What therapeutic interventions can help promote positive parent-child interactions? The PACT Therapeutic Nursery in Baltimore, Maryland has developed an attachment-based therapeutic child-care program for very young children and parents living in emergency shelters. Programs use a strengths-based approach to promote improved social, emotional, and cognitive development for children and parents who have suffered the trauma of homelessness.

Visit the HRC Parenting and Homelessness webpage to learn more about the latest research on parenting and homelessness.

Kim Cosgrove, LCSW-C is the Director of the PACT Therapeutic Nursery in Baltimore, Maryland. She has been instrumental in developing an attachment-based therapeutic childcare program for very young homeless children and their families. Twelve years ago, the program was a half-day drop-in program. A mental health consultant, Carole Norris-Shortle, had just finished a one-year sabbatical studying the Nursing Child Assessment Training Tool (NCAST) in Seattle, Washington. The knowledge she brought back to Baltimore was the impetus for transforming the PACT Therapeutic Nursery’s service delivery.

NCAST is a research and training organization that has developed evidence-based practices for assessing behaviors of children and parents. These assessments demonstrate the importance of parent-child interactions as a predictor of later cognitive and language development.

Kim and her colleagues realized that they could use NCAST and offer a warm and nurturing environment. Here, attachment-based interventions could buffer the traumatic impact of homelessness for both children and parents. Children who have experienced homelessness often have delays in speech and language, heightened separation anxiety, and difficulty engaging in play.

The PACT Therapeutic Nursery has used NCAST’s Keys to Caregiving to develop programs to support families in caring for their children. The NCAST concept of the Teaching Loop is used to help engage parents in a therapeutic process that they call “Wee Cuddle and Grow.” Through a strengths-based approach, parents learn how to interact with their babies, identify their cues, and provide positive interactions that promote social, emotional, and cognitive growth.

“Our interventions are all pretty short-term, about eight weeks long. We have to implement interventions quickly because we don’t know how long families will be with us,” explains Kim.

All PACT Therapeutic Nursery programs have been developed to assist children and parents to connect in a nurturing way. There are multiple interventions that address a range of issues presented by parents and children living in emergency shelters.

“Wee Cuddle and Grow” is a parent/child session based on NCAST. Nursery staff use parent/child interaction scales to measure how parents and children interact together, beginning with scoring for an initial baseline session. Staff use video sessions to provide feedback to parents on responding to cues from their child.

Staff members provide prompts to parents such as “Did you notice how your baby smiled when you spoke?” or “What did you notice about your child’s behavior that you really liked?” Areas of improvement and examples of these behaviors for participants in the nursery program include the following:

• positioning their child so that eye contact is possible
• soothing their child when distressed
• decreasing negative comments to the child
• focusing their own and the child’s attention on the task
• praising the child’s attempts
• using modeling in their teaching

“We really play on parent strengths and talk to them about becoming their baby’s best teacher,” says Kim. The PACT Therapeutic Nursery is working with parents who are very stressed. They may have a difficult time reading cues from their children and responding in a warm and nurturing manner. Often, this is a result of trauma from domestic violence, homelessness, or mental health issues.

Parent and child activities in which parents provide choices and offer a clear beginning, middle, and end to play sessions require intense parent/child work with the support of a clinical social worker.

Another intervention that has proven successful is the “Family Traditions Breakfast,” based on the work of Dr. Laurel Kiser. It provides the opportunity for parents to engage in a mealtime experience with their children and staff members. Staff members facilitate conversations and welcome parents, providing instruction and modeling on the importance of community.

“We talk a lot about how we want to speak to each other as adults to promote good manners and positive language,” says Kim. Many adults in the program have a difficult time engaging with other adults in a positive way. There can be a lot of teasing and sarcasm that will escalate into more intense conflicts.

“The Beautiful Babies Book” provides photographs of parents and children together.  Parents are asked to write thoughtful captions with positive statements about their children. “It is an intense experience when the child wants to kiss the page,” explains Kim. These photos help children to remember being with the parent when they are dropped off for childcare.

The program is highly focused on family-centered attachment. Both circle time and songs about mommy returning are central to teaching children that the parent will return. Parents are taught to offer facial expressions that are warm, welcoming, and present. “Some of our parents are highly stressed and smiling is the last thing they want to do, but that is the seed we want to plant.”

Parent groups provide an opportunity for parents to share with each other what it means to be a family and helping parents to create deliberate traditions and family routines. This may include envisioning the composition of their family unit. “Some of our parents have been disconnected from their families of origin, so family can mean anything related to someone you are connected to. We may have an entire session,” explains Kim, “on what mealtime or bedtime looks like.”

Staff at the PACT Therapeutic Nursery also train others. “We train childcare providers, physicians, nurses, psychologists, psychiatrists, and social workers on the NCAST scale,” offers Kim. PACT is a training site for social work and nursing students. “We pride ourselves in helping people to understand these interventions at a hands-on level,” says Kim.