Family Connections: Promoting safety & well-being in families at risk for neglect

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Family Connections: Promoting safety & well-being in families at risk for neglect. Diane DePanfilis Howard Dubowitz University of Maryland Center for Families Helfer Society Annual Meeting Montebello, Canada, September 2003. Funding.
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Family Connections: Promoting safety & well-being in families at risk for neglectDiane DePanfilisHoward DubowitzUniversity of Maryland Center for FamiliesHelfer Society Annual MeetingMontebello, Canada, September 2003Funding 5-year U.S. DHHS, Children’s Bureau grant to demonstrate a model intervention to prevent child neglectWhy neglect prevention?
  • Neglect is common
  • Neglect can result in serious harm
  • Prevention should protect children, & lead to other benefits for children, families & society
  • Study Objective
  • To examine the relationship between length of service & child & family outcomes of a community-based project
  • to help families prevent neglectResearch Question 1
  • Is there change over time in:
  • risk factors?
  • protective factors?
  • child safety & well being?
  • Research Question 2
  • Does length of services affect change in:
  • risk factors?
  • protective factors?
  • child safety & well being?
  • Constructs in this Analysis
  • Decrease Risk Factors:
  • Caregiver depression
  • Parenting stress
  • Life stress
  • Enhance Child Safety
  • CPS reports
  • Physical Care
  • Psychological care
  • Enhance Protective Factors:
  • Parenting attitudes
  • Parenting competence
  • Family functioning
  • Social support
  • Enhance Child Well-Being
  • Child behavior
  • West Baltimore Empowerment ZoneAt least one child 5 - 11 years in the householdPresence of > 1 risk factorNo current CPS involvementVoluntaryTarget PopulationCaregivers
  • 154 families
  • 86% African American
  • Mean age: 39 years
  • 98% female
  • 58% unemployed
  • 5% married, 65% never married,
  • 30% separated, divorced, or widowed
  • 62% < high school
  • Children
  • Average no. of children per family: 3
  • 31% > 3 children
  • Mean age: 9 yrs. (1 month - 21 yrs)
  • 49% female
  • Relationship to caregiver
  • 78% children
  • 14% grandchildren
  • 8% other relative
  • Intervention:Random assignment
  • 3 months
  • 9 months
  • Guiding Principles toIncrease Capacity & Reduce Risk
  • Ecological developmental framework
  • Community outreach
  • Family assessment & tailored intervention
  • Helping alliance with family
  • Empowerment/strengths-based
  • Cultural competence
  • Outcome-driven service plans
  • Interventionists
  • SW interns
  • initial & ongoing training
  • supervision
  • manual
  • Intervention Elements
  • Emergency assistance
  • Family assessment
  • Home-based counseling
  • Referrals
  • Service coordination & facilitation
  • Data Collection Methods
  • Computer Assisted Self-Interview
  • Baseline
  • Case closure
  • 6-month follow-up
  • Standardized self-report & observational measures
  • At 30 days, 3 & 6 months, & at closure
  • Intern driven  integrated with intervention
  • Data AnalysisRepeated Measures Analysis1. Assess change over time Baseline  Closing  6-month F/U
  • Comparison of length of service
  • 3 vs. 9 monthsResults: Risk Factors
  • Comparing all caregivers
  • baseline to 6 months post intervention, significant in:
  • Risk Factors
  • Caregiver depressive symptoms
  • Parenting stress
  • Life stress
  • Results: Parenting StressResults: Protective Factors
  • Comparing all families
  • baseline to 6 months post intervention, significant in:
  • Protective Factors
  • Parenting attitudes
  • Parenting satisfaction
  • Social support
  • Results: Parenting Attitudes (N=125)STEN Scores7-10 Exceeds expectations5-6 Norm3-4 Low 1-2 High riskResults: Child Safety
  • Significantly Improved Physical Care
  • Household furnishings
  • Overcrowding
  • Household sanitation
  • Significantly Improved Psychological Care
  • Mental health care
  • Caregiver teaching stimulation of children
  • CPS reports & CPS indicated reports
  • Child Safety: Physical Care
  • Household Sanitation*
  • Measure: CWBS Household Sanitation subscale
  • Score:
  • 100 = Adequate
  • 71 = Mildly inadequate
  • 38 = Moderately Inadequate
  • Score increased from baseline (M= 81.57) to Closing (M= 85.05, p= .038)
  • *N = 100; 3 mos = 50; 9 mos = 50Child Safety: Psychological Care
  • Caregiver Teaching/Stimulation of Children*
  • Measure: CWBS Teaching/Stimulation of Children subscale
  • Score:
  • 100 = High activity
  • 84 = Moderate activity
  • 70 = Passive approach, some
  • deprivation
  • Score increased from baseline (M= 86.63) to Closing (M= 90.21, p= .004)
  • *N = 60; 3 mos = 33; 9 mos =27Child Safety: Indicated CPS Reports
  • No significant group differences
  • Logistic regression: Did length of service predict CPS reports? NS
  • Results: Child Well Being
  • Comparing all families
  • baseline to 6 months post intervention, significant in:
  • Total behavior problems
  • Internalizing behavior problems
  • Externalizing behavior problems
  • Child Internalizing & Externalizing Behavior Main Effects of Time (N=111)Results: 3 vs. 9 Month Group Comparison
  • 9 month intervention demonstrated greater improvement than the 3 month group in:
  • Child behavior
  • Caregiver depressive symptoms
  • No differences between groups in other domains (eg, parenting stress, life stress, parenting attitudes, social support, household safety)
  • Child Internalizing Behavior (N=111)Depressive Symptoms (N=125)6 mo f/u for 3 mo6 mo f/u for 9 moLimitations
  • Relatively small sample
  • Intervention delivered mostly by MSW interns
  • Questions about fidelity of intervention
  • Short follow-up (6 months)
  • ConclusionsIntervention helped:
  • Reduce Risk Factors
  • depressive symptoms
  • parenting stress
  • life stress
  • Increase Protective Factors
  • parenting attitudes & satisfaction
  • social support
  • Conclusions
  • Results suggest improved targeted outcomes:
  • Child Safety
  • housing problems
  • mental health care
  • parental teaching of children
  • Child Well Being (Behavior)
  • externalizing & internalizing behavior
  • Most positive effects endured 6 months post intervention
  • Conclusions
  • 9 mos. intervention more effective than 3 mos.
  • Child behavior
  • Caregiver depressive symptoms
  • No group differences in other domains
  • (eg, parenting stress, life stress, parenting attitudes, social support, household safety).Conclusions
  • Family Connections appears to be a promising model intervention
  • Promoting caregiver & child functioning
  • Helping ensure children’s basic needs are met
  • Helping preventing child neglect
  • DOWNLOAD A COPY OF THIS PRESENTATION and other materials at: http://www.family.umaryland.eduClick on ResearchClick on PowerPoint PresentationsFamily Connections: MissionTo promote the safety & well-being of children & families through family & community services, professional education & training, & research & evaluation
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