roles for psychologists will be vital ones if the ever-increasing demands and needs for mental health services are to be met (Cowen, 1973). Preventive educational programs, as described above, represent only one type of intervention strategy in helping disadvantaged children. It should be recognized that a multitude of long-term pernicious influences (dilapidated housing, rundown neighborhoods, unemployment, lack of successful adult models, inadequate schools, discrimination) continually confront the disadvantaged. More comprehensive primary preventive approaches might restructure environments to eliminate irritants that predispose individuals to unfortunate later outcomes. More collaborative investigations, both on the early secondary and primary levels, are needed to provide the technology and knowledge for insuring sound, salutary development for all children-whether advantaged or disadvantaged. REFERENCES Baratz, J. C. Language abilities of black Americans. In K. S. Miller and R. M. Dreger (Eds.), Comparative studies of blacks and whites in the United States. New York: Seminar Press, 1973. Bayley, N. Manual for the Bayley Scales of infant development. Berkeley, Calif.: Psychological Corporation, 1969. Bereiter, C., & Engelmann, S. Teaching disadvantaged children in the preschool. Englewood Cliffs, N.J.: Prentice-Hall, 1966. Carter, B. Preschool program for economically disadvantaged children: A comparison of two intervention procedures. Unpublished doctoral dissertation, University of Rochester, 1977. Clark, K. R. Defeatism in ghetto schools. In J. I. Roberts (Ed.), School children in the urban slum. New York: Free Press, 1967. Cowen, E. L. Social and community interventions. Annual Review of Psychology, 1973, 24, 423492. Horowitz, F. D., & Paden, L. Y. The effectiveness of environmental intervention programs. In B. M. Caldweil and H. Riccuti (Eds.), Review of child development research (Vol. 3). New York: Russell Sage Foundation, 1973. Hunt, J. McV. The challenge of incompetence and poverty. Urbana, Ill.: University of Illinois Press, 1969. Hunt, J. McV. Parent and child centers: Their basis in behavioral and educational sciences. American Journal of Orthopsychiatry, 1971, 41, 13-38. Jason, L. Westside Health Services" infant stimulation manual. Unpublished manuscript, 1974. Jason, L. Early secondary prevention with disadvantaged children. American Journal of Community Psychology, 1975, 3, 33-46. Jason, L. A behavioral approach in enhancing disadvantaged children's academic abilities. American Journal of Community Psychology, 1977, 5, 413-421. Jason, L., Clarfield, S., & Cowen, E. L. Preventive intervention with young disadvantaged children. American Journal of Community Psychology, 1973, 1, 50-61. Jason, L., Gesten, E., & Yock, T. Relational and behavioral interventions with economically disadvantaged toddlers. American Journal of Orthopsychiatry, 1976, 46, 270-278. Jason, L., & Kimbrough, C. A preventive educational program for young economically disadvantaged children. Journal of Community Psychology, 1974, 2, 134-139. Rotter, J. The future of clinical psychology. Journal of Consulting and Clinical Psychology, 1973, 40, 313-321. Specter, G. A., & Cowen, E. L. A pilot study in stimulation of culturally deprived infants. Child Psychiatry and Human Development, 1971, 1, 168-177.
278
Community Mental Health Journal
Williams, F. Some preliminaries and prospects. In F. Williams (Ed.), Language and poverty. Chicago: Markham Publishing Company, 1970. Zax, M., & Cowen, E. L. Abnormal psychology: Changing conceptions (2nd ed.). New York: Holt, Rinehart & Winston, 1976. Zigler, E., & gutterfield, E. Motivational aspects of changes in IQ test performance of culturally deprived nursery school children. Child Development, 1968, 39, 1-14.
