USF HOT DOCS encourages a practical approach to problem-solving

Cristina Ortiz and son Sebastian, 2

It was clear to Cristina Ortiz that from a very early age her son Sebastian Santa was different.

While other youngsters were chatting away, Sebastian was learning his first words. And while simple routines like going grocery shopping were almost fun adventures for most toddlers, a short visit to the store would throw the two and a half-year-old boy into complete confusion resulting in bad, attention-getting behaviors.

For Ortiz, the pressure was enormous. Not only was she faced with a child who had clear development challenges, but she also felt intense culpability.

“I was very desperate and feeling very, very guilty about my son’s behavior,” said Ortiz. “I did not understand why he was behaving the way he was.”

After franticly searching for help, Ortiz was directed to a program that would ultimately change her, and her son’s life, called HOT DOCS (Helping Our Toddlers, Developing Our Children’s Skills), a six week, hands-on course offered by USF’s Department of Pediatrics, Division of Child Development.

Ortiz, whose son benefitted from HOT DOCS, is now lead facilitator for the bilingual classes.

Using interactive, practical activities, parents and caregivers learn to problem-solve and address challenging behaviors such as constant whining, temper tantrums, aggression, and non-compliance by designing their own behavior strategy with the guidance of HOT DOCS coaches.

Ortiz is not alone. About 20 percent of all children have challenging behavior problems, said Kathleen Armstrong, PhD, director of the Pediatric Psychology Program at USF, and author of the HOT DOCS program.

The earlier the problems start, she observes, the more constant and extreme the associated negative outcomes are over time.

“The single best predictor of delinquency in adolescence is behavior problems in the preschool years,” Dr. Armstrong said. Many interventions have been developed; however, few focus on very young children and their families, as does HOT DOCS.

Initiated three years ago, HOT DOCS was an outgrowth of a federal grant to document research on young children who displayed challenging behavior patterns. Since then the program has been generously funded by the Children’s Board of Hillsborough County, which has enabled the course to reach more than 300 families.

The program’s team is made up of graduate students from psychology and public health, medical students, and a parent support specialist, all working together to help the family devise the most appropriate intervention program for each specific child.

L to R: The HOT DOCS team includes Cathy Armstrong, director of the USF Pediatric Psychology Program; Jillian Williams; Abraham A. Salinas; and Heather Curtiss.

Using an evidence-based method (Positive Behavioral Support) the entire concept is so leading edge because the parents become the main actors, and providers help only as partners, says Abraham A. Salinas, a PhD student in Community and Family Health, and a coach in the HOT DOCS bilingual Spanish class.

“This is a partnership among parents and providers which is different than the traditional power relationship of professional versus patients,” Salinas said. “Only through the eyes of parents are we going to be able to see the true potential of each child.”

It is interesting to note the wide demographics of those who have attended the course. Participants have ranged in age from 23 to 69, and represent the entire gamut of educational, ethnic, and socioeconomic backgrounds. As different as their characteristics might be, their response to the program has been overwhelmingly positive.

According to Jillian Williams, a doctoral intern in the Psychology program who is writing her thesis on the effectiveness of HOT DOCS, most of the caregivers reported that the program was beneficial to their families (97%), the trainers were knowledgeable and effective instructors (100%), the parenting tips were beneficial (96%), the special play strategies promoted positive interactions with their children (97%), the program positively impacted parenting attitudes and practices (95%), and the program positively impacted children’s behavior (96%).

For Sebastian, now age 4, and his mother, the changes have been dramatic. Now the family has implemented structured rituals that not only make daily activities easier and more enjoyable, but also transferable.

Bedtime, for example, used to be a veritable nightmare with Sebastian refusing to get into his pajamas, waking several times a night and often ending up in bed with Mom and Dad before he’d fall asleep. Now, Sebastian’s routine is so precise and carefree that by repeating it wherever they are, the family can even travel and avoid behavioral issues.

Jillian Williams (standing), a psychology doctoral intern, helps facilitate a HOT DOCS session.

Ortiz became such a proponent that she is now the lead facilitator for the bilingual course.

HOT DOCS is also critical to USF, and its outreach efforts into the greater community. “It’s a chance for USF to translate research into practice,” said Dr. Armstrong. “And the program is free, making it accessible to families who could not otherwise receive this kind of support.”

HOT DOCS is available to any Hillsborough County resident, with a child under age six, who has concerns about their child’s behavior.

The six-week course meets two hours each week in the CMS building, 13101 N. Bruce B. Downs Blvd., on the USF Tampa campus. Special sessions are offered in Spanish, and for caregivers of children with autism spectrum disorders.

“Parenting is the most important job we will ever do, and none of us receive training,” Dr. Armstrong said. “HOT DOCS provides parents with the tools to solve everyday behavior problems and help prepare their children for success in school, and in life.”

The next HOT DOCS sessions begin in Tampa on Jan 15, 2008. In addition, beginning Jan. 14, USF will offer its first HOT DOCS program in the CMS Building at 4718 Old Highway 47 in Lakeland. For more information, please contact Jillian Williams, 813-974-1189, jlwillia@mail.usf.edu (English-speaking classes, all locations), or Cristina Ortiz, 813-974-0355, cortiz@health.usf.edu (Spanish-speaking classes, Tampa only).

OTHER USF HEALTH DEVELOPMENTAL PEDIATRIC PROGRAMS

Two additional USF developmental pediatrics programs include Coping Cats and Early Steps. Coping Cats teaches children ages 9 to 12 with anxiety disorders how to manage their own anxious feelings. The program accepts insurance, Medicaid and private pay, with a sliding fee if necessary. For more information, contact Heather Curtiss at hcurtiss@health.usf.edu.

Early Steps, a federally-funded program for intervention of infants and toddlers with developmental delays, provides free services such as speech therapy and support for eligible families. Contact John Landi at 813-974-6072 or Jlandi@health.usf.edu.

Other services offered include multidisciplinary team evaluations (pediatrics, psychology, neurology), consultations, and individualized intervention planning and medical management for children struggling with school, behavioral and social issues.

– Story by Sheryl Kay
– Photos by John Lofreddo/USF Health Media Center