Penfield Early Pathways

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EARLY PATHWAYS

Early Childhood is a critical period of development. What young children experience today may not only impact them now, but well into their futures. Intervention at a young age is crucial for behavioral and emotional concerns, including trauma, to be identified and addressed early to establish positive pathways for children as they grow.

Early Pathways Timeline
  • Early Pathways was built upon previous research conducted by Dr. Robert Fox that began in the 1980’s with parents and young children. He implemented the STAR Parenting model, a program designed to help parents utilize cognitive strategies when responding to their child using the acronym “Stop, Think, Ask, Respond” or STAR. This program helped parents learn developmentally appropriate expectations for their child, improve nurturing in their relationship, and set appropriate limits for challenging behavior. The STAR Parenting model was shown through randomized control trial research in 2002 to be effective at improving children’s behavior and in reducing parent stress and frustration. Effects were maintained at 1 year follow up
  • A tool called the Parent Behavior Checklist was developed in order to assess parents’ levels of age-appropriate discipline, nurturing, and expectations for their child.
  • Dr. Robert Fox opened the Behavior Clinic, an outpatient mental health clinic, in partnership with Penfield Children’s Center in Milwaukee, WI. Behavior Clinic works with families who have children age birth to 6 years old throughout Milwaukee county, particularly families below the federal poverty line who may not otherwise have access to mental health services for young children.
  • An assessment tool called the Early Childhood Behavior Screen was developed to evaluate levels of challenging and prosocial behavior in young children. Criteria for clinical cutoff is based on the norm for the child’s age
  • Following all of the modifications made to the STAR Parenting program through research up to this point, the treatment program was renamed “Early Pathways” to fit with the more comprehensive treatment program now being utilized.
  • Research shows the Early Pathways program works equally well across cultural groups (Caucasian, African American, Latinx). A randomized control trial established efficacy of Early Pathways with Lantino and Spanish-speaking families, and services were provided in English or Spanish, based on family’s preference.
  • The unique competencies needed for therapists to successfully implement our home-based model were identified.
  • A random control trial was conducted to further establish effectiveness of Early Pathways with all of the components that had been added or modified via research over time. This study found Early Pathways to be an effective treatment model in reducing behavior concerns in young children, and that treatment gains were maintained at 3 months following completion of the program.
  • A component was researched through randomized control trial and added to Early Pathways to evaluate and address trauma in young children. The trauma component of our program was based on available research and evidence-based models existing for older children that we adapted to the younger population.
  • In order to accurately screen, assess, and diagnose trauma symptoms in young children, the Preschool Inventory of Traumatic Stress was developed through research at Behavior Clinic. This measure maps onto the DSM5 diagnostic criteria for Post-Traumatic Stress Disorder in children younger than 6 years of age and includes subscales for attachment concerns and reliability of reporters.

MEET THE TEAM

OUR PROFESSIONALS

Early Pathways

FIRST LAST

Team member’s biography coming soon!

Early Pathways

FIRST LAST

Team member’s biography coming soon!

Early Pathways

FIRST LAST

Team member’s biography coming soon!

Early Pathways

FIRST LAST

Team member’s biography coming soon!

LEARN ABOUT EARLY PATHWAYS

OUR WORK

  • Clark, C., & Duncan, K. (2020, October 20). Healing trauma through storytelling: Creating and utilizing narrative with toddlers and preschoolers. Virtual workshop presented at the Charleston Child Trauma Conference (80 attendees), Charleston, SC.
  • Clark, C. & Langfield, M. (2019, November). Supporting Children Experiencing Community Violence. Children Come First Conference (30 attendees), Wisconsin Dells, WI.
  • Fox, R., & Clark, C. (2019, October). Addressing Behavior and Trauma Symptoms in Preschoolers in Poverty through an In-Home, Evidence-Based Program. Workshop presented at the Zero to Three Annual Conference (200 attendees), Fort Lauderdale, FL.
  • Clark, C. (2019, October). Screening and Addressing Trauma Symptoms in Very Young Children. Workshop to be presented at the Charleston Child Trauma Conference (75 attendees), Charleston, SC.
  • Solano-Pacheco, A., & Waschbisch, M. (2019, October). Culture & Cognitive Dissonance: Working with the Latin X Community. Workshop to be presented at the 2019 Summit on Poverty & SWIM Conference (35 participants), Milwaukee, WI.
  • Boeding, S., Tomlin, J., & Burkard, A. (2019, October). Early Pathways: A Behavior Clinic Intervention for Young Children with Trauma. Workshop to be presented at the 2019 Summit on Poverty & SWIM Conference (38 participants), Milwaukee, WI.
  • Fox, R., & Clark, C. (2019, September). Addressing Behavior and Trauma Symptoms in Preschoolers in Poverty through an In-Home, Evidence-Based Program. Workshop presented at the Zero to Three Annual Conference (200 attendees), Fort Lauderdale, FL.
  • Tomlin, J., Boeding, S., & Burkard, A. W. (2019, August). Behavior Clinic: Engaging Our Community Through Trauma-Informed Care for Young Children in Poverty. Poster accepted for presentation at the American Psychological Association Annual Conference, Chicago, IL.
  • Boeding, S., Brickner, M., & Burkard, A. W. (2019, April). Early Pathways: Home-based mental health services for very young children living in poverty. Poster presented at the 91st Annual Meeting of the Midwestern Psychological Association, Chicago, IL.
  • Langfield, M. (2018, November). Trauma-Sensitive Mental Health Treatment for Young Children in Poverty. Children Come First Conference, Wisconsin Dells, WI.
  • Burkard, A. W. (2018, October). The Behavior Clinic: Key Leadership Factors that have Influenced Collaboration and Partnership. Presentation at the Coalition of Urban and Metropolitan Universities Annual Conference, Chicago, IL.
  • Burkard, A. W. (2018, October). The Behavior Clinic: Helping Children in Poverty with Behavioral and Mental Health Concerns. Poster presented at the Coalition of Urban and Metropolitan Universities Annual Conference, Chicago, IL.
  • Ernst, C. (2018, October). Assessing trauma in very young children in poverty. Poster presented at the annual conference of Zero to Three: Explore New Territory, Denver, CO.
  • Langfield, M., & Solano-Pacheco, A. (2018, September). Working with Latino Families: In-Home Trauma Interventions for Young Children. Healing Trauma. Healthy Communities Conference, Milwaukee, WI.
  • Tomlin, J., & Wittmann, S. (2018, September). Trauma-Informed Mental Health Treatment for Young Children in Milwaukee: Home and School Interventions. Healing Trauma, Healthy Communities Conference, Milwaukee, WI.
  • NCTSN Early Pathways Fact Sheet
  • SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) (November 2015):
    • This program (EP) is effective for reducing disruptive behavior disorders and externalizing/antisocial behaviors. The review of the program yielded strong evidence of a favorable effect.
    • This program is effective for improving the family-child relationship. The review of the program yielded strong evidence of a favorable effect.
    • This program is effective for improving general functioning and well-being. The review of the program yielded strong evidence of a favorable effect.
    • This program is effective for improving social functioning/competence. The review of the program yielded strong evidence of a favorable effect.
    • This program is effective for reducing unspecified and other mental health disorders. The review of the program yielded strong evidence of a favorable effect.
    • This program is promising for improving parenting behaviors. The review of the program yielded sufficient evidence of a favorable effect.
  • Bollens, S. E., & Fox, R. A. (2019). Assessment of trauma symptoms in toddlers and preschoolers living in poverty. Child Maltreatment, 24(3) 275-285. Doi: 10.1177/1077559519830790
  • Love, J. R., & Fox, R.A. (2019). Home-based parent child therapy for young traumatized children living in poverty: A randomized controlled trial. Journal of Child and Adolescent Trauma, 12, 73-83. Doi:10.1007/s40653-017-0170-z
  • Muhar, C. Early Pathways Program Helps Vulnerable Children (August, 2017). Newsletter of the Southeast Chapter of the Wisconsin Alliance for Infant Mental Health.
  • Fox, R.  A., Besasie, L. A., & Fung, M. P. (2017). Tools for treating behavior problems in young Latino children. In L. T. Benuto (Ed.), Toolkit for Counseling Spanish-Speaking Clients: Enhancing Behavioral Health Services. Switzerland: Springer International Publishing.
  • Mattek, R.J., Harris, S.E., & Fox, R. A. (2016). Predicting treatment success in child and parent therapy among families in poverty. Journal of Genetic Psychology, 177 (2), 44-54. doi: 10.1080/00221325.2016.1147415
  • Gresl, B., L., Fox, R. A., & Besasie, L. A. (2016). Development of a barriers scale to predict early treatment success for young children in poverty with behavior problems. Clinical Practice in Pediatric Psychology, http://dx.doi.org/10.1037/cpp0000124
  • Harris, S. E., Fox, R. A., & Holtz, C. A. (2016). Screening for significant behavior problems in young children living in poverty. Journal of Child and Family Studies, 25 (4), 1076-1085. doi:10.1007/s10826-015-0300-x
  • Harris, S. E., Fox, R.A., & Love, J.R. (2015). Early Pathways therapy for young children in poverty: A randomized controlled trial. Counseling Outcome Research and Evaluation. doi: 10.1177/2150137815573628
  • Holtz, C. A., Fox, R. A., & Meurer, J. R. (2015). Incidence of behavior problems in toddlers and preschool children from families living in Poverty. Journal of Psychology: Interdisciplinary and Applied, 149, 161-174. doi:10.1080/00223980.2013.853020

EARLY PATHWAYS

FAQS

  • Early Pathways can be billed under some insurances. Our providers at Behavior Clinic also utilize a sliding fee scale based on family size and income. 
  • There are opportunities to utilize Early Pathways in obtaining grant funding.

Professionals in the mental health, psychology, psychiatry, or social work fields who have a Master’s or Doctorate level degree, or students in Master’s or Doctoral programs for these fields. 

Yes! We will continue to keep our portal updated with our latest research and evidence-based materials for certified providers to utilize. Providers can also communicate with us to address any questions regarding assessments or treatment materials.  

  • We have been doing research on the components of Early Pathways for more than 30 years! The program has shown to work in reducing most challenging behaviors, emotional concerns, and trauma symptoms if caregivers are able to use recommendations fully and consistently. 
  • Early Pathways is not effective for children who need a higher level of intervention, such as those diagnosed with Autism Spectrum Disorder.
  • Sometimes additional services are required to help a child improve. Examples of this include speech therapy, occupational therapy, or medical evaluations, such as for hearing impairment. 

Caregiver participation is the most important part of Early Pathways! We have found that the more involved caregivers are, the more likely it is that a child’s concerns improve. The goal is that the more work you are able to put into your child’s treatment now, the less work you will have to do later in responding to concerns, and instead, you will be able to spend more time enjoying your interactions with your child!

No, agreeing to participate in the Early Pathways program does not mean something is wrong with your child. Many caregivers participate in Early Pathways to learn new ways to respond to normal behaviors that all children have, like temper tantrums. Early Pathways can be used for a wide range of behaviors and concerns, from common behaviors to behavior or emotional disorders, and everything in between!

REVIEWS

We were very pleased to learn that EP received the highest possible rating as “HIGHLY RELEVANT” for use by staff working in Child Welfare Agencies.

CALIFORNIA EVIDENCE-BASED CLEARINGHOUSE FOR CHILD WELFARE (CEBC)

Outcome #1: Disruptive Behavior Disorders and Externalizing/Antisocial Behaviors

This program is effective for reducing disruptive behavior disorders and externalizing/antisocial behaviors. The review of the program yielded strong evidence of a favorable effect (effect size = .95)

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES

Outcome #2: Family-Child Relationship.

This program is effective for improving the family-child relationship. The review of the program yielded strong evidence of a favorable effect (effect size = .97).

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES

Outcome #3: General Functioning and Well-Being

This program is effective for improving general functioning and well-being. The review of the program yielded strong evidence of a favorable effect (effect size = 2.47).

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES

Outcome #4: Social Functioning/Competence

This program is effective for improving social functioning/competence. The review of the program yielded strong evidence of a favorable effect (effect size = .55).

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES

Outcome #5: Unspecified and Other Mental Health Disorders

This program is effective for reducing unspecified and other mental health disorders. The review of the program yielded strong evidence of a favorable effect (effect size = .99).

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES

Outcome #6: Parenting Behaviors

This program is promising for improving parenting behaviors. The review of the program yielded sufficient evidence of a favorable effect (effect size = .40).

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES