STACY PHILLIPS: My name is Stacy Phillips. I am the Project Coordinator of Family Leadership here at the Institute on Disabilities at Temple University. And are joining us today for our Families First training. Families First is a Philadelphia Interagency Coordinating Council activity, which is funded by Philadelphia's Department of Behavioral Health and Intellectual Disability Services, or DBHIDS, and Elwyn Early Learning Services. Today, I have the great pleasure of introducing Cynthia Gray and Kim Prendergast, who will be presenting on addressing social emotional development concerns and challenging behavior in young children.

I'm going to read their bios so that you know who they are, and then we will get started. Cynthia Gray, or Cindy, is an occupational therapist and currently serves as the training coordinator for Early Intervention in Philadelphia. She is employed at Thomas Jefferson University, where she also serves as a lab instructor for master and doctoral students in occupational therapy program. She has extensive training and experience in sensory integration and sensory processing differences among children, and she serves on the ABC Sustainability Team in Philadelphia Early Integration.

And with us also is Kim. Kim is a social worker and ABC parent coach in the Philadelphia Infant Toddler Early Intervention Program, where she has worked for over 25 years. She is an ITSE, which is Infant Toddler Social Emotional, interventionist and provides evidence-based services to children who need support around social, emotional, and behavioral concerns. Additionally, Kim is part of the ABC sustainability team with ITEI and ABC supervisor and provides direct support to other ABC Parent Coaches in Philadelphia.

I also want to mention that this session is being recorded. So most all of you have your cameras off. That's fine if you don't feel comfortable with your camera's on, not a problem. Please keep your microphone muted unless you have a question, someone raises their hand, and you've been asked to share.

If you have a question, you can drop that in the chat. Kim and Cindy will be taking some questions throughout, but we want to make sure that they have an opportunity to get through their slides. So if you can hold your questions till later, please drop it in the chat, and we will make sure we address that.

At the end of the session, there'll be some time for Q&A, as well as the completion of an evaluation. And we will put those links in the chat for you. At the end of the session, we will also drop the PDF of the slides in the chat, if anyone would like access to them. And now I am going to turn it over to Kim and Cindy. Thank you so much for being here.

CINDY GRAY: OK, thank you, Stacy. We're so happy to be here. And without further ado, I'm going to pull up our slides. And Kim and I and Raquel, behind the scenes, and Stacy are helping with all the technology. So we will try to make it as smooth as possible. OK. So you should be seeing my cover slide. Good. OK.

All right, so today, our plan is to really explain the basis of the child's healthy social emotional development and incorporate social emotional supports in the child's everyday activities and routines so that every single day, they're being supported in their social emotional development. We're going to discuss strategies to prevent challenging behavior from occurring. And then you're going to learn more about the Attachment Biobehavioral Catchup, or ABC, intervention strategy offered through Philadelphia Early Intervention. OK, so Kim is going to take you through a little quiz.

KIM PRENDERGAST: Yeah good morning. It's nice to be here. I'm Kim Prendergast. So yeah, we're just going to do a little quiz questionnaire, just thinking about some parenting ideas and ideas about social emotional development. So we're just going to think about them as a group. We're not going to answer them in real time.

But the first one is babies are wired for human interaction, true or false? So Cynthia, you want to just progress the slide? Yeah, true, absolutely. Brain science has taught us that early brain development is really influenced by babies' everyday interactions. And their positive interactions support healthy social and emotional development.

And genetics is the only influence of social emotional competence, true or false? Yeah, again, false. We know that genetics, environment, temperament all play a part in social emotional development.

This is one that I think lots of people have heard. If you pick up a baby when they cry, you're going to spoil them. What do we think about that? Actually, it's false. A researcher named Mary Ainsworth found that parents who picked up their babies who were crying quickly had babies that cried less than parents who did not pick up their babies quickly.

When my child is being good, she doesn't need my attention. Again, that is false. Kids need their parents' attention all the time. And we know that sometimes when they're not getting it, they can let us in all kinds of ways that they need our attention.

Responsive interactions between caregivers and child foster healthy social emotional development and more regulated behavior. Yes, and we're going to talk a lot about that as the training goes on. And when we think about the environment, some people think, well, it doesn't really have an influence on the social emotional abilities and capabilities. We actually know that it has a lot to do with prevention and supporting the development of social emotional skills. So next slide, please. OK.

So when Cindy and I were thinking about this training, we were thinking, what's on parents' minds? I know, as an Early Intervention social worker, these are the kinds of things I hear from parents. I want my child to listen. Why does she cry when we leave the playground, even if I've given her a little warning? What do I do when my child is having such a big tantrum.

So we do hear you. And we know those moments are tough. And kids with those behaviors are letting us know in all kinds of ways how they feel. And we know that their behavior is sending us a message and communicating so many things.

We're going to talk a lot in the first part of the training about the foundation of social emotional development and how this supports their ability over time and with lots and lots of practice, their own regulatory abilities. We're going to talk about lots of universal strategies and some prevention strategies. And we know this topic is huge, and we're going to talk more about this later. But there was a national survey that confirmed that figuring out how to handle behavioral needs is one of the biggest challenges that parents report when it comes to parenting a young child. I think there's someone in the waiting room, too.

Thank you. I got it.

OK.

She's having a hard time joining. Thank you.

All right, OK, so why address social emotional development. One of the best ways to understand challenging behavior is to understand behavior in general, and the interaction between the caregiver and child, and how that affects behavior, which is really, at the core, that responsive interaction between baby and caregiver.

So in this slide, this light blue arrow at the bottom, let's say, is your social emotional development. And it is foundational to many, many things as a child grows up, like establishing empathy, feeling empathy toward others; skills for learning, such as being regulated enough to listen, to learn, to develop their cognition, and their executive function; emotional management, just how to manage those big emotions and maybe calm down or co-regulate with their caregiver; and finally, as they are growing up, developing friendship skills and problem-solving skills with others, impulse control. And all of that is dependent on a good social emotional foundation, that's domain of social emotional development.

So I just wanted to show you the model that we follow in Early Intervention, when we talk about social emotional development. And schools follow this as well. This is the pyramid model. And what it shows here is the supports, the nurturing and responsive relationships, that we just really started talking about. And high quality, supportive environments form the foundation of social emotional development.

And then there are more targeted supports, when behavior becomes more challenging or in need of individual supports. We're going to talk a little bit about that as well. And then up at the top, this signifies the most intensive interventions, which really are targeted for less children, children that might need them, but not the general population. So as you see, most kids are going to get their interventions at a very universal level. And as you go up the pyramid, they get more individualized to the child and family as needed.

So for today, we're focusing on that bottom tier. And then toward the end of the presentation, when Kim talks about ABC, that's a more individualized or intensive intervention. OK, so where to find information on typical/atypical social emotional behavior, milestones approaches? There's many, many resources. And at the end of the presentation, we have a resource page, which is also in your PDF slideshow, that Stacy will be dropping into the chat box toward the end. So you can take a look at resources on your own.

OK, so the first thing we're going to talk about, though, is that tier one, that basis of the pyramid, universal promotion/prevention. And this is in handout one, and Raquel's going to put that into the chat for you to take a look at. But tier one interventions really-- your handout is divided into three columns. And they comprise responsive interactions, which include serve-return, which we're going to talk more about; structuring the environment to promote regulation; and then also, individual activities, that can actually help the child develop social emotional competence and help them develop that relationship with their loving caregiver or parent and to also support that development.

And then other fundamental supports, which we're not going to be talking about as much today, but you're well aware of-- their nutrition, good nutrition; parenting education, like maybe this kind of a presentation or others that caregivers avail themselves of to get more ideas or tips. And so those are other fundamental supports. Safety, providing safe environments, obviously, is a fundamental support as well.

So serve-return interaction, this is a continuous and mutual interaction between genetics and environment. So the baby comes with their genetic makeup, but the environment actually helps unlock the genetic potential. Because we are wired for experiences. The baby is wired for that back and forth responsive interaction with their caregiver.

So when a young child reaches out, we call that the serve. They're reaching out for that responsive interaction. And when the adult responds with some kind of vocalization or gesture, that's the return. They're returning the serve. So it completes that circuit between baby and caregiver. And that actually helps to grow the brain, establish circuitry in the brain. And that is how we learn and develop.

So we're going to show you a video from the Harvard Center for Developing Child. This is a wonderful resource, the Harvard Center for the Developing Child. If you look that up, there are lots of really good videos on the science of what young babies need, articles about it. They have handouts, tip sheets for parents. So that's in your resource. That's on the resource page of this slide show as well. But I'm going to stop sharing, so Kim can show you this video.

[VIDEO PLAYBACK]

[MUSIC PLAYING]

- Did you know that you can help build a child's brain? Everyday interactions can have a big impact on developing brains throughout childhood, starting even before babies can talk.

- Scientists call this serve and return. Like a game of tennis or ping pong, a child serves by showing an interest in something, and the adult responds in a supportive way.

- Finding moments throughout the day to do it is easy and fun, and you'll be building strong brains. You can use five steps to practice serve and return with any child. Step one, share the focus.

- When a child is interested or curious, you can see it.

- What's this? The stroller.

- Watch this child look at something in a book right there. Pointing shows interest.

- Cow.

- So does making a sound, like this child. And Mom is paying close attention.

- See baby moving those little arms and legs and focusing on the ball? That's a serve.

- The key is paying attention to what the child is noticing.

- Oh, you like those guys, too?

- Look at Grandpa sharing the focus.

- By noticing serves, you will help build curiosity, and you'll strengthen your relationship.

- Step two, support and encourage.

- You can return a child's serve by saying a word of encouragement.

- That's right, very good.

- Watch Grandpa return the serve by saying thank you.

- Yeah, thank you.

- Even a facial expression can encourage a child--

- Orange.

- --or emotion, like this mom dancing.

- Dance time, aye, aye, aye.

- You can also pick up the object that the child is pointing to and bring it closer.

- You need help to sit her down?

- Things like helping and playing with the child let them know that their thoughts and feelings are heard and understood.

- [MAKING CAR SOUNDS]

- Step three, name it.

- Yeah, the puppy. The puppy. See the windows, the house.

- When you return a child serve by naming what they are seeing, doing, or feeling, you make important language connections in their brain.

- He's got bumps all over him, huh?

- This brain-building happens even before a child can talk or understand your words.

- You can name anything, a person, a thing, an action, a feeling, or a combination.

- (SINGING) Clean up, clean up. Everybody do your share.

- When you name what a child is focused on, you help build understanding of the world around us and what to expect from it.

- The baby's sitting. Ooh, the baby's sitting in the back seat of the car.

- You like those? Those are raisins. You have raisins all the time.

- Naming also gives a child words to use later and shows that words are important to you.

- OK.

[END PLAYBACK]

CINDY GRAY: OK, and I think we're moving right into another video, the serve-- the still face experiment?

KIM PRENDERGAST: Yeah, just want to know--

CINDY GRAY: I don't know if I need to pull up the slide. But this is an example of responsive interaction and that serve and return as a basis for predictable routines and co-regulation between the child and the caregiver. So we're going to see what happens when that's disrupted. So Kim's going to show.

This is an experiment that happened years ago, which started forming the basis of the brain science of young children and that co-regulation. There's no volume. Are you hearing it, Kim? You're muted. I don't hear anything. You're muted, though, Kim.

KIM PRENDERGAST: Oh, I'm sorry.

CINDY GRAY: Are you hearing it?

KIM PRENDERGAST: Now I'm going to start. I'm sorry. Here we go.

CINDY GRAY: OK.

[VIDEO PLAYBACK]

- Here we go.

- Babies this young are extremely responsive to the emotions and the reactivity and the social interaction that they get from the world around them. This is something that we started studying, oh, 34 years ago, when people didn't think that infants could engage in social interaction. And this still phase experiment, what the mother did was she sits down, and she's playing with her baby, who's about a year of age.

- And we're like, yeah. Oh--

- And she gives a greeting to the baby. The baby gives a greeting back to her.

- Yeah?

- Yeah.

- This baby starts pointing at different places in the world. And the mother's trying to engage her and play with her. They're working to coordinate their emotions and their intentions, what they want to do in the world. And that's really what the baby is used to.

And then we ask the mother to not respond to the baby. The baby very quickly picks up on this. And then she uses all of her abilities to try and get the mother back. She smiles at the mother. She points because she's used to the mother looking where she points.

- Da.

- The baby puts both hands up in front of her and says, what's happening here?

- [VOCALIZES]

- She makes that screechy sound at the mother, like, come on, why aren't we doing this? Even in this two minutes when they don't get the normal reaction, they react with negative emotions. They turn away. They feel the stress of it. They actually may lose control of their posture because of the stress that they're experiencing.

- [SOOTHING WORDS]

- [CRYING]

- Monkey.

- [CRYING]

- Don't cry, dear. I love you, too.

[END PLAYBACK]

- Cindy, you're muted.

- Thank you. So in the still face experiment, that example, when the baby's not attended to, it's a sign of biological danger to the baby. And so they start to reach out in terms of letting the caregiver know that this is stressful. So the stress felt by the child is immediately mitigated by the resumption of those responsive interactions of the parent.

This occasional inattention, when the child is receiving attention most of the time, does not harm the child when it's temporary. But left unchecked is when that stress is ongoing and not alleviated that causes what sometimes is called toxic stress or releasing those stress hormone, like cortisol, which can adversely affect brain development and contribute to dysregulation. So temporary bouts of that, we have all had experience with that.

Back in the day, I'm an old mom. I've been around the block a few times. But we had those things called the wall phone in the kitchen. And the kids would be attending just fine until the phone would ring. And I'd get on the phone. And next thing you know, they're climbing up my leg, and they're upset. And it's like they have radar.

They do have radar. And when you're not responding to them, you get a reaction, which tends to be, could be dysregulated behavior. So then that's what that experiment showed us.

OK, and just a word about temperament, we always have to bring in temperament into the picture. Because not all babies are alike. And we know this. So we're looking at social emotional development, but you're also seeing differences in children because of their personality, their temperament, their sensory makeup, lots of different factors.

So these are three temperamental categories that make up about 65% of all babies. They fit into one of these. But that leaves another 35% that aren't even classified. There's so many differences in babies' temperaments.

So of these three, the easy, flexible babies are about 40%. Active or feisty make up about 10%. And those slow to warm, more cautious babies, that might withdraw or act negatively at the beginning in new situations, are about 15%.

And so all these types of temperament and personality can develop totally typical social emotional patterns and develop good social emotional competence. It just might look a little different because of personality differences. And it's the same with sensory differences. Some kids like loud noises, busy environments. Some kids like more calm, quiet, more peaceful environments.

Some like lots of sensory input. Bumped and jostled and everything else doesn't bother them. And other kids get aggravated by too much stimulation, let's say, touch stimulation or movement stimulation. And so that does feed into behavior as well.

So it's not a one size fits all. Our job as adults is to try to find that just right fit to develop some co-regulation with our kids. So that's really the job at hand. And that helps us to prevent challenging behavior from occurring.

And just a word about resilience, and there's a handout number two, that Raquel can put in the chat box. But every child needs one person who's crazy about him. This is the mitigating factors. We know life happens. Life is not always easy. Life is not fair. Things happen that throw us for a loop, and they definitely can happen to children as well.

So the definition of resilience is the capacity to withstand or recover quickly from difficulties that come your way. So it's a surmounting of some of those difficulties. And it's the ability to adapt well to adversity, to manage stress, to manage anxiety, to figure out what to do with uncertainty.

So resilience is really the reserves that a child can pull on to overcome adversity when it comes their way. And so some of the main ingredients, it's a learned behavior. We teach our children this. And we teach them through some real basic relationship kinds of things, like we're talking about, like that positive relationship that fosters trust from the caregiver to the child.

So they are, OK, my caregiver, my one person is in my corner. They have my back. And the child can rest easier. It feels safer. So it's having positive, safe environments that encourage exploration, having expectations that the child can do what they set out to do, and supporting them, supporting them with expressions of love or acknowledging their feelings.

Those big emotions, when they're angry or disappointed or frustrated, doesn't mean the end of the world We got this. I'll help you where you need help. This is what we as the adults can do to encourage this development of resilience and keeping the child safe throughout, so they can explore the world but not get hurt. And that's our job. We really try to offer that just right fit so they can go out and explore, but we're there. We're their safety net, so keeping them safe throughout and modeling confidence and optimism.

Now, on your handout, I did put a reference, a resource at the bottom by Dewar, called "Disruptive Behavior Problems-- 10 Evidence-Based Tips for Handling Aggressing Defiance and Acting Out Behavior." It's in the Parenting Science Journal. And that gives you more evidence-based tips when the behavior is truly challenging, and you're not sure what to do. And so I thought that might be useful for you to take a look at on your own, if you're interested.

OK, so I just want to talk a little bit about universal practices. The literature is very clear that when trying to manage or prevent dysregulated or challenging behavior, adopting universal practices is recommended. The universal practices work very well, and they work quickly. And so we wanted to go over those with you.

And this is in handout number 3. And there's a top portion, which are universal. And then below that are more individualized, targeted strategies, which I'll come back to a little bit later.

So I will go through each of these four in detail so you know what they are. You could try them out this afternoon if you want. So the positive to negative 5 to 1 ratio positive to negative, what that means is, for every negative comment you might make to your child, you have to come up with five positive ones, right?

So we're going to overwhelm the negative with positives because looking for the positive in your child is something that can become so commonplace and natural. So this makes it intentional. So it's things like noticing the child doing what's expected and reinforce it, like, oh, I like how you're sitting at the table like a big boy, ready for lunch.

So you're actually noticing your child, quote, "being good," and in one of those good moments, those moments that you're like, "wow, look at him," you tell him, that's great. I love that. So that's a wonderful way to give positive reinforcement. It also teaches the child what you're considering as really wonderful behavior. You're teaching them what quote, "good behavior" looks like by giving them feedback.

Using animated facial expressions to show positive warmth or excitement and engagement really does bring the child in and helps with that responsive interaction-- like, "oh, I'm so excited! You did that so well!" Changing your voice, changing your expression, so that you get their attention, and they say, wow, I really am great.

Or using humor as a means of positive connection, being silly, kids love it. And you can use humor in a way to pull them into that responsive interaction, where you're really feeling connected, or just saying positive things like, you really stuck with it. You really kept trying. I'm proud of you. Or you're great at doing puzzles. Look at that. Or oh, you did that so well. Show me how you play with that toy. I'm so curious.

So they honestly see that they have your attention, and you're there with them. It builds their self-esteem. It builds their confidence, and they know you're in their corner. You have their back.

The next one is predictable schedules. We all love predictability, but nobody loves it more than a toddler, a two-year-old. They want to know what's next, right? So some ways to give predictability is through visual schedules of what's next, maybe just verbally reinforcing. "What's next?" We all sitting at the table at noon, "what's next?" They go, lunchtime, Mom.

And then you say, you're right. Here it is. Because they know the schedule. Once you sit down, you're at the stove, they know you are making something. It's lunch.

The key is to honor the schedule. Once you come up with some predictability in your general day to day, try to honor it with consistency. Kids need it, and they respond well to it.

Think about if you left the house to run errands, to go to the doctor, and to pick up your family member at an appointment, and forgot your cell phone. Oh, my goodness. That would blow my mind, right? I don't have anybody's phone number. I don't have my GPS. I don't even know what time the appointment was. I don't have my phone.

The lack of predictability can throw us, can throw a wrench into the works for us. Same with the child, they like to know what's next. So think about using first/then statements. OK, first we're going to finish breakfast. Then we'll get dressed. Or Mom, Mom, I want to play. OK, fine. First, we're going to brush your teeth, and then we're going to play. It's just basically saying we're going to follow a predictable sequence.

And this is one that they talk about. And I had to really think about this. This is through the Prevent Teach Reinforce for young children, the research project and the book that they wrote about helping with prevent strategies, is to embed multiple routines within a daily routine. And I'll show you how this works in a second.

It enhances predictability. It helps to teach the expected behavior to the child. We sometimes think they know what's expected. But if we haven't taught them, they might not know; maybe creating visual schedules and teaching them about how to follow the steps and the schedule.

So this is an example of the morning routine, let's say, for this particular child. They're going to wake up, go to the bathroom, run down, going to eat breakfast, brush your teeth. You might have about five minutes of free time to play with your dinosaurs or your book. Everybody's going to race to the car or the bus, everybody in, off to childcare, preschool, wherever. OK.

So let's say this routine, this is your morning routine. It's going pretty well except breakfast is a little challenging. So what they're saying in the literature is create a routine within the routine. The child is signaling, basically, they need more structure during the breakfast routine.

OK, so here is a routine for just breakfast, which is the challenging part of the morning routine. So you're going to put out two boxes of their favorite cereal. They get to pick one. Then you're going to help them pour the milk because more than once, it's all over the floor. Or you fill a little measuring cup of milk because they might want to pour it themselves. Give them some independence.

Then you might time it because you're always late for work because they dawdle over breakfast, and you have a big back and forth, and it's a challenging time. So you might set a timer for 15 minutes, or you might play some songs on your phone for 15 minutes, their favorite song. So that when those songs are over, when the timer goes off, it's time to be finished, right?

The child puts the bowl in the sink, get a high 5 from you, and off they go. So you're figuring out a routine within the morning routine to give them more predictability. And also, you're teaching them what you expect them to do. Because they cannot read our minds, we found out, right?

OK, and so another one is directly teaching behavioral expectations during a routine. So let's say, for the dressing routine, we want them to get through this routine pretty smoothly. You might give them a choice of two shirts to wear. They always want to pick out their own clothes.

But sometimes you don't like their choices. If you provide a couple choices that either one is fine with you, they get to choose. And you like either one, so you win, too, right? Let's say when putting on their shirt, they cannot always pull it over their head. They just don't know. They don't have the strength.

They can ask for help. And they always know you're going to make a little joke. And we're going to pull it down, right? Boop. There you go. I see your head. You came through. So you're scaffolding. You're actually providing enough support for them.

They want to put their pants on independently, tend to put them on backwards. You're going to teach them that the tags go in the back. Lay the pants on the floor. The tag's always on the bottom next to the floor. And then you're going to teach them how to do that. And before you know it, they will do as much as they can independently.

Give them a choice of socks. But you know you have to put them over their heel because they can't do it yet. Developmentally, they don't know how. That's fine. You let them do what they can do, which might be just to pull them up at the end. And then you teach them about putting shoes on, but you still have to help them with fasteners.

So you see how it's a give and take. And you want that just right fit. You only want to expect from them what they developmentally can do. And that's kind of important.

OK, and this handout-- got to pull this up for you. I like this handout. It's handout number 4, Communication is Key. And this is about telling the child what you expect and what you want them to do, not what you don't want them to do. So let me pull this up for a minute, if I'm so lucky to find it, like I am hoping.

OK, can you see it? Yeah. So communication is key. So it's telling the child what to do instead of what not to do. And here you see, instead of saying, don't run, you're going to say, walk. Let's use your walking feet. You might do motions with that; or stay with me, hold my hand.

And then always remember to reinforce. Way to go. Look at you using your walking feet. Oh, thanks for walking. I love walking with you. I love it when we walk together.

And so instead of don't run, they might not know, well, what do I do? I don't run. What is that? Explain to them what you want them to do. And that's part of that teaching piece.

And so "no yelling." But what do you want them to do? Use a calm voice. Use an inside voice. Oh, now I can listen. You're using your calm voice. I love that voice. So you're encouraging them in a way that lets him know when he's doing the desired behavior.

And so I really like this handout because it flips it and says, tell them what you want, not what you don't want. Sometimes they just don't understand the negative aspect of that. OK. All right. And always being enthusiastic and encouraging is perfect-- whoops-- because they can never get enough of that.

So another word about prevention, strategies to prevent challenging behaviors or making it less likely to occur is to change the environment to support the behavior you're looking for. So if you're trying to support, let's say, reading stories, it might be a good idea not to have the TV on or not to have a lot of interruptions. Because sometimes, the lights and sounds of TV will pull that attention right off the book.

So you might want to think about, what is capturing his attention? And if it's not you and the book, think about how to change the environment. Maybe go find favorite blankie, get in your favorite cozy chair, cuddle up. Give them a choice of two books. He picks a book, and oh, we're set for it. Time for reading.

Or change how adults respond to the challenging behavior; so for instance, noticing when you need to provide more support and provide it. Follow the child's lead by changing the activity. Sometimes a child will walk away, and we're like, wait a minute. We're not done yet.

And then we get into a battle of wills. The child's done. I'm not done. When possible, if you can follow the child's lead, he's done serving during book time, but he's off wanting to do something with music or with dancing. When you can, follow their lead and join in. OK.

Trying new ways to prompt the child, you might prompt through words. You might prompt through gestures. You might tap. You might, say, avoid certain words. That might help, too; so finding new ways to interact.

Always match your expectations to what the child's developmental level allows him to do. And change up your instructions. Maybe three-step directions are too hard for the child at the age they're at. Limit it to one or one or two, and see if that helps.

But when you find things that are working, consistency is key. So if you finally got to the point where you have a cozy book reading time, try to stick with it. If you find a routine that works, if the environment is set up that works for that child, try to stick with it. And you'll see the child will start to ask for it, or they'll remind you, TV off, which I need a book. So they start to learn about your expectations within the routine. OK, I'm going to turn this over to Kim.

KIM PRENDERGAST: OK. Hi again. Yeah we're going to watch-- oops-- just in a second, we'll watch a quick video summarizing some of those strategies-- predictable routines, consistent schedules, letting kids know what's coming up next, and giving choices. One little caveat about choices, before we watch it, is trying to avoid those things where aren't really choices, saying, do you want to get dressed now? It could be like, time to get dressed.

Do you want your jeans or your blue pants? Are you ready to go, when it's not really a choice. You really have to go. We're almost done playing. Do you want to hold my hand or walk in the stroller on the way to the bus? Really thinking about choices-- so it's a subtle, but important difference to a child. So we're going to watch a quick video. Let's see. All right.

[VIDEO PLAYBACK]

- Part of being a toddler is learning to handle strong emotions. Sometimes, kids act out and have tantrums when they don't get what they want or can't say how they feel. You can help your toddler learn to deal with frustration and feel more independent.

Toddlers do best when they know what to expect. Stick to consistent schedules for meal and sleep times whenever possible. This keeps them from getting overly tired or hungry.

Try to prepare for situations that might be hard for your toddler to handle. If there's a chance you'll be somewhere longer than planned, bring what you need to keep your child happy. Praise good behavior or give a small reward.

Avoid overscheduling. Squeezing in too many activities can easily lead to a meltdown. Toddlers love having choices. When you can, offer the choice between two small things, such as choosing which shirt to wear or snack to eat.

Remember to give lots of positive attention immediately following good behavior. Praise your child by pointing out exactly what they're doing well, like sharing toys or following your directions. This can make kids more likely to keep up the good work.

[END PLAYBACK]

OK, so I'm going to stop sharing now. Cindy, can you pull up the PowerPoint, please? Thank you. So yeah, just a little bit about that, just reinforcing some of the things Cindy's been talking about this morning, and we know that we're talking a lot about prevention. But for very young children, as Cindy said, the research really shows that sensitive, responsive style of interaction and some of those tips can really support the prevention of what parents are concerned about.

But we are going to talk about, what is challenging behavior? I know that's a big topic. We mentioned in the beginning it's probably the biggest concern that parents bring to their Early Intervention providers. It was in a national survey.

So parents know what's hard for them, what parts of their day are tough. And we're going to think about what the messages are that kids are sending when they're exhibiting those kinds of behaviors. And then hopefully, we can get better at the prevention.

And we're going to talk about, what's tough for parents in those moments when their child is dysregulated or having a hard time? And we're really going to do some thinking about, what is the child communicating with those behaviors? So next slide, please.

So these are some things that we hear from parents. What does behavior look like with very young children? We hear about hitting and biting. Kids who are hard to calm down, they don't soothe quickly. Maybe they withdraw a little bit or don't cooperate, classic toddler "I'm not listening" kinds of things.

So these are very common with young children. And we hear it all the time when we're working with families. Especially, we know that very young children can't regulate their emotions, haven't yet developed self control. And the brain science really tells us that their brains have not formed that area that helps them manage emotions. And parents can definitely attest to that.

We know it's hard, and those moments are tough. We're going to keep talking about some strategies to support development and prevent challenges and to talk about what to do in the moment when, even if we've done everything we can, the kids are still really having a hard time, things like transitions, playing near other children, managing toys and playthings, waiting. It's really hard for toddlers to wait, feeling like they don't have any control.

And then we see some of the behaviors that parents certainly describe with very young children. And those are the behaviors that we might see in young kids. You can go to the next slide, please.

CINDY GRAY: OK, so this is, again, handout 3, where right under the universal practices, I listed a few individual practices. So I'm just going to go through them briefly. So you could think about incorporating them in your daily routines, where they might be useful to prevent some of those challenging behaviors or bigger emotions that are hard to calm down once they occur.

So providing choices allows the child to select choices and have some control over what happens, like bubbles or no bubbles during bath time, or where to sit at meal times, what to take in the car, movement or song to sing during transitions. Transitions are tough for everybody.

I teach adult learners in Early Intervention, and they do small group work. And it is so hard to pull them back into the larger group. I'm flashing the lights, just like the kindergarten teacher does, to say, it's time to come back. Because transitions are just hard, not just for our little ones.

Enhancing predictability, like I mentioned before, in schedules and routines-- so purposefully plan a routine or a transition so the child can understand and follow the activity sequences. So you teach them what the sequences are. It might be like, before you go off to child care, we're going to have your lunchbox, your shoes, and your coat lined up at the front door.

And those are your physical cues to tell them, this is what we have to do before we walk out the door. You're going to put on your coat, grab your lunch, get your shoes on, off we go. And you're going to be there to help as necessary, right?

So you're planning out what the routine looks like, the transition from, let's say, breakfast to going out the door, and you're giving them supports along the way. And that's like a physical visual schedule. You can do it with a picture schedule, as well, to describe the steps in an activity or a timer to help with the timing of that. And if you're going to use different supports, they should be readily available, and you should try to use them consistently.

So altering the physical arrangement or environment is important. For example, you could change the seating arrangement. Let's say two siblings fight at the dinner table all the time. You might separate them at dinner, but not make it punitive. Maybe make it fun or figure out, maybe every dinnertime, we rotate our seats, or whatever; turning off the TV when you need their attention to be elsewhere; putting up a baby gate for safety; making items more or less acceptable.

Let's say you want them to ask for their favorite toy. You're trying to get them to talk more. Maybe putting it up, so they have to point and say what they want or try to verbalize it to you or gesture to you. So that promotes appropriate behavior. It promotes asking. It promotes some kind of interaction between you and the child.

So for instance, the baby gate in front of the stairs for safety allows you the caregiver to focus on the toddler in a different way. So if you don't want to worry about them climbing the stairs, getting hurt, falling down, the baby gate just takes that whole aspect of you trying to keep them safe. And sometimes we get, like, stop climbing the stairs. It's dangerous. And so it gets everybody on high alert. So a baby gate might be a wonderful environmental adaptation to make it more fun for you and your toddler to just hang out together and not worry about the safety issue. Because you took care of it with the environment.

Bedtime routine and environment, you might want to think about low lighting, calming music, or songs, reading stories, quiet activities, predictable schedule. For instance, a bedtime routine might always be bath, brushing teeth, and then we pick out a book. We get in our cozy corner with your favorite lovey or blankie, and we read.

And maybe part of that is the toddler wants to turn the pages. And that becomes part of a predictable routine before going to bed. And the child really starts to look forward to that. They know what's coming. It's very comforting and calming because it's predictable.

Another environmental thing is just seating arrangement to enhance that positive connections between baby and caregiver, so that the warmth of sitting close, whether you're reading a book or watching something or singing a song, is to pick the seating arrangement that enhances that connection. OK.

KIM PRENDERGAST: Hey. Hi. So I'm going to talk a minute about triggers for challenging behavior and thinking about, what happens right before, in what we call the antecedent? Sometimes parents will say, it just came out of nowhere. Like, I didn't-- nothing happened.

But if we really put on that detective hat, and we really watch and observe and get really curious about what's going on, we can often see what is the trigger. And it can be so many things at this age and things that might not seem like a big deal to us, but can be a huge deal to very young children, who are still not yet ready to manage big emotions.

One of the things that we hear a lot is, my child gets so mad when I say no. So we do have to be this calm and confident leader. Yes, we have to hold boundaries, but can we find the yes?

A couple of examples are, as Cindy mentioned, instead of "no, you can't play with that now. It's lunch time," "yes, we can play after lunch." It reframes what could be very triggering for a very young child. No drawing on the wall, versus let's find some paper for you to draw on-- again, limiting sometimes that word that toddlers hear hundreds of times a day sometimes.

"No, you can't go outside without your shoes on" could become "when your shoes are on, we can go outside and play." So I'm just flipping it a little bit, and we're setting the limit and setting a boundary, but without the no. Every child is different, and we have to really, like I said, get curious and look and watch. Because it might not be apparent initially what is the challenging behavior.

I was working with a mom, doing my social emotional support. And she said, every time my son plays with his cousin, he hits him. And so she really watched and really saw that these are very young kids. They were grabbing toys from each other and really needed adult support to manage the playthings and to play even next to each other at that age.

And quick transitions can be a challenge. So we've been talking a lot about some of those prevention, what's coming up next, offering choices. When we can really dig and see, what is that trigger and what is behind it, or what is the behavior communicating, then we can do-- sometimes really do some great prevention work with-- once we know what's behind it. So next slide, please.

So again, parenting is hard. That's why we're here today. I've been doing this a long time, and I know it's hard. I also a parent-- my kids are adults now, but I remember. I think what's also hard is parents hear so many messages from other family members, from social media, from people in the grocery store, and our own messages that we carry within ourselves from our own history of being parented.

And so no wonder this is hard, so many messages and expectations that we have for ourselves. And as I mentioned, there was a national survey done with the organization ZERO TO THREE, that confirms that behavior discipline is really what's on the mind of so many parents. And the other very interesting thing that came out of that study is that a lot of parents overestimate the ability their child's ability to have self control and manage emotions and share, those kinds of skills that really don't develop until 3 and 1/2 or 4.

That part of the brain that controls emotions and controls impulses is still in very much of the early stages of development. And so when we know that and can understand, hey, this is part of brain development, it can hopefully just shed some light on why it's happening. It's not that we're not good parents or that that person in the grocery store who's looking at our child having a tantrum-- that's normal. And we can just feel confident that I've got this because I know this is normal. But it is hard. So next slide, please.

Thank you, Raquel. There is a handout, handout 5. The handout is called "Tuning In National Parent Survey Takeaways for Parents." And this is part of that study that I mentioned, where parents really reflected on what was so hard for them. And again, we know it's behavior. It's discipline. It's managing big emotions.

I like this framework because it gives us something to really think about. The first box is, what is the behavior? The child refuses to stop doing something and this, for example, like throwing a ball in the house.

And then the second box is that time where we as parents reflect, what's going on here? Taking a second, maybe taking some perspective taking, and understanding something from the child's point of view, that's where we look at the message. What is the child trying to send to us or the developmental reality of where the child is? And we put themselves ourselves in their shoes. So they want to play ball. It's really hard not to do that, and they're not doing it to manipulate or to drive you crazy.

The next part of this framework is that connection first, validating feelings. We can still hold our boundaries, but connect first. I know you love throwing the ball. It's so much fun. But we can't throw the ball in the house. The ball could hit something. We're going to explain the rule, but we're going to make that connection first. Because that's how we're going to support the child's social emotional development.

And then for older kids, over 2 and 1/2, we could say, if you're inside, do you want to throw some newspapers into a basket? Do you want to throw-- it's things they can do or other ways to play with the ball. You can enlist the child with some problem solving.

Other ideas are like-- another behavior in a child doesn't want to leave the playground. That's the behavior. The parent self-check, I know they're not doing this because they're trying to manipulate me. They're doing it because transitions are hard, and they're having fun.

And saying what Cindy was saying, when we think about things for ourselves that it's hard to stop-- it's hard to stop, I don't know, scrolling on my phone or hard to stop watching a TV show that I'm really interested in, that perspective taking of, even for adults, it's sometimes hard to stop; so that validating feelings and acknowledging that something's hard.

And then with, like I said, with older kids, if we can, over 2 and 1/2, doing just some conversation with them about, what can we do to work this out, and using playfulness, and being silly together, and trying to figure it out. So the next handout-- next slide, please?

So this is just another. And this is on that handout. There are several but you can use this framework for any behavior. What is the behavior? What's my self-check? What am I stopping and thinking, oh, what is this about for my child / what are they communicating to me? What is the message? That next step, that connection, validating, I know it's hard, you're letting them know, I'm here with you. I've got you.

But the timer has gone off. We've got to get in the car and go to child care. And then, again, with kids over 2 and 1/2, there's some silliness that can happen, like, we're in the car. We're in our spaceship. Or let's bring bear to school. Can he sit on your lap on the way? So these are some, I feel like, some nice tools to think about when the behavior's happening, some strategies to think about the behavior, what it means, and then some ideas to help the child move through their big emotions. OK, next slide.

All right, so if a child is having a hard time, a tantrum, out of control, very upset, what we know from research is that they need a caregiver to support them through their big emotions. And as Cindy mentioned, that's called co-regulation. They're going to develop self regulation and self control through lots and lots of practice of co-regulation.

This acronym is based on one of the intervention targets of the ABC Early Childhood Toddler Program. And it's a tool just to think about. I like little acronyms and things to help me remember some strategies in my toolbox.

So the first is C, staying calm. It can be tough, and we might need a second in our own, when we're faced with strong emotions, to before we respond. And we can even say, I'm having a hard time. I need a second before I help you calm down. I'm frustrated, too.

It's that analogy we hear, analogy we hear all the time. Put your oxygen mask on first. We can't calm down a dysregulated child if we're really dysregulated ourselves, and thinking about what's coming up for us in the moment and getting ourselves as calm as we can before we respond.

That A, again, acknowledge, acknowledge. I know you're frustrated. I said whatever. I know you're sad blank. Just that labeling of the emotion can be really powerful for children, just like it can be for adults.

Remaining close-- so when a child is having a hard time, even if we're not talking a lot, even if we're not going to try to really engage them in a lot of conversation at this time, they know we're there for them. It could be a hand on the back.

It could be holding. If they want that, it could be just in close proximity. But they know you're there for them. And it's hard to teach in those moments because their brains are-- I don't know. The lizard brain, they're just not there.

Cindy talked a lot about environment. When a child is very dysregulated, they might need a change of environment. I had a parent tell me recently they went to a birthday party, and the child was having a really hard time. So they really listened and saw that message and moved them somewhere just for a little bit, stayed with them until they could calm down and go back to the party.

I mean, something in the environment that might need to be changed, things that are really frustrating a child-- I worked with a parent who had a bag of chips in front of her child, and she kept saying, no chips, no chips, no chips. But her very young children-- her very young child had a hard time managing his big emotions about seeing them in his environment. So what can we put away? Just remove it so it's not so dysregulating.

And then back to those prevention strategies, when the child is calmed down, we're going to avoid lectures. Follow their lead, that serve return, just getting back to, we're back on the good foot now. And all of that is under the umbrella of co-regulation, which children need to experience many, many, many times from an adult who shows calm and composure and connection, so that they can learn to do that as they get older on their own. So next slide, please. OK, I'm going to show a quick video that shares a little bit more about co-regulation.

[VIDEO PLAYBACK]

[MUSIC PLAYING]

- Have you ever seen someone yawn and then yawned yourself? Did you know that some emotions are considered contagious, like yawns? This is an example of how one person's state can have an impact on yours. Your calm is one of these emotions that can help your child when they are overwhelmed.

Children aren't born with the ability to soothe themselves. They develop this ability over time with the assistance of a caregiver. The ability to match your emotional and physical state to the situation is what occupational therapists call self-regulation. And when parents help children to self-regulate, they are practicing co-regulation.

When a child becomes dysregulated, it is important to co-regulate. This can be achieved through checking yourself. Make sure you are calm, through deep breaths, noticing your body tension, and attempting to relax your muscles. You can also help with co-regulation by getting down to the child's level, by not focusing on the child's behavior, but instead, staying in the moment with them.

You can also help co-regulate by modeling how you want them to behave, for example, using a quiet voice yourself. We like to think of this approach as timing in, as opposed to timing out. It is basically staying with the child instead of removing the child.

You may need to remove the child from the situation first, for example, take your screaming toddler out of the grocery store. But the key is to stay with them as their co-regulator. Parents can gradually decrease their support as children take over regulating themselves.

[END PLAYBACK]

KIM PRENDERGAST: OK. Yeah, I really love that phrase, your calm can be contagious, because we know that that's what's going to work with very young children who are in a state, who are having tantrums. And we can see that. If you want to watch that again-- I really like watching that-- that'll be in the PowerPoint. So I think we can go back to the-- oh, wait, l have another video, too. So sorry. Thanks, Cindy.

CINDY GRAY: And not only occupational therapists --

KIM PRENDERGAST: I know.

CINDY GRAY: --co-regulation. We laughed about that.

KIM PRENDERGAST: I know.

CINDY GRAY: They're saying it's an OT thing. It's not.

KIM PRENDERGAST: Right, right.

CINDY GRAY: It's a human thing.

KIM PRENDERGAST: It's a human thing. We're going to watch the second part of that video we watched in the beginning, which is about the serve and return and how that's going to support the child to develop self control. We really know that this style of responsive interaction really supports healthy social emotional development and some ideas that support goals and parents, that the parents have with when they want their child to develop self control-- so following the lead, when possible; waiting and going with the child's game; going at their pace and not taking over; and some concrete strategies that help with following their cues and signals.

And that sensitive and responsive interaction really does support the development of increased independence and self control. So we're going to watch last little part of that. All right.

[VIDEO PLAYBACK]

- Therefore, take turns back and forth.

- Taking turns helps children learn self-control and how to get along with others.

- Waiting is crucial. When you return a serve, give the child a chance to respond.

- Hi. How are you? I'm good. How are you?

- Note that the caregiver waits here for the next serve.

- See this toddler navigating a new adventure? Grandpa is waiting patiently, returning serves by asking questions and then waiting to see what happens next.

- [INAUDIBLE].

- You want a cover?

- Yeah.

- Are you cold?

- Yeah.

- All right. Put this over your lap like this, OK? Yeah. You like that?

- No.

- Oh.

- Yay!

- By waiting, you give the child time to develop ideas and build confidence and independence.

- Step five, practice endings and beginnings. The child will signal when they're done or ready to move on to a new activity.

- Watch how this child shows it's time to start something new. Letting go of a toy signals an ending. Then picking up a new toy signals the next beginning.

- Want to play with the giraffe? And you can change--

- Sharing the focus is important in this step.

- Ooh, the big eagle.

- Because this mom is sharing the focus, she notices when her child is ready to end one activity and begin something new.

- When you can find these moments for a child to take the lead--

- Want to try this one?

- --you support the child in exploring their world--

- Would you like to play with something else?

- --and make more serve and return interactions possible.

- Serve and return interaction is critical for a child's developing brain. And the best news is that you can do it any time, anywhere, without any need for toys or technology.

- Look for small opportunities throughout the day, like while you're making a snack or while your grocery shopping what matters most is that you're doing each of these five steps. Notice the serve and share the child's focus of attention. Return the serve by supporting and encouraging. Name it. Take turns going back and forth. And practice endings and beginnings.

- Serve and return interactions make everyday moments fun and become second nature with practice. Try practicing with a child today.

[END PLAYBACK]

KIM PRENDERGAST: So yeah, so just reinforcing some of those strategies we've been talking about all morning and how those very, what might seem basic to us, those style of interacting, there is research evidence that really does support self regulation and the development of self regulation over time. When we're following their lead, when we're going at their pace, we're not taking over-- so again, some prevention strategies.

As Cindy mentioned, we're going to talk a little bit at the end of this about ABC, which is a targeted, intensive program, that's offered in the Philadelphia Early Intervention System. It's at that tip of the pyramid. It's for children in our Early Intervention program. There's been a huge focus recently, which is a great thing, on really supporting social emotional development and looking at that as an important domain to really focus on and to pay a lot of attention to. So next slide, please.

So in Early Intervention, we in Philadelphia, we are using the ABC, which stands for Attachment and Biobehavioral Catchup program. ABC is an evidence-based program-- it's been around for over 25 years-- that supports families with children, actually 0 to 4. And they have three different programs, a newborn, infant, and toddler program.

It was developed by Dr. Mary Dozier, at the University of Delaware. And in conjunction with EI in Philadelphia, we're offering this evidence-based program intervention to children who are receiving Early Intervention services. And we know it has long-lasting effects, which is pretty amazing. Next slide, please.

So the key components of ABC-- so we focus on nurturance, the foundation of social emotional-- of development, helping parents to provide that sensitive, nurturing care, even if children don't show they need it, which sometimes happens. They don't send clear signals. Or it's not coming naturally to a parent.

When children are dysregulated behaviorally and biologically, it supports parents to behave in that synchronous way that really helps them develop regulatory strategies, things we've been talking about, following the lead. In other slides, it was called serve and return. But we do know those ways of interacting, that sensitive way of interacting, supports behavioral and biological, physiological regulation.

We also look at helping parents to think about how their own behavior may be contributing in some way to their child's dysregulation and to try to support them to find a way that's not intrusive or overwhelming or frightening. So those are the key components. Next slide, please.

How it works is there are Early Interventionists in Philadelphia who have completed the ABC training to fidelity. It takes many months, anywhere from six months to a year, to complete the training program and to become certified. And I'm an ABC parent coach in infant, newborn, and toddler.

And we work with families over the course of 13 weeks. It's a 10-week program, but to really support attachment and nurturance between caregiver and child, a responsive style of interaction, teaching parents some really concrete strategies to help them support their child, encouraging positive caregiver interactions. And we use videotaping.

What we do is we videotape the sessions with the caregiver's consent. And we do it over tele-intervention as well. And we use those little clips at each session to review, look. When baby rolled that ball back to you, and you rolled it back to him, you were following his lead, and he really stuck with this game for so long. So we use it to really try to reinforce the ABC targets.

We also make lots of in-the-moment comments with the parents. The parent coaches do about one a minute to try to reinforce the positive that's going on with caregiver and baby and to support this kind of sensitive parenting and style of interaction. Next slide, please.

As I mentioned, families have been studied over a long time. And there were really strong, measurable, long-term effects. What the researchers found, even with this very short intervention, is that there's a more secure attachment, a more normative pattern of cortisol. It means just less stress. The children are showing less of the stress hormone.

Increased self-regulation when presented with a challenging task-- so in the research, they set kids up to have something enticing in front of them and told them to wait. And the kids who have gone through this have a better ability to manage that-- they could inhibit that response better; stronger self control and improved communication abilities. And it's all about the parent-child interaction. The parent coach isn't doing it. It's the parent and the caregiver.

And at the end of the session or the sessions, we give the caregivers a little montage video of all of our sessions together set to music. So it's like a little, I don't know, highlight your best of your parenting moments. And the parents really usually love it.

STACY PHILLIPS: This is Stacy. I love that, too. That's so adorable. I wanted to let you know there's a question in the chat. So I just wanted to read that. How does a family qualify to receive ABC intervention therapy?

KIM PRENDERGAST: OK. In Philadelphia right now, the program is being administered under the umbrella of Early Intervention. So we're going to put in the chat-- I think, Raquel, you have the ABC brochure, right? Yeah, she just shared it. So you'll see an ABC brochure. And there's a name on there and a phone number. And you could call-- are you going to share it right now? I think we just lost the slide show. OK.

CINDY GRAY: No, I was just so they could go face to face--

KIM PRENDERGAST: Oh, OK. So OK, so you can see that. You can call and say, I'm interested. I heard about this program. Because it's administered under the auspices of Early Intervention, there would be an evaluation done through an evaluation team. And certainly, a parent could say, I heard about this program. I would like to learn more about it and to see if my child would be eligible and talk with the evaluating team about that. OK, do you want us to go back?

CINDY GRAY: I'll bring it back up.

KIM PRENDERGAST: All right, and so-- oh yeah, thank you. Oh, there's the brochure. Oh, there, OK, yeah, all right now back to-- so benefits of ABC, so we've gone over some of these, strengthening the relationship. It's a strengths-based intervention. It's compatible with our philosophy in Early Intervention, really learning those cues and signals and supporting the child's self-regulation, developing crucial relationships with parent and child and developmental skills that we know have long-term benefits.

Not just when the baby is two or three, but the child is learning, like, you're my person now. And I can come to you when I'm three or two. But I can come to you when I'm 12 or 15, that very supportive relationship. And supporting all those things we already talked about, so what's really great about ABC is that it's such a short intervention that really has research to show that its really long-lasting effects.

And the ABC website, which I can, at some point, put in the chat, has lots of information, as well, about research. And there's a couple of little videos on there, if you're interested. And the only last thing I would say, a couple of things that parents have said about participating in ABC, "I now interpret my child's upset feelings as disappointment rather than her not getting her way." "ABC meant a lot to me. I loved the sessions and the skills that helped me recognize I had just through my everyday interactions with my little ones."

It says, "the nurturing piece has been huge for me with my child. He definitely gets frustrated easily, but I found that nurturing for him can be calming. And "the ABC program helped me regulate emotions. It gave me skills I didn't know I had, and they work very well." So just some nice feedback from parents who've gone through the program. So next slide, please. Oh, that's it.

So yeah, Cindy and I love this little quote, "the parent-child connection is the most powerful mental health intervention known to mankind." This is a psychiatrist who wrote, The Body Keeps Score, and just really sums it all up. So Cindy, do you have anything to add? And we have time lots of time for questions now. l

CINDY GRAY: The one thing about ABC is the child doesn't need to be showing any type of delay to get into Early Intervention. Because we know, in the social emotional developmental domain, that young kids, birth to three, don't always show a delay, even though they're struggling with some social emotional development. l It's just so foundational.

But because it influences cognition and learning and all those other supports, different developmental domains, it could pop up later in life. So if, let's say, you came in with your child. There might be risk factors. Maybe there was a traumatic experience or the loss of a loved one, and you're not sure.

Maybe they're in out-of-home placement. Maybe you're a resource parent. So all those kinds of things would be taken into consideration to determine eligibility. And Early Intervention, as you know, is free of charge in Pennsylvania. So that's not a barrier, which is a blessing, right? So just to let you know that.

So if you're concerned about a risk factor or trauma or something that might have disrupted social emotional development, or you're just not sure, that's OK. We will sort it out with you.

KIM PRENDERGAST: Yeah, thank you for that.

STACY PHILLIPS: Thank you, both. Are there any questions now from our participants? You can either drop them in the chat, or you can feel free to unmute and ask Kim and Cindy whatever you'd like.

KIM PRENDERGAST: Oh, you're welcome. Thanks for being here.

STACY PHILLIPS: I agree the videos were great. I think they were really spot on and really tied together so nicely, the information that you're presenting in each section. So I really appreciated the way that you all organized it and had those videos in there. Roxana is asking, is the ABC program also available for EI ages three to four?

KIM PRENDERGAST: No, not at this time. It's just in the Zero to Three program.

STACY PHILLIPS: Good to know, good question. I already bookmarked the ABC website, so definitely great to know.

KIM PRENDERGAST: You know who's coming in is Deepak. And this is great, right on time. Maybe Deepak can introduce. When he comes on, I'll--

CINDY GRAY: OK, he's in.

KIM PRENDERGAST: OK, I will share the website. And I'm going to just say, hello, Deepak. We've just finished the presentation, and Cindy and I are answering some questions about ABC. I put you on the spot. But if you want to say hello and introduce yourself, because there's some questions about how to access ABC, who's eligible? And if you want to introduce yourself, thanks.

DEEPAK: Sure. Yeah. Yeah. Hi, everyone. My name is Deepak [? Kumar. ?] I work with Kim and Cindy with the goal of disseminating ABC across Philadelphia. Particularly, as you may know, it's through the Department of Behavioral Health and Intellectual Disability Services through our Infant, Toddler Early Intervention program. And ABC is one of the interventions that we offer for families, particularly, as I'm sure by now, is centered around addressing social, emotional, and behavioral concerns for young children and their families. And yeah, happy to join, if there's anything I can help answer. Yeah, looking forward to speaking more with you.

STACY PHILLIPS: This is Stacy. Thank you so much for being here, Deepak. And this was a really wonderful presentation. Folks that are on, if you have any other questions, definitely now is your time to ask. We do have about 25 minutes left, if needed. Trying to practice my teacher wait time. I haven't been in the classroom in a while. The longer I wait, the more students would raise their hands.

KIM PRENDERGAST: Oh, can you share the PowerPoint? OK.

STACY PHILLIPS: Yeah, I think we mentioned it at the beginning. We definitely will share the PowerPoint. There is a PDF version of it. Raquel, did you want to drop that in there? That would be great. If not, I can find it.

RAQUEL: Yeah, I can do that.

STACY PHILLIPS: Thank you so much.

CINDY GRAY: Yeah, and in the last couple of pages of the PowerPoint are all your resources. And they're clickable links. If you want to, you could access some videos. And there's articles and just websites, in general, that you could visit for more information about.

RAQUEL: Cindy, you are a little low.

CINDY GRAY: Oh, you can't hear me?

RAQUEL: Well, it's lower now.

CINDY GRAY: Oh.

STACY PHILLIPS: So Cynthia, you said the resources are with clickable links in there, which is awesome. Thank you for including that. Is your contact information in there, both of you, email addresses?

KIM PRENDERGAST: I'll add that right now.

STACY PHILLIPS: That would be super. So if anyone here had any specific questions or followup questions, they can reach out to you. That would be wonderful.

KIM PRENDERGAST: I just put it in the chat, Stacy.

STACY PHILLIPS: Great. Yep, thank you so much. So for those of you on, email addresses are now in the chat, along with all of the handouts and links will also be included in that PowerPoint. So you will have access to them.

If there are no other comments or questions, I guess we will end a little early. I want to thank you both for being here. And Deepak, thanks for joining. We really appreciate your time. And anything that we can do to support families in Philadelphia receiving Early Intervention is our mission as well. So thank you so much.

RAQUEL: I'm sorry, Stacy, it's Raquel again. I thought I had the PowerPoint, but I have the notes one. So I don't have the one to share.

STACY PHILLIPS: OK, I'll grab that real quick.

RAQUEL: Thank you.

KIM PRENDERGAST: Well, thanks for having us. It's been a pleasure. Thank you.

CINDY GRAY: Yeah, thanks for letting us join you today and share some information. I hope it was helpful. Feel free to reach out if you need anything else.

STACY PHILLIPS: Sorry I muted myself. It's loud in my office today. My apologies. This was very helpful. I learned a lot. And I'm just searching for that PDF version of the slides, and I will pop that in there in just a moment.

CINDY GRAY: Do you want me to look for it as well? I probably have it.

STACY PHILLIPS: Sure.

CINDY GRAY: I guess we could team up on this--

STACY PHILLIPS: Thank you.

CINDY GRAY: --eventually find it.

STACY PHILLIPS: Thanks for those of you hanging on and just waiting patiently. I am not finding the PDF version. I am finding handouts, but not the PDF version. My apologies. So if you have it, yeah, you could drop that in there. That would be fantastic.

CINDY GRAY: Trying to find it, too.

STACY PHILLIPS: Thank you.

CINDY GRAY: OK, you know what I'm going to do? Raquel, are you still on?

RAQUEL: Yes.

CINDY GRAY: I'm sending it to both of you just because I don't usually drop things in the chat, so I don't know if I know how to do it right. Isn't that crazy? I sent it to both Stacy and Raquel.

STACY PHILLIPS: OK.