Sherri MacKay, Ph.D., C.Psych.

May 2013

About Dr. Sherri MacKay

Dr. Sherri MacKay is a Psychologist at the Centre for Addiction and Mental Health. She is the Provincial Director and founder of TAPP-C (The Arson Prevention Program for Children). Dr. MacKay has worked with youth in conflict with the law for 20 years and currently is an Assistant Professor in the Department of Psychiatry, University of Toronto and has a cross-appointment to the Department of Psychiatry at the Hospital for Sick Children. She is actively engaged in the education and supervision of clinical and research students and fellows, and conducts TAPP-C workshops and seminars for professionals across Canada. She is a Director on the Fire Marshal of Ontario’s Public Fire Safety Council and in 2004 received the Award for Excellence in Fire Safety from the Ontario Fire Marshal’s Office. Dr. MacKay is the lead author or co-author on numerous research publications devoted to child and juvenile firesetting as well as presenting nationally and internationally on the topic. Her areas of interest include further development of university training programs and the evaluation of intervention models for firesetting.

MB: This edition of MatchBook focuses on issues related to interventions and supports for the caregivers and families of kids involved in firesetting. As a professional with a particular interest in the YouTube/firesetting area, do you have any definitive thoughts as to priorities, needs and directions for us as field to begin improving our abilities to address the needs of caregivers and families of these kids?

SM: In general, one emerging trend in this field is to draw upon evidence based programs to fit children’s presenting problems. Since these kids have problems with impulsive behavior, we need to deliver them a good package that combines what we know about juvenile firesetting with treating these kids who have behavioral problems.

It would be great to find a way to offer kids a fire specific treatment for the general problems they are facing. One of the programs I was talking to Dr. Stadolnik about was SNAP; it provides structured, manualized programs for kids. There is also the Strengthening Family Program and the Incredible Years Program, which deal with the caregiver’s weaknesses. These programs allow caregivers to provide the appropriate measures to change their kids behavior.

The evidence based work out there is also important. The trick is, how do you combine these programs with something specific to fire setting treatment for the child? A lot of these programs are using a structured approach however, we have a session by session approach that works with the child and the caregiver because they don’t tend to last in really structured approaches.

In terms of approaching this as a family issue, these treatments should be community based and home based. We have to design treatments that suit the lives of the people we are trying to help— we have to work around schedules that work with the families. This means designing programs that are accessible and suitable for families.  Some of these programs are more than treatment—to have a meal, babysitting. It is important to make these programs more desirable and convenient for families so that they come. One challenge with this is the economy of scale and making these programs group based so they will be sustainable from an economic perspective. We also do very good work with kids in groups, which is a good model because caregivers like group based programs. A lot of the evidence based programs are group based—they are both quick and efficient.

MB: Could you share a story or two of a family you have worked with where the child’s success or struggle was directly linked to a caregiver or family’s response to the situation?

SM: Many of the children and adolescents that I work with are living in chaotic and complex single parent families. The common theme, is “what the Caregiver can do is hugely important to the outcome”— it can seem simple but the caregiver is very important.

One case that sticks on my mind, is that one caregiver I was working with, who despite our best efforts didn’t have the energy to improve supervision, needed treatment for herself. We first worked on an interim plan for the child until we could get her to a place where she could help her child. She went on medication, worked with a counselor, got respite care for herself, and then returned home and was able to contain his fire involvement. She couldn’t do it until she was better. This is an example that it comes down to the question, how do we help the caregivers have the resources they need? It’s a change in the way they live and a change in the way they interact with their children. If there is a change in their behavior, there is a change in their child’s behavior.

As a caregiver you need a lot of energy and internal strength to be the best resource for your child, hence Caregivering Programs—these are issues they take care of. An important part of this work is for caregivers to know that these resources are out there, and for them to not alienate their resources. It’s important for caregivers to build their own support system and reinforce it.

MB: What have you found are the three keys to success when working with families of kids who exhibit serious conduct problems?

SM: The first is the theme of having family or caregiver involvement. This is especially important when doing treatment with children or adolescents. The caregivers are part of the solution. They often feel blamed but we need caregivers to understand they need to be involved. Evidence based practice is often proceeded with family based interventions that increase therapy. We need to work this into the program with juvenile firesetting. Caregivers tend to think about the child based problem. We need them to understand they are our most important resource. The best chance your child has is through you.

Caregivers are also part of the second key to success: caregivers need to feel like a helpful partner. Once this occurs, it’s important to offer them hope that change is possible. This means offering things they can do in collaboration with you to know they can make a difference. With firesetting, we know what to do, we have some basic changes that if they are made, you can get a handle on this problem. The sense they can make a difference. We know how to do this. These are simple but they are the foundation of a successful intervention.

When giving them a sense of hope, we need to give them a model of how firesetting occurs. It’s not a random event and doesn’t just happen. They do have control. We want to give them a model of how the behavior works. There are things that come before that we can work on. Starting by helping caregivers understand in their home based and environmental perspective what we can do to shake this up so there will be a different outcome.

Thirdly, we see juvenile firesetting as a safety concern. Our approach is that your child in danger of hurting themselves. Injury prevention mobilizes caregivers to help because caregivers are concerned about safety. This is easier than to focus on changing behavior. Most caregivers see safety as their responsibility. First and foremost this is a child safety problem.

We talked about attitudes and behaviors. Helping caregivers understand that their help with fire safety sets the tone for the house. Even in group homes, they are there to convey that fire safety is important in this setting. Preventing firesetting needs to include fire safety, part of which is restricting accessibility. If there are no matches and lighters available, there is no firesetting. It’s important to find out how your child is getting access and preventing your child from unsupervised access.

MB: Is there anything else you’d like to add?

SM: Important components of treatments include drawing on the evidence based programs to implement cognitive change, as well as structure and having goals with the family.

Another point worthy of note is that any good program starts with some success. A program should start with a reasonable goal– once the child or family gets a little success they are more likely to continue with the program. That’s why we start with access restriction and then move onto the harder points before moving onto rewarding and positive reinforcements. Caregivers need these too. Building in some gains very quickly and building in some reinforcements from these gains very quickly increases the likelihood that families and kids will stick with it.

Families and caregivers are the most important resource in terms of working with these kids. Our programs need to fit them. They need to work and be accessible and offer something to these families. There has to be some gain for this hard work. If they do the hard work our job is 80% done. As a professional in this field, I see myself as the facilitator; as a clinician and educator I am the person that has to help the other people do the work.

The MB Interview includes questions from MatchBook’s Editorial Board & was conducted by Publication Manager, Morgan Callahan.