Attention Magazine October 2024

Designed to help a parent learn to manage and, in many instances, learn to effectively remediate their young child’s behavioral challenges, the Regional Intervention Program (RIP) in Nashville, Tennessee, continues to enjoy a national reputation for its effectiveness in improving the quality of life for the families it serves.

The program is designed specifically to address the needs of parents or other caregivers with children younger than six who experience challenging behaviors that range from mild to severe, to the degree that families are having difficulty managing their daily lives. Defiance, separation anxiety, aggression toward others, tantrums, and not following instructions are among the behaviors commonly seen at RIP.

How the program works
At least one parent or guardian attends the program twice per week with their child in a group setting with other families. From the first day each family is scheduled to meet with an assigned case manager. The RIP case managers are parents who have been through the program with their own child. The parents work toward specific family goals, which include meetings with their case manager and sessions with their child.

The parents learn how the classrooms function by going through classroom training and social skills training. First they observe, then they assist as a co-teacher, and eventually they become one of the lead teachers in the classrooms.

During their time at RIP, families are coached on ways to attend to and reinforce specific child behaviors that need to increase. They are also coached on how to remove reinforcement from behaviors that need to decrease. Importantly, they can put these new skills into practice in both group and individual environments designed to replicate their day-to-day life, including scenarios such as when someone is talking on the telephone, when a friend comes to visit, or when the child hears the word “no.” Equally important, the parents practice these skills until they’re mastered.

RIP operates in two phases of treatment, an active treatment phase (Phase I) and a payback phase (Phase II). Once a parent completes the active treatment phase they enroll in the payback phase, where they coach newly enrolled parents on the skills that they’ve mastered. Because RIP is a parent-implemented program, there are a variety of opportunities to connect with other parents during the second phase. The payback phase is how parents pay for the program, which is offered free of charge. Funding for the program is provided entirely by the Tennessee Department of Mental Health and Substance Abuse Services. The average length of time for most parents to complete both treatment phases is six to nine months.

To help children generalize newly learned behavioral skills to other situations, the children also participate in a small classroom-based training program, where they learn to master the skills needed to make friends, get along better with others, and be more successful in a classroom setting, both now and years down the road. Along with other RIP staff, parents are involved in helping their children in these classroom settings.

RIP also relies on built-in outcome measures to insure both the parent and their child progress and progress of the model. Exit surveys demonstrate that graduated families rate their overall experience positively (an average of 9.5 out of 10). Graduated families also report being satisfied that RIP helped with their child’s behavior (average of 9.4 out of 10), and that RIP improved their parenting skills (average of 9.8 out of 10). Eighty-seven percent of graduated families report that the intensity of their child’s behavior decreased, and their perception of the behavior improved, as reflected by their response to the following item: This behavior is a problem for me: (Yes/No) from enrollment to graduation during the 2023/2024 service year.

Beyond the services offered in Nashville, RIP also provides other services in Middle Tennessee, including training programs to help parents and other caregivers learn effective behavioral management practices for children, tips on how families can collaborate more closely with schools, among other topics. Currently, there are nine RIP sites across the state, including the original program in Nashville, which serves as the training site for the other programs. In addition, RIP replication sites have also expanded to several other communities across the United States. Currently, replication sites are in active operation in Cedar Rapids, Iowa; Chula Vista, California; and San Diego, California.

While the Regional Intervention Program has grown over the years to include additional services and updated practices, its family-centered philosophy of services and practices goes back over fifty years. Surprisingly, many people remain unfamiliar with this very impressive model.

A clinical and consulting psychologist, Mark Katz, PhD, is the director of Learning Development Services, an educational, psychological, and neuropsychological center in San Diego, California. As a contributing editor to Attention magazine, he writes the Promising Practices column and serves on the editorial advisory board. He is also a former member of CHADD’s professional advisory board and a recipient of the CHADD Hall of Fame Award.

ADDITIONAL INFORMATION
To learn more about RIP, its community-based services, or for information about how to replicate the program in your community, go to https://www.tn.gov/parenting-that-works, email rip.tdmhsas@tn.gov, or call (615) 963-1177.