Section 8 - FIRST 5 Santa Clara County

Transcription

Santa Clara County High-Risk Design
Compendium of Relevant Research
Volume II of II
High-Risk Research and Design Teams
January 2005
FIRST 5 Santa Clara County 4000 Moorpark Avenue, Suite 200 San Jose, CA 95117 P 408.260.3700 F 408.296.5642 www.ﬁrst5kids.org
FIRST 5 Santa Clara County would like to acknowledge David E. Arredondo, M.D. for
his passion and commitment to serving the most vulnerable children of our county.
Dr. Arredondo served as the lead researcher and convener of the High-Risk Design
Team, and together with Patricia Jordan, redacted research articles, program briefs
and abstracts for this Compendium. Additionally Dr. Arredondo's own essays have
significantly contributed to this body of work. FIRST 5 Santa Clara County recognizes
the importance of this work and thanks Dr. Arredondo for his invaluable contributions.
Materials in this publication are intended for educational and research purposes. This
compendium represents data and analysis from numerous sources. It is a work in
progress; figures, charts, and maps are subject to change as additional information
becomes available and is incorporated into the document.
© 2004-2005 FIRST 5 Santa Clara County
All Rights Reserved
This document, or any part thereof, may not be duplicated or reproduced in any
manner without written permission from FIRST 5 Santa Clara County.
FIRST 5 High-Risk Design Research and Development Groups
Compendium of Relevant Research
January 2005
Table of Contents
VOLUME II
VIII. Research Abstracts
A.
Randomized Trial of Two Parent-Training Programs for Families with ConductDisordered Children and Enhancing the Effectiveness of Self-Administered Videotape
Parent Training for Families with Conduct-Problem Children, C. Webster-Stratton ............VIII-1
B.
Early Intervention for Families of Preschool Children with Conduct
Problems, C. Webster-Stratton ..............................................................................................VIII-3
C.
Educational Perspectives (Prepared by the WestEd Team)
1.
Education Policy Under Cultural Pluralism, December 2003 ...................................... VIII-5
2.
New Lives for Poor Families? Mothers and Young Children Move Through Welfare
Reform, April 2002....................................................................................................... VIII-7
3.
Preschool and Child-Care Quality in California Neighborhoods: Policy Success,
Remaining Gaps, August 2001 ................................................................................... VIII-9
4.
2003 Local Early Education Planning Council of Santa Clara County Child Care
Needs Assessment..................................................................................................... VIII-11
5.
Head Start Community Assessment, Santa Clara and San Benito Counties,
September 2003 ........................................................................................................ VIII-13
6.
A New Assessment of Child Care Need for Children Age 5 and under in
Santa Clara County .................................................................................................... VIII-17
D.
Children Exposed to Domestic Violence, Working with Multi-Risk Families, Parenting
Programs, Home Visiting, and Infant and Toddler Mental Health Programming
1.
Intervention for Children Exposed to Interparental Violence: Assessment of Needs
and Research Priorities, S.G. Graham-Bermann, H.M. Hughes ................................ VIII-21
2.
Good Practice With Multiply Vulnerable Young Families: Challenges and Principles,
R. Halpern .................................................................................................................. VIII-24
3.
Large Group Community-Based Parenting Programs for Families of Preschoolers at
Risk for Disruptive Behavior Disorders: Utilization, Cost Effectiveness, and
Outcome, C.E. Cunningham, R. Bremner, M. Boyle ................................................. VIII-26
4.
A Large-Group Community-Based, Family Systems Approach to Parent Training,”
C.E. Cunningham ....................................................................................................... VIII-29
5.
Predictors of Treatment Outcome in Parent Training for Families with ConductDisordered Children, C. Webster-Stratton ............................................................... VIII-30
6.
Improving the Life-Course Development of Socially Disadvantaged Mothers: A
Randomized Trial of Nurse Home Visitation, D.L. Olds et al. ................................... VIII-32
7.
Long-term Effects of Nurse Home Visitation on Children’s Criminal and Antisocial
Behavior: 15-year Follow-up of a Randomized Trial, D.L. Olds et al. ....................... VIII-33
8.
Infant Mental Health Interventions in Juvenile Court: Ameliorating the Effects of
Maltreatment and Deprivation, C.S. Lederman, J.D. Osofsky.................................. VIII-34
IX.
General Research Articles
Cartoon: Twins................................................................................................................................... IX-1
A.
The Effects of Early Intervention on Maltreating Parents and Their Children, D. Barnett,
The Effectiveness of Early Intervention, M. J. Guralnick, Ed., 1997
Compendium Table of Contents, Continued
B.
C.
D.
E.
F.
G.
H.
I.
J.
Education Policy Under Cultural Pluralism, B. Fuller
The Role of Home-Visitation Programs in Improving Health Outcomes for Children
and Families, American Academy of Pediatrics, American Council on Child and
Adolescent Health, March 1998
Mania in Six Preschool Children, by Tumuluru et al.
Patterns of Comorbidity and Dysfunction in Clinically Referred Preschool and
School-Age Children with Bipolar Disorder, Wilens, et al.
Affective Comorbidity in Psychiatrically Hospitalized Adolescents with Conduct
Disorder or Oppositional Defiant Disorder: Should Conduct Disorder be Treated
with Mood Stabilizers, Arredondo et al
Attachment, Bonding, and Reciprocal Connectedness, D. Arredondo and The Honorable
L. Edwards
Zero to Three: Critical Issues for the Juvenile and Family Court, J. Cohen and V. Youcha
Policy Brief: Preschool for California’s Children: Promising Benefits, Unequal Access,
PACE and the UC Linguistic Minority Research Institute, M. Bridges, B. Fuller, R.
Rumberger, L. Tran
Leveling the Playing Field: Supporting Immigrant Children from Birth to Eight, Future of
Children, R. Takanishi
X.
Education Articles
Cartoon: The Challenge of Interdisciplinary Communication............................................................X-1
A.
News from American Academy of Pediatrics: Developmental Milestones are
Especially Important for Bilingual Children .............................................................................X-3
B.
Language Development in Bilingual Children: A Primer for Pediatricians,
by V. Fierro-Cobas, and E. Chan .............................................................................................X-7
C.
Acquiring English as a Second Language: What’s Normal, What’s Not,
C. Roseberry-McKibbin, A. Brice, American Speech-Language-Hearing Association .........X-17
D.
Bilingual Acquisition in Preschool Children, by F. Genesee,
McGill University....................................................................................................................X-21
E.
10 Lessons Learned from My Students After a Few Tears: Lessons for
New Teachers, S. Duval, National Association for Bilingual Education................................X-25
F.
The Lessons from Classroom 506, L. Belkin, New York Times Magazine .............................X-29
G.
Getting from Here to There: To an Ideal Early Preschool System, Early
Childhood Research and Practice, J.J. Gallagher, R.M. Clifford, K. Maxwell........................X-43
XI.
General Interest and Background Articles
A.
Family Group Conferencing: Letting the Family Decide ........................................................ XI-1
B.
When You’re Not a Parent, But Your Client Is, by J. Johnson................................................ XI-5
C.
Harvard Family Research Project: How can early childhood settings encourage parents to
advocate for their child?........................................................................................................ XI-10
D.
Building Bridges for Babies in Foster Care: The Babies Can’t Wait Initiative,
S. Dicker and E. Gordon ........................................................................................................ XI-15
E.
Questions Every Judge and Lawyer Should Ask About Infants and Toddlers in the
Child Welfare System, J. Osofsky, C. Maze, Judge Lederman, Chief Grace,
S. Dicker
F.
Court Teams for Maltreated Infants and Toddlers, Zero to Three and the National
Council of Juvenile and Family Court Judges
XII.
Miscellaneous Articles, Book Reviews, and Book Redactions
A.
Chapter Redaction: Processes Associated with Resilience: Policy Implications, from
Resilience Reconsidered: Conceptual Considerations by Michael Rutter in Handbook of
Early Childhood Intervention .................................................................................................. XII-1
B.
Article Redaction: When Interventions Harm: Peer Groups and Problem Behaviors, by T.
J. Dishion, J. McCord, F. Poulin ............................................................................................. XII-5
FIRST 5 Santa Clara County
Page 2 of 3
Compendium Table of Contents, Continued
C.
D.
E.
Chapter Redaction: Nature, Nurture, and the Disunity of Knowledge, by Michael J.
Meaney, in The Convergence of Natural and Human Science ............................................ XII-11
Book Redaction: Power Beyond Measure by Ira Chasnoff, M.D. ........................................ XII-21
Book Review by C. Toppelberg, MD: Constructing a Language: A Usage-Based Theory
of Language Acquisition, by M. Tomasello, Harvard University Press, 2003 ...................... XII-29
XIII. Review Articles and Chapters
A.
Harvard Family Research Project Article: The Transition to Kindergarten: A Review of
Current Research and Promising Practices to Involve Families,
Bohan-Baker et al. .............................................................................................................. XIII-1
B.
Fetal Alcohol Spectrum Disorder, JAMA ......................................................................... XIII-11
C.
Resilience Reconsidered: Conceptual Considerations, Empirical Findings, and Policy
Implications, by M. Rutter, from Handbook of Early Childhood Intervention
D.
Paraprofessionals Revisited and Reconsidered, by J. Musick and F. Stott, Chapter 20,
Handbook of Early Childhood Intervention
E.
F.
G.
Early Childhood Intervention for Low-Income Children and Families, by
R. Halpern, Chapter 17, Handbook of Early Childhood Intervention
Language Disorders: A 10-Year Research Update Review,
C.O. Toppelberg, T. Shapiro, Journal of the American Academy of Child and Adolescent
Psychiatry
Pervasive Developmental Disorders: A 10-Year Review, P.E. Tanguay, Journal of the
American Academy of Child and Adolescent Psychiatry
Page 3 of 3
Section VIII. Research Abstracts
A. Randomized Trial of Two Parent-Training Programs for Families with
Conduct-Disordered Children
and
Enhancing the Effectiveness of Self-Administered Videotape Parent Training
for Families with Conduct-Problem Children
Carolyn Webster-Stratton PhD, FAAN
Professor, Family and Child Nursing
Director, Parenting Clinic
School of Nursing,
University of Washington
The first article appeared in the Journal of Consulting and Clinical Psychology in 1984, the second in the
Journal of Abnormal Child Psychology in 1990. Both were assessing the effectiveness of a series of
parent training videos under different conditions both immediately post-treatment and at one year post
treatment. The videotapes were produced by Carolyn Webster-Stratton and consisted of series of
vignettes lasting from one and a half to two minutes each.
In the first article, the 9-week group therapy program based on a standardized videotape-modeling
program was compared to 9 weeks of individual parent therapy. The group studied was “high-risk”
based upon the high number of single parents, the low socioeconomic scored, the low mean education
of the parents, the high prevalence of previous reports of child abuse and the deviant nature of the
child (CBCL reports of externalizing behaviors in the clinical range)
Multiple assessment procedures including the CBCL, The Eyberg Child Behavior Inventory, Parent Daily
Reports, Parenting Stress Index and the Dyadic Parent-Child Interaction Coding System employed by
trained raters were utilized pre-treatment, post treatment and at one year follow-up. Two findings
consistently emerged. First, at the immediate post-treatment assessment, both treatment groups of
mothers showed significant attitudinal and behavioral improvements when compared with untreated
controls. In addition, the children in the treatment groups showed reductions in deviant and
noncompliant behaviors compared with control children, but these changes were of borderline
significance. One year later, most of the changes in the mothers and children were maintained. Most
important, one year later, both treatment groups of children showed significant reductions in
noncompliant and deviant behaviors.
The second important finding that emerged was that there were no significant differences between the
two treatments on any of the attitudinal measures immediately post-treatment and also one year later.
Consistent with other findings, videotape modeling therapist-led group discussion appears to be highly
effective in training parents according to the author.
The second article (1990) contrasted two versions of the same videotape parent training program—one
version was totally self-administered and the other had two one hour consultations with a therapist and
availability of the therapist for consultation during the program in addition to the videotape training.
Parents were randomly assigned to one of the two treatments or to a waiting-list control group.
Measures utilized were the same as those utilized in the first article. Results indicated that regardless of
therapist feedback, the 10-week standardized self-administered videotape parent-training program led
Section VIII - Page 1 of 35
Compendium of Relevant Research: Section VIII—Research Abstracts, Continued
to significant improvements in mother reports of their children’s behavior problems as well as reduced
mother stress levels and reported use of daily spankings when compared with control mother reports.
The only significant difference found between the two treatment groups was that the therapist available
group mothers exhibited fewer no-opportunity commands and the children were less deviant with their
mothers than the non-therapist group.
The videotape program, according to the results, seemed to provide a “rough fit” and answers to most
of the parent’s questions. In other words, the vignettes in the videotape program were somewhat
generic and the use of therapist consultations helped customize the therapy to provide the best fit for
the unique problems and needs of each family.
B. Early Intervention for Families of Preschool Children with Conduct Problems
Carolyn Webster-Stratton PhD, FAAN
Professor, Family and Child Nursing
Director, Parenting Clinic
School of Nursing,
University of Washington
The first section of this chapter discusses the prevalence of oppositional and externalizing problems in
young children, the diagnostic ambiguity among ODD, ADHD and CD in the young preschool and early
school-age group as well as the co-morbidity among these diagnoses in young children. Stratton cites
research that suggests two pathways related to aberrant conduct disorders—“early starter” and “late
starter”. The early pathway begins with the emergence of aggressive and oppositional behaviors in the
early preschool period, progresses to aggressive and non-aggressive symptoms of conduct disorders in
middle childhood and then develops into the most serious symptoms by adolescence, and often into
antisocial adult behavior. Research suggests that the “early starter” type is the more serious pathway.
Stratton divides causes of conduct problems into three categories: child factors, parent and family
factors, and school-related factors. Child risk factors include: 1) Temperament; 2) Impairments in social
problem-solving skills and lack of social competence; 3) Low academic readiness-although for this
factor, the cause and effect relationship may be bi-directional. Parent and Family risk factors include: 1)
Parents’ personal and interpersonal problems including mental health problems, substance abuse, interparental conflict and violence, and maternal insularity or lack of support; 2) Ineffective parenting skills;
3) High levels of stressors including poverty, illnesses, unemployment; 4) Low school/home involvement.
School-related risk factors include: 1) Peer rejection; 2) Ineffective behavior management by teachers.
A final statement sums up much of the reading that the EMQ/First 5 Research Group has done:
“There are no clear-cut causal links between single risk factors and a child’s behavior;
most of these factors (child, parent/family and school factors) are intertwined,
synergistic and cumulative.”
Two types of programs were reviewed: Parent management training interventions and Child training
programs.
Parent Management Training Programs:
1. Oregon Social Learning Center (Patterson, Reid, Jones & Conger) – In this program, parents
first read a book, complete a test on the material and then work individually with a therapist
learning how to pinpoint problem behaviors, use reinforcement techniques, learn discipline
procedures, practice monitoring their children’s behaviors and develop problem-solving and
negotiation strategies.
2. Helping the Noncompliant Child (McMahon and Forehand) – In this program, parents are
taught how to play with their children in a nondirective way and how to identify and reward
children’s pro-social behaviors through praise and attention. Following this phase, parents are
taught ways to give direct, concise and effective commands and how to use 3-minute time-outs
for noncompliance. The program is conducted in a clinic setting with the therapist working with
individual parents and children together.
3. BASIC and ADVANCE Videotape Parent Programs (Webster-Stratton) – The BASIC program
takes 26 hours (13 two-hour sessions) and its methods include a series of 10 videotape
programs of modeled parenting skills shown by a therapist to groups of 8-10 parents. After
each vignette (1-2 minutes in length each), the therapist leads a group discussion of the relevant
interactions and encourages parents’ ideas. The group process is cost-effective and addresses
a family risk factor of isolation and stigmatization as the groups enhance and promote mutual
parent support networks. The ADVANCE videotape parent program takes 28 hours and
consists of 6 videotape programs which address other risk factors such as anger management,
depression, marital distress, effective communication skills, problem-solving strategies, ways to
give and get support and strategies for teaching children to solve problems and manage their
anger more effectively. Children to not participate in these sessions but parents are given
weekly homework exercises to practice various skills with their children at home.
Outcome immediately post treatment and at one year follow-up for all the above programs was
generally positive, especially for those parents who attended more than 50% of the sessions.
However, results often did not generalize to school environments even though family and child
reported fewer home problems.
Child Training Programs
1. Programs targeting specific social behaviors – For example, coaching children in positive
social skills such as play skills, friendship and conversational skills, behavioral control skills,
sharing skills.
2. Programs focusing on training children in the cognitive processes such as problem-solving
skills, self-control, empathy training, and perspective taking.
3. The Dinosaur Social Skills and Problem Solving Curriculum for children 4-8: This program
uses role playing, rehearsal, fantasy play, puppet plays and cooperative art activities and
games in a 22 week program of two-hour sessions teaching empathy training, building selfesteem, problem solving, anger management, etc. (Webster-Stratton). There is a parenttraining component that dovetails with the content of the child-training program.
Few outcome studies have been conducted, but those that have, indicate that outcomes with Child
Training Programs alone are less effective, especially for younger or less mature children and more
aggressive children, than programs that target the parent/family and may or may not include the
children.
Conclusions and Recommendations include the following:
• One limitation of parent training approach is the failure of improvements in child behavior
brought about by the parent training programs to generalize beyond the home to the childcare
and school settings and peer relationships.
• A second limitation of parent training programs is that they rarely, if ever, have included an
academic skills enhancement component.
• A third limitation of parent intervention programs is the possibility that parents will refuse to
participate.
• Many child-training programs are carried out with older middle-grade school children or
adolescents and these children have already had 5-10 years of experience in negative
relationships with peer groups, families and teachers and their behavior patterns may be well
established.
• Greater attention must be paid to developmental differences in work with younger children and
programs that are imaginative rather than cognitive might be more successful with younger
children.
• Preschool teachers and child-care workers should be well trained in child development and
behavior management skills.
• The most successful interventions will be those that are comprehensive and ongoing and
attentive to different Microsystems (classroom and family), involving child care providers,
teachers, health professionals, and the child’s peer group in the interventions along with the
family.
• Integrated programs should be offered early with populations at high risk to strengthen
families’ protective factors.
• The preschool period appears to be the optimal time to first intervene with programs that
facilitate children’s social competence and enhance parenting skills.
C. Educational Perspectives (Prepared by the WestEd Team)
Table of Contents: Educational Perspectives
1. Education Policy Under Cultural Pluralism, December 2003
2. New Lives for Poor Families? Mothers and Young Children Move Through Welfare Reform,
April 2002
3. Preschool and Child-Care Quality in California Neighborhoods: Policy Success, Remaining
Gaps, August 2001
4. 2003 Local Early Education Planning Council of Santa Clara County Child Care Needs
Assessment
5. Head Start Community Assessment, Santa Clara and San Benito Counties, September 2003
6. A New Assessment of Child Care Need for Children Age 5 and under in
Santa Clara County
-C 1Report:
Education Policy Under Cultural Pluralism
Educational Researcher, December 2003, Vol. 32, No. 9, pp. 15-24
Contact:
Address:
Bruce Fuller, Author, Co-Director of Policy Analysis for California Education
Policy Analysis for California Education
University of California, Berkeley School of Education
3653 Tolman Hall, Berkeley CA 94720-1670
(510) 642-7223
Phone:
Overview:
The article focuses on policy cases that prompt the long-term question of how
government can effectively balance the press for particular forms of schooling such as
charter schools and community building, against its modern desire to integrate groups
in large institutions. The author believes that the challenge to modern-day systemic
reformers is fundamentally cultural in nature, developing from a pluralist group of
inventive educators, ethnic networks (including affluent Whites), and community based
organizations, which together utilize public resources to advance particular ways of
raising and instructing children. This article suggests that these groups display little
interest in the modern state’s struggle to advance a larger, more inclusive common
ground.
Cultural Challenges to the Modern State:
• A variety of ethnic communities has lost faith in urban school leaders and their
bureaucracies. They, instead of participating, are creating their own schools, and
government is now legitimating this liberation to allow the utilization of public resources
to advance particular ways of raising and instruction children.
• The challenge of cultural pluralism is manifest in the idea that learning and child rearing
are structured more powerfully when situated in a particular milieu, where the child is
viewed as an autonomous creature with individual differences and naturalistic ways of
developing.
• The new policy of culture is becoming de-centered, promising assimilation into an
abstract community.
Policy Case on Early Care and Education in California:
• In 1989 when former President Bush introduced legislation to expand childcare through
tax credit, teacher unions, education lobbyists and House of Democrat countered the
proposal by a national program run by local schools. This resulted in $18 billion public
dollars moving into urban schools and deflected the attempts to move toward universal
preschooling. The Congress eventually created a $2 billion block grant program,
allocating funds to governors who must distribute the funds to low-income parents as
vouchers for child development services.
•
California spends $3 billion annually for public childcare and preschool programs,
through 23 separate funding streams and contracts with more than 1,300 local
organizations. The early care and education sectors are fluid and unsystematic with no
defined terminologies available. Many questions continue in the public dialogue, such
as:
o Are preschools the same as centers?
o What are the elements of quality that actually contribute to child development
and should be regulated by state government?
o Is this sector providing early education or just day care?
Local Effect of Modern Policy:
• Case 1: Scholars found Catholic schools have higher graduation rates, compared to
youths moving through public high schools. There is interest to further study this
outcome.
• Case 2: Many ECE practitioners continue to view an all-Latino charter school on its test
scores, rather than pushing deeper to assess students’ motivation or civic engagement.
Policy Implications-Policy Under Cultural Pluralism:
• Researchers need to investigate further to understand how diverse cultural groups and
their organizations are placing new demands on the state, the postmodern forces within
policy circles, including the rise of neighborhood organizations and national advocates
for decentralization, as well as their success in moving the central state to fund local
schools and preschools.
• Continued empirical research is helpful to address the underlying political dynamics and
consider whether the rise of these new organizational forms would improve children
and families’ lives.
• It is naïve under conditions of cultural pluralism for researchers continue to functionally
assume that the state’s intentions are aimed at how local communities want to raise
their children.
• What is truly public? Moral commitments and forms of economic activity endorsed by
diverse cultural, religious and social-class groups?
This study can be found at <http://www.aera.net/pubs/er/pdf/vol32_09/ERv32n9_pp15-24.pdf>
-C 2Report:
New Lives for Poor Families? Mothers and Young Children Move through Welfare
Reform. Wave 2 Findings—The Growing Up in Poverty Project California,
Connecticut, Florida, April 2002.
Contact:
Address:
Bruce Fuller, Project Manager, Growing Up in Poverty Project
Policy Analysis for California Education University of California, Berkeley School of
Education 3653 Tolman Hall, Berkeley CA 94720-1670
(510) 642-7223
Phone:
Funding:
The Growing Up in Poverty Project is funded by the Packard, Spencer, and Annie E.
Casey Foundations, The U.S. Department of Education, the Child Care Bureau of the
U.S. Department of Health and Human Services, the Miriam and Peter Haas Fund, and
the Luke Hancock Foundation.
Background:
In 1996, the White House passed the Personal Responsibility and Work Opportunities
Reconciliation Act (PRWORA). The Congress and the President expressed hope that
welfare-to-work initiatives would aid women and their children with new resources to
support work such as increased child care funding, extended child health insurance to
working-poor parents, and enlarged tax benefits for low-income parents who remain on
the job. This PRWORA led to changes in family behavior inside communities. Nationally,
single mothers drawing cash aid fell from 5 million in 1994 to 2.1 million in 2001.
Project Goals:
The goals of the Growing Up in Poverty Project were to measure the effects of welfare
reform on children and their mothers; the percentage of eligible parents using licensed
child care and child-care subsidies and to make recommendations regarding the new
welfare reform regulations.
Study Design: The Growing Up in Poverty Project field staff invited over 1,000 single mothers between
1998 and 2000, as these families moved through new state welfare programs in
California, Connecticut and Florida. These single mothers shared two characteristics:
each was entering a new state welfare program with a strong work-first emphasis, and
each had at least one preschool-age children of 12 to 42 months at home. The project
recruited these families from five counties, San Francisco, Santa Clara, Manchester, New
Haven and Tampa, spread across three states: California, Connecticut and Florida.
Study findings from wave 1 and wave 2 data collection were released in 2000 and 2002.
A third wave of maternal interviews and child assessments are being completed in the
years 2003 to 2004 among the California samples. Wave 3 findings will be available in
Spring, 2004.
Data:
Major findings from this report indicated that the lives of mothers had changed in years
between 1998 and 2000 after entering new welfare programs: many had found jobs,
often working odd-hours and weekends; most reported spending less time with their
young child; and most were replying more heavily on child care providers. Maternal
employment gains and upward movement in total income were the modest magnitude,
with mothers earning less than $13,000 per year. Home environments changed little
and mothers continued to suffer high rates of emotional depression. More children
(over one-third of participating children) entered center-based programs. Lowperforming children who were in centers displayed stronger learning trajectories in
terms of cognitive proficiencies, language, and school readiness skills.
Policy Implications:
The study's findings suggest that although mothers' net income were able to raise as
they transitioned off cash aid, the gains were not sufficient to alter the character and
quality of home environment. Many families remained below the poverty line and in
debt. Few reported being able to move into better neighborhoods. Others spent less
time with their young children. There were no consistent signs that home settings were
becoming more nurturing places, or mothers could find more time or to read with their
children, develop deeper attachments, or to heal from emotional depression. Although
these single mothers have succeeded in finding a job, the study's evidence suggests
that working low-wage jobs alone does not improve the daily settings in which children
are being raised. For a truly successful welfare reform, work must pay for children, as
well as for their mothers to provide new possibilities and a new life.
-C 3Report:
Preschool and Child-Care Quality in California Neighborhoods:
Policy Success, Remaining Gaps August 2001
Contact:
Address:
Bruce Fuller, Co-Director of Policy Analysis for California Education
Policy Analysis for California Education
University of California, Berkeley School of Education
3653 Tolman Hall, Berkeley CA 94720-1670
(510) 642-7223
Phone:
Preschool and Child-Care Quality in California Neighborhoods: Policy Success,
Remaining Gaps study is funded by the David and Lucile Packard Foundation and is a
Funding:
cooperative study by University of California, Berkeley, Policy Analysis for California
Education and the California Child Care Resource and Referral Network in San
Francisco.
Background:
Due to the steadily increased rates of maternal employment, the demand for centerbased care and preschools has increased. Researchers have conducted studies to
examine center quality across diverse communities in the United States. Findings from
these studies reveal mixed results. Some studies have shown quality indicators among
centers in poor neighborhoods fall significantly below levels observed in centers in
affluent or middle income areas, where other research reveals that quality such as childto-staff ratios or staff salaries is higher in heavily subsidized centers.
This study examined whether quality is unequally distributed between affluent and poor
communities in 170 sample centers and preschools in California’s three counties: Los
Angeles, San Francisco, and Santa Clara.
Research Goals:
The research goals of the report, Preschool and Child-Care Quality in California
Neighborhoods: Policy Success, Remaining Gaps were to measure and examine 1) the
levels of quality observed among centers located in diverse lower-income communities;
2) association between local supply conditions and program quality and; 3) relation
between a program’s quality and it’s ability to draw different subsidy flows from its
environment.
Study Design: The study explored variability in the quality of 170 centers and preschools located in 20
California zip codes in three counties: Los Angeles, San Francisco and Santa Clara. The
zip codes selected for the study contain significant concentrations of lower-income
families in which a large share of families earned less than 200% of the poverty line.
California was chosen for this study due to its large child development services
contracting system through 13,000 different agencies (including school districts and
community based organizations). The quality indicators used in the study included the
maximum number of children in class for 3 year-olds, the average ratio of children per
adult across all classes comprised of 3 year-olds, the number of staff who left the center
in the prior year and the director’s school attainment level. The data of the study were
obtained through a half-hour phone interview with the 176 center directors located in
the selected zip code areas.
Data:
•
The average level of quality for the 170 sampled center is quite high, despite the fact
that the centers were located mostly in the lower-income communities. Quality levels
were similar or higher than centers in national studies in middle-class neighborhoods.
•
•
•
•
Centers showed higher levels of quality when directors were able to obtain public
funding, in part, due to the subsidies tied to state quality standards.
The quality of centers decreases in communities where family demand outpace the
supply of existing centers, especially within predominantly Latino areas and workingclass neighborhoods where family income is somewhat higher than in poor
communities.
Center quality is largely insulated from the exigencies of lower-income communities
except in areas where excess family demand persists. The state financing and regulatory
system appears to be effective in strengthening quality, despite levels of poverty.
Linkages with local resource and referral agencies appear to strengthen a center’s
ability to sustain higher quality and offer additional services, such as infant care.
Policy makers have little knowledge on how the quality of center-based programs is
distributed across communities, and whether income-rooted inequities are apparent.
Therefore, pushing forward along this line of research could be informative to include a
wider range of communities and centers to serve middle-income and affluent families.
Further investigate and identify policy levers that most effectively advance center
quality; for instance, to examine whether Title 22 regulations exert a similar or weaker
pressure on centers to improve quality, given that they have no direct relationship with
the state education department.
The study findings demonstrate directors who have stronger linkages to public funding
can sustain higher quality. However, further investigation is needed to examine which
funding strategies and incentives are most effective.
The study findings suggest that centers with stronger links to local resource and
referrals display higher quality, yet, the question remains: how centers can be brought
together locally to form stronger infrastructures.
-C 4Report:
2003 Local Early Education Planning Council of Santa Clara County
Child Care Needs Assessment
Contact:
Martin Selznik, Coordinator, Local Early Education Planning Council
of Santa Clara County
Santa Clara County Office of Education
1290 Ridder Park Drive - MC 225
San Jose, CA 95131-2398
408-453-6649
Address:
Phone:
Overview:
This report contains eleven data categories and seven policy implications on child care
needs assessment in Santa Clara County. The categories include data on the child care
needs of families who are eligible and ineligible for subsidized child care, waiting list
statistics for State funded programs, child care needs for children determined by the
child protective services agency, number of children in families receiving public
assistance, family income among families with preschool or school age children, number
of children in migrant agricultural families, number of children who have been
determined by a regional center or a Local Education Agency to require services
pursuant to an Individualized Family Service Plan or an Individualized Education Plan,
special needs based on geographic considerations, number of children in county by
primary language, and the number of children needing child care services by age.
Data:
Santa Clara County has 143,338 children age 0-5, 61% need child care by someone
other than a parent, 39% are cared for full time by their parents.
34,600 or 24% of the children need financial or other assistance with their child care
arrangements.
14,803 referrals for child care from abuse situations were reported.
23,000 children receive public assistance including CalWORKs, Food Stamps, MediCal and CHI health insurance
Self-sufficiency income in the County is $60,070 for a family of one working adult
and two children(one infant and one preschool child). 13% of households have
family income less than $30,000, 21% have income $30,000-60,000, 24% have
income of $60,000-125,000 and 27% have income of over $125,000 per year
There are a total of 4,564 children from migrant agricultural families. Gilroy Unified
School District, Morgan Hill Unified School District, Alum rock Elementary, and
Franklin McKinley Elementary have a large number of children from migrant
families.
Special Education Local Plan Area (SELPA) has identified 17,727 children age 0-13
with a disability. 10,862 of the children need childcare
1,339 children ages 0-5 are at risk for, or have an identified developmental disability
through the San Andreas Regional Center. 816 of the children need child care
services.
54 different languages are spoken in Santa Clara County. The majority of the
English Learners are Spanish speaking 62%, 14% speak Vietnamese and Pilipino
(Tagalog), Mandarin (Putonghua), Cantoneses, Punjabi, Korean, Japanese and
Khmer (Cambodian) comprise the other 18% of different spoken languages.
There is a total of 24,785 licensed center-based child care and 14,669 licensed
family child care slots available for children age 0-5 with approximately 41,568
children age 0-5 need center-based child care.
•
What kind of school readiness services are available to children who are being cared
for by family members or do not have access to childcare?
•
Without adequate funding for childcare for CalWORKs participants, the quality of
(early care and education) services will suffer, negatively impacting children’s
readiness for school.
•
When the economy is in a recession, low-income families have fewer options when
adjusting to harsher economic times.
•
Access to school readiness programs must be made available to children whose
parents must migrate to stay employed
•
The State legislature and Department of Education need to consider the cost of
living in all areas of California when determining reimbursement rates for state
subsidized programs. Santa Clara County is reimbursed at the same rate as
programs in lower cost counties, making it difficult to provide necessary support
services to all children, especially for children with special needs.
•
Teacher preparation and training institutions must provide public and private
agencies with personnel that are prepared to respond to family and children’s
needs.
•
Support of staff development and compensation of early education staff must
improve to enable agencies have qualified staff and will insure children are ready to
learn, and families are able to support school.
-C 5Report:
Head Start Community Assessment
Santa Clara and San Benito Counties, September 2003
Center for Educational Planning,
Contact:
Address:
Don Bolce, Center for Educational Planning
1290 Ridder Park Drive, MC 243
San Jose, CA 95131-2398
(408) 453-6649
Phone:
OVERVIEW
Intent of Assessment:
Head Start regulations require each Early Head Start and Head Start grantee agency to
conduct a Community Assessment within its service area once every three years. The
report is intended to provide a basis for planning for the Santa Clara County Office of
Education Head Start Program for the period 2004-07. The Head Start planning group
is charged with developing three-year goals, one-year objectives, and a framework for
providing services for Head Start eligible children in Santa Clara and San Benito
counties. This includes decisions about:
1. Geographic distribution of services
2. Options (home-base/center-base, part-day/full-day, etc.)
3. Staffing patterns
4. Collaboration priorities
The Assessment provides external county and internal Head Start data on these areas of
planning.1
Head Start:
Head Start is a comprehensive child development program for young children and
families living below the federal poverty level. The comprehensive program includes:
1. Early childhood education
2. Health and nutrition services
3. Parent education
4. Social service support.
Begun as a six-week summer preschool program in 1965, Head Start offers multiple
program options including: full-day and part-day center programs, home based
programs, home-center combination, and partnerships with local community resources
(e.g. child care, health, and housing and programs organizations).
The Santa Clara County Office of Education is the Head Start grantee serving Santa
Clara County and San Benito County. The Head Start programs divides these counties
into eight service areas: Northwest County, Northeast County, Downtown San Jose,
West Valley, East Valley, Morgan Hill/Diablo, and San Benito County.
Assessment Approach:
The data gathered for the Community assessment required different sources. The key
resources for the Assessment were: the Santa Clara County Head Start Program
Information Reports (PIR), the Santa Clara County Social Services Department, the Local
Child Care Planning Council, the California Department of Education and the Santa
1
The Head Start data section is based on 2,317 Head Start children, 514 less than the actual enrollment of 2,831.
Complete data was not available for the report
Clara Count Public Health Department-Santa Clara’s County Children and Youth, Key
Indicators of Well-Being, 2003.
EXTERNAL DATA: COUNTY
Demographics:
•
•
•
•
•
Based on Census 2000 data, California has a total population of 33,871,658, Santa
Clara County has a total population of 1,682,592 and San Benito County has a total
population of 53,235.
124,123 children under age 5 live in Santa Clara and San Benito Counties. Of this
population, 44.7% are White, 34.9% are Latino, 25.2% are Asian American, and
2.6% are African American. Of 27,076 total live births in Santa Clara County in 2001,
8,086 were White/Other/Unknown, 8,818 were Asian/Pacific Islander, and 9,499
were Latino. 1,754 of the total were teen births.
7,096 families with children under 5 have an income level below the poverty level in
Santa Clara County and 302 families with children under 5 have an income level
below the poverty level in San Benito County. 9,476 children under 5 are living
below the poverty level in Santa Clara County and 463 children in San Benito
County. An estimated 3,976 3- and 4-year-olds are living below the federal poverty
level in Santa Clara and San Benito Counties.
6,590 pubic assistance cases in Santa Clara County for food stamps and 460 in San
Benito County.
$81,707 median family income in Santa Clara County, $53,025 median family in
California and $50,046 median family income in the United States.
Health:
•
•
•
24% of 2,657 three to four-year olds who were enrolled the Women, Infants, and
Children Program (2001) were overweight. Of the 3,718 children between one and
two years enrolled in this program in the same year, 19% were overweight.
5,900 estimate number of children in Santa Clara County between one to five years
of age with abnormal blood lead levels. Of the serious cases of abnormal blood
levels between 1990 to 2000, 84% were Hispanic children, 54% were younger than
two years old, and 33% were between the ages of three and four
In 2003, Hispanics children were recognized to be twice as likely to be without
dental insurance compared to White and Asian children.
K-14 School System:
• Number of Public K-14 School Districts in Santa Clara County: 36
• Number of Public K-14 School Sites: 347
• Schools in Santa Clara County with API scores below 800 (680 average) have a
higher percentage of low-income students, English learners and non-fully
credentialed teachers in comparison with schools with API scores above 800 (869
average).
Child Development Services:
• Child development services by the California Department of Education (CDE) in
Santa Clara County: 1. Contract Child Care and Development (General Child Care,
Campus Child Care, State Preschool) and 2. Alternative Payment Program
(Alternative Payment Program/AP and CalWORKs for Stage 2 & Stage 3)
• Child Care through CalWORKs Stage 1 is administered by the California
Department of Social Services.
• 3,454 children ages 0-5 are recipients of Stage 1 child care subsidy.
• Approximately 4,472 child care spaces were provided in Santa Clara County
through Contract Child Care and Development by 28 agencies in FY 2002-03.
•
•
Approximately 6,447 child care space were provided in Santa Clara County through
Alternative Payment and CalWORKs contracts.
Other Child Development Programs in Santa Clara County include: First 5 Santa
Clara County, Even Start, & Migrant Head Start.
INTERNAL DATA: HEAD START
Demographics
•
•
•
•
64% of Head Start population is Latino, 24.9% are Asian American, 3.5% are African
American and 6.6% are White.
Spanish is the primary home language for 44.6% of Head Start children, Vietnamese
for 18% of Head Start children, and English for 33.8% of Head Start children.
40% of Head Start children live in a two-parent family and 60% live in a one parent
family.
Of 2361 children, 39.3% (929) of mothers of Head Start enrolled children are
employed full time while 29.7% (701) are unemployed. Of 1,232 children, the
employment status for guardians other than mothers is 55.8% (688) are employed
full time and 33.4% are unemployed (412).
Enrollment
•
•
•
•
77 Head Start Centers are located in Santa Clara Country and 4 in San Benito
County.
Based on the 2002-2003 program year, Head Start had a total actual enrollment of
2,831 children.
Of 2,361 children, full-day sessions were provided to 1,414 children and part-day
sessions (either AM or PM) were provided to 947 children.
Of the service areas in Santa Clara County, Northeast County, Downtown San Jose
and East Valley enroll the largest number of Head Start Children, a total of 1,701
children.
Health and Family Services
• The most prevalent known medical conditions for Head Start children are: asthma,
anemia, vision problems, overweight and seizures.
• In the 2002-03 program year, 1,270 Head Start children received a dental exam and
864 were diagnosed as needing dental treatment.
• The primary disabilities of Head Start Enrolled Children are: speech/language
impairments, orthopedic impairment, health impairment, autism, and visual
impairment/blind.
• The most common social service need for families of Head Start enrolled children
are: education, health, dental, employment and parenting.
ISSUES
Report Issues
1. Distribution of Centers
Head Start Centers are generally located in areas with the greatest need. Locations
may hold subsidized child care programs where these programs may be enrolling Head
Start eligible children. Head Start may choose to partner with these programs or may
choose to allocate services in another area.
2. Program Options
Head Start has made a strategic shift towards providing full-day services to meet the
needs of employed parents. Head Start funding, however, may not be sufficient to
sustain or expand full-day services.
3. Child Health & Family Partnership
The report found insufficient or less clear data resulting in questions on the health and
social service needs of Head Start eligible families. The 2002-2003 program data
regarding health and social service needs was incomplete at the time the report was
being prepared.
Internal Issues
1.
2.
3.
4.
How will the program reduce class size without additional resources?
How will the program recruit and retain qualified staff?
What new management systems are needed for new delivery systems?
How will the Santa Clara County Office of Education, as the grantee, support the
Head Start program?
External Issues
1. How will California’s state and local budget crises affect Head Start services?
2. How will federal legislation, policies on funding affect Head Start services?
3. How will Head Start work with public schools around “school readiness” and
transition?
4. What role will Head Start play in Universal Preschool initiatives?
-C 6Report:
A New Assessment of Child Care Need for Children Age 5 and Under
In Santa Clara County, September 2002
Contact Address:
International Child Resource Institute
1581 LeRoy Avenue
Berkeley, CA 94708
Phone:
(510) 644-1000
Sponsor:
OVERVIEW
Intent of Assessment
First 5 Santa Clara County initiated a need assessment project to develop an accurate
estimate of the current child care need in Santa Clara County with four project goals: 1)
estimate need for child care for children age 0-5, 2) estimate the number of children
age 0-5 whose parents need subsidized child care program (public or private source)
and 3) estimate unduplicated number of children age 0-5 on subsidized
eligibility/waiting lists and 4) level of duplication on non-subsidized and subsidized child
care center eligibility/waiting lists. The International Child Resource Institute (ICRI) was
selected to develop the assessment.
Assessment Approach
ICRI made analysis through four methods: 1) analysis of wait/eligibility list samplings
from non-subsidized centers, subsidized centers and Alternative Payment programs 2)
analysis of the results from a survey of families in the community 3) analysis of the
combination of the two sources of data and 4) developing a methodology to calculate
the total need for child care for children 0-5 years of age.2
Comparison of findings are made with Santa Clara County findings found in the
following sources: 2001 Child Care Portfolio by the California Child Care Resource and
Referral Network, US Census demographic data, the Silicon Valley Children’s Report
Card 2000, reports from Harder+Company Community Research.
DATA
The project was designed to answer the following questions:
•
How many children need childcare in Santa Clara County?
An estimate total of 87,436 children (61% of total number of children in Santa Clara
County of 142,338 age 0-5) need childcare by someone other than a parent.
• How many parents need licensed care or unlicensed care?
Approximately 8% (11,467of 87,436 children) use licensed family child care and 29%
(41,568 of 87,436 children) use licensed center-based care. An estimate total of 22% of
families (31,534 of 87,436 children) use unlicensed care through relative or nanny care.
•
How many parents stay at home with their children?
2
The overall need for child care in Santa Clara County was calculated based on two factors: the total
number of children age 5 and under (143,338) multiplied by the percentage of parents who indicated
need for child care for their children (61%). The formula is: (143,338 children) * (.61) = 87,436 children.
Overall, approximately 39% of parents indicated that they use only parent care for their
children.
•
What is the income of families with children needing childcare in Santa Clara
County?
Family income of households in Santa Clara County (SCC) in comparison to the need
assessment project survey is as follows: Under $30,000-12% SCC/3% Survey; $30,000
to $70,000-29% SCC/14% Survey; Over $70,000-79% SCC/83% Survey.
•
What is the ethnic breakdown of families who indicated they needed childcare?
The ethnicity of children 0-4 in Santa Clara County, based on Census 2000 data, is 31%
White, 26% Asian/Pacific Islander, 34% Latino, 2% African American, 1% American
Indian/Native Alaskan and 6% are other.
•
What is the marital and employment status of families with children age 0-5 who
need child care?
About 85% of the households in Santa Clara County are married couple families with
children under age 6. The assessment project survey reflected 91% of the married
couple families. The employment status of the survey respondents reflect that 61% of
the respondents are employed outside the home while 86% of their spouses are
employed.
•
Where do parents live who indicated they need childcare?
Approximately 36% of the parents needing childcare live in San Jose, 16% live in
Sunnyvale, 12% live in Mountain View, and 11% live in Los Altos.
•
What is the cost of childcare to parents?
The average monthly cost of full time childcare in Santa Clara County is approximately
$940 for an infant and $610 for a preschool age child according to the 2001 California
Child Care Portfolio. Of the families surveyed through the assessment project, 66%
pay less than $600 per month for child care including parents and relative care and 43%
pay $200 or less. Of the families not using related caregivers, 40% pay less than $600
and 61% pay $600 or more per month.
•
How many parents need help to pay for childcare?
15% of families (21,500 children or 15% of 143,338) indicated that they needed help to
pay for childcare and 3% of families indicated that they had their child listed on an
eligibility/waiting list in the county.
•
How many parents currently receive some sort of financial or other assistance with
their childcare?
8% (11,000 children or 8% of 143,338) indicated that they currently receive some type
of subsidy assistance. Both Harder+Company Community Research and Silicon Valley
Children’s Report Card 2000 have also reported that approximately 11,000 children are
receiving childcare subsidy assistance.
Eligibility/Waiting List Data
• 202 full-cost non-subsidized center programs indicated that they did not have a
waiting list.
• 42% of children on a subsidized eligibility/waiting list were age 0 to 2 years.
• 58% of the children on a subsidized eligibility/waiting list were age 3 to 5 years.
• Within the combined non-subsidized and subsidized eligibility/waiting lists, 5.2% of
the children were duplicates.
• 48 is the average length of a eligibility/waiting list from subsidized centers with
children ranging from 1 to 401. The unduplicated number of children on a
subsidized eligibility/waiting list is 5,670.
• 58 is the average length of a waiting list from non-subsidized centers with children
ranging from 2 to 282. The unduplicated number of children on a non-subsidized
waiting list is 3,445 children.
• 2,620 is the approximate non-duplicate number of children waiting to be accepted
to one of the Alternative Payment programs in Santa Clara County.
• The total number of subsidized centers serving children age 0 to 5 years in Santa
Clara County is 148.
ISSUES
There is a continuing need for all types of child care in Santa Clara County.
There is a significant need for subsidized care.
Duplication on subsidized eligibility/waiting lists is significantly lower than expected.
D. Children Exposed to Domestic Violence, Working with Multi-Risk Families, Parenting
Programs, Home Visiting, and infant and Toddler Mental Health Programming
Table of Contents
1. Intervention for Children Exposed to Interparental Violence: Assessment of Needs and
Research Priorities, S.G. Graham-Bermann, H.M. Hughes
2. Good Practice With Multiply Vulnerable Young Families: Challenges and Principles, R.
Halpern
3. Large Group Community-Based Parenting Programs for Families of Preschoolers at Risk for
Disruptive Behavior Disorders: Utilization, Cost Effectiveness, and Outcome, C.E.
Cunningham, R. Bremner, M. Boyle
4. A Large-Group Community-Based, Family Systems Approach to Parent Training, C.E.
Cunningham
5. Predictors of Treatment Outcome in Parent Training for Families with Conduct-Disordered
Children, C. Webster-Stratton
6. Improving the Life-Course Development of Socially Disadvantaged Mothers: A
Randomized Trial of Nurse Home Visitation, D.L. Olds et al.
7. Long-term Effects of Nurse Home Visitation on Children’s Criminal and Antisocial Behavior:
15-year Follow-up of a Randomized Trial, D.L. Olds et al.
8. Infant Mental Health Interventions in Juvenile Court: Ameliorating the Effects of
Maltreatment and Deprivation, C.S. Lederman, J.D. Osofsky
- D 1Intervention for Children Exposed to Interparental Violence: Assessment of Needs
and Research Priorities
Sandra Graham-Bermann,
Department of Psychology, University of Michigan, Ann Arbor, Michigan
Honore M Hughes
Saint Louis University, Saint Louis, Missouri
Clinical Child and Family Psychology Review, September 2003,
pp. 189-204, Vol.6, No. 3, Plenum Publishing Corp
This review paper provides an overview of research and programs geared to children who have been
exposed to interparental violence (IPV). Current thinking and research point out the following:
•
•
•
•
•
•
Within a group of children exposed to IPV, there are marked differences in what the children
may witness and experience.
Children with a single risk factor were no more likely to exhibit adjustment problems than
were those with no risk factors
Children exposed to multiple forms of violence were identified as high in risk for negative
outcomes and frequently those most in need of intervention services
A differential impact by gender was found in several studies, with boys more likely to exhibit
externalizing symptoms and girls more likely to react with internalizing symptoms.
Young children in particular (ages 0-5) were more likely to be present in households with
domestic violence, and thus at greater risk of being affected by violence.
Family stress and poverty are added risk factors for children exposed to IPV.
•
•
Parenting practices and mother’s mental health have been identified as potential contributors
to risk for children exposed to family violence.
Most training manuals do not elucidate the needs of children in diverse ethnic groups.
The article then goes on to give three examples of recent exemplary studies. The studies were felt to
be exemplary because they had been designed on the basis of theory and practice, have random
assignment of children to different treatment conditions, use appropriate comparison groups, contain
pre- and post-treatment assessments, have a reasonably long follow-up period, utilize adequate
samples and address the needs of children in different cultural groups. The three studies cited are:
•
Advocacy and The Learning Club: This is a 16-week intervention for abused women and their
children that provides advocacy services to mothers, a 16-week mentoring experience for
children and an educational program. The sample consisted of women leaving shelters and
their children ages 7-11. Mothers receive advocacy by trained undergraduate students in
obtaining help with difficult issues regarding their children, obtaining goods and services, legal
issues, employment, education, social support, child care, housing and transportation.
Contact with the family is intense and trained students work with each family for an average of
9 hours per week. Transportation is provided for the children to attend the Learning Club.
Outcome data at 8 month post treatment showed that the advocacy for the women and
children, plus the children’s group education program significantly reduced violence and
changed children’s perceptions of themselves.
•
Project SUPPORT: This program was specifically designed for young children ages 4-9 years
exposed to IPV who have high levels of diagnosed aggressive behavior problems. Participants
were mothers and children leaving shelters for battered women. A thorough screening and
assessment of the child’s behavior problems was followed by clear goal setting for both the
child and the parent. On average, the intervention lasted for 8 months with a mean number of
23 home visit sessions per family. The primary focus was on the mothers who met with a
therapist weekly for 60-90 minutes to receive parenting coaching with the goal of building on
existing parenting skills. Trained paraprofessionals also provided advocacy for the mothers
and served as role models. Child had a supportive mentor and weekly supervision sessions
were included. The program served Anglo, African American and Latina mothers.
Improvements in the children’s externalizing behavior problems were found to remain at 16
months post shelter stay.
•
The Kids Club: This program takes place over 10 weeks and provides support for children
aged 5-13 and their mothers. Sessions are devoted to educating children about family
violence, promoting positive beliefs and attitudes about families and gender, reducing fears
and worries and building social skills in a small group setting. Group leaders follow a training
manual and mothers receive support for parenting. The program was developed and then
adapted for use with children from a range of ethnically diverse groups, including African
American, biracial, Hispanic, Native American, Arab American, international and Caucasian
families. Change was greatest for those in the child-plus mother groups.
General recommendations provided include the following:
•
•
•
•
•
•
Match family members’ needs with appropriate types of interventions. Many children who
complete intervention programs have unmet needs that can be addressed with additional
treatment
Evaluation researchers need to assess the cumulative risk factors with which many children must
contend.
Test interventions that include age, gender and cultural diversity factors.
Assess protective factors by examining the “successful” children and the parents who
successfully survive adversity and parent effectively.
Expand the range of outcomes studied
Specify and test various levels of intensity of interventions.
•
•
Include a study of duration of interventions
Create public policy for better funding of outcome studies of interventions.
-D 2Good Practice With Multiply Vulnerable Young Families: Challenges and Principles
Robert Halpern
Children and Youth Services Review, 1997. Vol. 19, No. 4, pp. 253-275
This article discusses challenges to helping professionals working with multiply vulnerable young
families and provides several suggestions on supporting “frontline” practice.
The personal histories of many of the young parents who come to the attention of social service and
community agencies are replete with adversity in many spheres, including disruptions in caregiving,
inadequate nurturance and/or rejection, parental substance abuse, family violence, sexual abuse,
chronic poverty, discrimination and school difficulties. This constant adversity impacts young adults and
does not provide them the opportunity to address and master key developmental tasks that provide a
foundation for parenting and adult role assumption. The nurturance experiences of these young
parents are internalized and create representational models of what they are like as people, what can
be expected from other people, and what both parent-child and adult relationships are like and this can
influence the young parents’ relationship with, behavior and feelings toward their own children.
These families frequently are ambivalent and may be indifferent, wary or hostile toward those who offer
help. They may have learned from their own childhoods that expectations of positive responses from
others lead to disappointment. They may have been part of the “system” themselves and be less than
trusting in the role of “professionals”. They can be hard to make and maintain contact with, requiring
persistent outreach. They may choose or be forced to move frequently and lack resources to maintain
phone service. Primary caregivers for children can change more than once during any year as can family
membership and support systems. They may make promises and not keep them, may seek help to
meet a concrete need and then refuse to follow-up after that assistance, make life decisions which
further exacerbate the chaos in their lives.
The effects of multiply vulnerable parents’ basic life situation and behavior on those who would try to
help are enormous. A provider may have little sense of whether or not they are “getting through” to
the young parent. They may go from crisis to crisis without any sense of progressing toward objectives
set with the family. They may put energy into a family, only to see that energy absorbed or dissipated
by a mother’s depression. They may feel that gains are being made only to have a bad decision or an
unexpected event unravel that progress. Often providers have to battle other agencies to undo
destructive decisions or to secure resources for the families.
Providers may experience a range of powerful emotions that can undermine their work. They may
come to feel angry at a parent’s lack of reciprocity. They may come to avoid certain difficult problems
(consciously or not) in order to avoid the feelings those problems evoke in themselves. They may wish
(consciously or not) to withdraw or escape from working with a family or close the case. They may
become angry at a service system that has repeatedly failed certain families. They may feel a strong
desire to by-pass a parent to assure that a child’s developmental needs are met. They often will have
doubts about the efficacy of their work and whether they are “cut-out” to be in the field.
The author suggests several general principles of good practice to help providers cope with the
heightened challenges of work with multiply vulnerable parents. He suggests that vital to the work with
multiply vulnerable young parents is the expectation that they will give—including giving back to the
helper—“within their capacities”. Equally vital is the assumption that such parents’ thoughts and
actions “are worthy of being considered in the most positive way possible”.
However, maintaining these perspectives requires understanding passivity, lack of reciprocity, or other
manifestations of “resistance” in context. For the most part, “resistance” represents the parent’s best
effort at “problem-solving and seeking mastery” albeit in disguised and often self-defeating ways.
Chronic poverty and its correlates are genuinely exhausting and demoralizing, sapping the physical and
psychological energy needed to maintain helping relationships. Young families living in poverty are
very vulnerable to the power of helping institutions and these often have been controlling, unreliable
and destructive, rather than supportive and reliable.
It is important to allow the helping relationship unfold in its own way and at its own pace and for the
provider to be available but without pressing, to contain their own anxieties about getting through to a
client, making progress and resolving problems. A balance must be struck between doing too little or
too much—not reinforcing the idea that the person is incapable of doing things on their own nor
reinforcing the belief that others are unavailable and unsupportive. Providers must retain a constant
focus on where the family is developmentally, what family members are capable of, and what realistic
expectations might be. It requires breaking tasks and expectations down, creating small steps for
parents and helping to hold the positive image. It requires the provider to model planful behavior and
ensure opportunities for parents to practice such behavior. It also requires the provider to reinforce
autonomous behavior, however tentatively it is expressed.
A framework of appropriately modest expectations regarding impacts and change and an
understanding that change is gradual, fragile and reversible with setbacks expected are necessary mindsets. Change is difficult in part because peoples’ ways of thinking, responding and coping are tied to
their basic sense of identity—their internal representations of themselves. Change often requires
letting go of, and sometimes repudiating beliefs, supports, customary ways of coping, etc. before new
beliefs, supports, ways of coping have been consolidated. Change is also difficult because people are
embedded in social milieus that reinforce existing views of self, ways of coping and relating. Change
can be threatening.
The two critical structures required to support work with multiply vulnerable families according to the
author are:
1. The articulation of a clear theoretical framework for work with families is the first critical
structure. This framework states what children need, what is most important about parenting
and parent-child relationships, and how parenting and other developmental domains
interrelate. It defines what good helping relationships are about, how they develop, what
factors are likely to create obstacles to such relationships, and how programs might respond.
The theoretical framework helps frontline providers make sense of what they are observing and
learning about families, and decide how and where to intervene. Theoretical frameworks also
give program staff “clinical” tools to select from, depending on situation and family capacity.
Key concepts and terms of a particular theory provide a common language, a kind of shorthand,
for staff to use in their work with each other, thereby contributing to shared understanding of
helping goals and issues. Theory helps give a name to what is happening in particular helping
relationships.
2. Internal structures and procedures created within a program provide the detailed guidance and
emotional support that sustain the day-by-day work. A central dimension of and purpose for
internal program structures is to give frontline staff opportunity to process and learn from their
day-in, day-out work, to share and reflect on their work with and on behalf of families, use each
other as resources, share and acknowledge feelings, get feedback, have accomplishments
recognized, receive guidance, reconceptualize, engage in joint problem-solving and modeling
or problem solving. Mechanisms for processing work with families can include consultation
from experienced outsiders; case conferences or staffing, and individual supervision.
-D 3Large Group Community-Based Parenting Programs for Families of Preschoolers at Risk for
Disruptive Behavior Disorders: Utilization, Cost Effectiveness, and Outcome
Charles E. Cunningham, Rebecca Bremner, Michael Boyle
Department of Psychiatry, McMaster University,
Faculty of Health Sciences, Hamilton, Ontario, Canada
Journal of Child Psychology and Psychiatry, October 1995, Vol. 36(7), pp. 1141-59
This article describes a study conducted in Ontario, Canada to contrast a parent-training program
provided in a clinic/individual-based setting, a community/group-based setting and a control group.
The parent-training program utilized in both the clinic and community settings was a coping
modeling problem-solving process (Cunningham, Davis, Bremner, Rzasa & Dunn, 1993). In this
program, parents formulate their own solutions by identifying videotaped child management errors,
discussing the consequences of these mistakes, suggesting alternative solutions, and considering
their advantages.
Subjects were children enrolled in a pre-school (junior kindergarten) who scored above the 90th
percentile on the Home Situations Questionnaire (Barkley & Edelbrock, 1987) and thus were considered
at high risk for disruptive behavior disorders. Cases were blocked according to one versus two parent
status and sex of the child, ranked according to number of problems, and randomly assigned to either:
1. Community/group parent training (Cunningham et al., 1993)
2. Clinic/Individual parent training (Cunningham, 1990)
3. A waiting list control condition
Subjects’ families were contacted and invited to join the program
Both the community/group and clinic/individual parent-training programs met for 11-12 weekly
sessions. The curriculum of both programs included problem solving skills, attending to and rewarding
pro-social behavior, transitional strategies, when-then strategies for encouraging compliance, ignoring
minor disruptions and disengaging from coercive interaction, prompting the child to plan in advance of
difficult situations, and time out (Cunningham, 1990; Cunningham et al., 1993). The basic structure and
process in the clinic/individual and community/group sessions were identical. Parents began with a
discussion of community resources then reviewed homework successes. Both conditions employed a
coping modeling problem solving model in which participants formulated solutions by observing
videotapes depicting common child management problems, identifying parenting errors, discussing
their consequences, devising alternative strategies, and formulating supporting rationales. Leaders
modeled the solutions suggested by the participants, parents role played the execution of new
strategies, set homework goals, and monitored homework completion.
To accommodate the schedules of working parents, both conditions were available at day, afternoon
and evening times. Families in both conditions were able to enroll their children in an activity-based
social skills program that was conducted conjointly with the parenting sessions. Finally, parents in both
conditions had an opportunity to participate in monthly booster sessions.
In the community/group model, groups averaged 27 members or approximately 18 families. These
larger groups were broken down into 5-7 member subgroups for homework reviews, coping modeling
problem-solving exercises, and homework planning projects. A different leader was selected each
week and this leader reported back to the larger group the discussion that had taken place within the
subgroup. To encourage cohesive working relationships, subgroups stayed together throughout the
program.
In the clinic/individual parent training, leaders met individually with parents to conduct homework
reviews, coping modeling problem-solving discussions, modeling, role-playing and homework planning.
Following the 6-month follow-up, control group participants were offered parenting courses.
At the start of the project, data were collected during home visits. The child’s intellectual abilities were
assessed using the similarities and block design subtests of the Weschler Preschool and Primary
Intelligence Scale (WPPSI). The mothers completed the General Functioning Scale of the Family
Assessment Device (a measure used in Canadian epidemiological research), the Beck Depression
Inventory and a measure of perceived social support (Cutrona & Russell, 1987)
Outcome measures included: Enrolment, Adherence, and Cost analysis. Also, parents completed the
Home Situations Questionnaire, the Child Behavior Checklist, and the Parenting Sense of Competence
Scale (Johnston & Mash, 1989). Mothers were observed interacting with their child during six 5-minute
activities, and observers coded the behavior of both parent and child. Mothers also suggested
solutions to nine written descriptions of child management problems and these were audiotaped and
analyzed.
Analysis of results indicated that:
• Immigrant families, families where English was a second language and families whose children
had more serious child management problems were more likely to agree to participate in a
community/group based program than a clinic/individual-based program.
• Parents with lower educational levels and poorer family functioning predicted poorer outcome
and attendance for the clinic/individual-based program but not for the community/group based
program.
• Parents were more likely to reject clinic/individual-based programs more quickly than
community/group-based programs when invited to join.
• Cost efficacy of the community/group-based program exceeded that of Clinic/individual-based
program when group sizes were greater than three families. With 18 families per
community/group-based programs, the cost savings is more than six times that of
clinic/individual-based programs.
• At follow-up, community/group-based groups reported greater reductions in child management
problems and better maintenance of gains.
• While coping modeling problem solving has been used in individual, family and small group
parent training programs, several factors enhance its effectiveness in large groups:
1. Solving problems in large groups yields a wider range of child management options
2. Proposing solutions, formulating personal goals, and describing homework
successes in a group may enhance commitment and adherence
3. Large groups with one leader requires parents to assume more responsibility for
solving problems, resolving disagreements and providing support to one another
4. Contacts made during interaction in the larger group can be maintained beyond the
termination of the program
The authors state that the results of this trial were not a function of sampling biases, differential attrition
or leadership influences. Limitations noted include:
•
•
•
The selection of a high-risk, but non-referred, voluntary community sample may have yielded a
less severely impaired population that was not representative of all high-risk children.
The screening questionnaire return rate was approximately 50%, and a significant percentage of
these families elected not to enroll in parent training. This is consistent with findings of other
research that families with a conduct-disordered child frequently do not seek professional
assistance or voluntarily attend programs to assist with their young child’s behavioral difficulties.
Despite parent training sessions available at morning, afternoon and evening times and within
the community, most parents who declined to participate attributed their decision to busy
•
personal schedules. This again is consistent with findings that suggest that families within a
lower socioeconomic status, with both parents or the single parent working, and whose lives are
relatively chaotic will find it more difficult to add another voluntary item to their list of things to
do.
Utilizing large group community parent-training programs was found to be cost-effective and
perhaps would address the needs of those more motivated and less seriously disturbed,
allowing more resources to be freed up for the most seriously disturbed children and families.
-D 4A Large-Group Community-Based, Family Systems Approach to Parent Training
Charles E. Cunningham
Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment,
pp. 394-412, 2nd edition, Russell A. Barkley, Ed. New York, NY, Guilford Press, 1998.
This chapter describes the COPE parent-training program (COmmunity Parent Education), which is
directed towards parents of children with the diagnosis of ADHD. The program is community based,
conducted in convenient neighborhood schools throughout the community and is conducted in the
evening to accommodate the schedules of working parents. Because of the difficulty of securing
reliable child care, the program also has on an-site children’s social skills activity group which operates
during the time of the parent program.
The large-group community-based model encourages the development of supportive personal contacts
and the exchange of knowledge regarding local resources useful to parents of children with ADHD.
The program is designed to reduce costs and increase availability by offering parent training in large
groups relying on a single-leader model, and scheduling courses in community settings that are
underutilized (e.g., school libraries in the evening).
Prior to the beginning of the program, a two-hour information session is conducted for parents
considering enrolling. At this time, the leader introduces participants, outlines the goals of the
program, discusses the format of individual sessions and presents the time and location of different
COPE courses.
The parenting course is organized into a curriculum of from 8 to 16 two-hour weekly sessions. A
curriculum of topics for twelve sessions includes encouraging positive behavior and improving parentchild relationships, balancing family relationships, avoiding conflicts, communication and problem
solving.
To facilitate the group’s discussion of the relative advantages of different child management skills, the
course leaders pose a series of attributional questions. Social learning attributional questions
encourage parents to consider the lessons that different strategies teach. Relational/communicative
attributional questions invite the group to explore the “messages” that different management
strategies communicate. Long-term outcome attributional questions anticipate the long-term effects of
alternative.
Following a large group discussion of a particular theme, small groups formed from the larger group
encourage participants to collaborate in the formulation of cognitive strategies that promote an
accurate interpretation of the child’s behavior, a longer-term perspective on change, and a sense of
personal control. Videotaped parenting errors are shown to the small sub-groups and, using the
program’s coping-modeling problem-solving protocol, parents formulate solutions by identifying
mistakes and discussing potential consequences using the attributional model. Subgroup leaders
summarize these discussions for the larger group and then, each subgroup formulates alternative
strategies, considers their relative merits and presents their subgroup’s conclusions to the larger group.
A large group attributional discussion concludes this phase of the session. Participants are encourages
to utilize some of the strategies from each session and report back on their efficacy.
-D 5Predictors of Treatment Outcome in Parent Training for Families with
Conduct-Disordered Children
Carolyn Webster-Stratton
Behavior Therapy, 1985. Vol. 16, pp. 223-243.
The purpose of this study was to use multiple predictor measures at one time with a large sample of
families with young conduct-disordered children and to determine how they related to one another or
acted in combination to predict treatment response immediately post-treatment and at I-year posttreatment.
Measures utilized included:
1. Holligshead and Relich's (1958) Two Factor Index of Socioeconomic Status
2. Life Experience Survey (Sarason, Johnson & Seigel, 1978) to assess positive and negative life
experiences over the previous year
3. Marital Adjustment Test (Locke & Wallace, 1959), a self-report measure of the quality of marital
satisfaction
4. Beck Depression Inventory (Beck, 1972)
5. CBCL (Achenback & Edelbrock, 1983)
6. Eyberg Child Behavior Inventory (Robinson, Eyberg & Ross, 1980)
7. Behar Preschool Questionnaire (Behar, 1977)
8. Dyadic Parent-Child Interaction Coding System (Robinson & Eyberg, 1981) used to code parentchild interactions in the home
Method:
1. Pre-treatment assessment. Data were collected for each family using the above measures, which
included home observations of parent -child interaction
2. Parent Therapy Program, which consisted of a series often two-hour training sessions focusing
on play skills, praise and tangible rewards and teaching parents non-punitive discipline
approaches and problem solving approaches.
3. Post-treatment assessment - Immediately following ending of 10 training sessions which
included two home visit observations and all parent report measures
4. One year post-treatment assessment - This included two home visit observations and all parent
report measures as well.
Results:
1. Pre-treatment levels of maternal and paternal depression were significant predictors of mother
and further reports of their children's maladjustment immediately post-treatment.
2. Pre-treatment socioeconomic status and marital status made the greatest significant
contribution to the prediction of mothers' critical and negative behaviors with their children
immediately post-treatment.
3. For fathers, pre-treatment marital status made the greatest contribution to the prediction of
negative behaviors with their children immediately post-treatment.
4. For both mothers and fathers, the amount of negative life stress which occurred during the year
following treatment emerged with at least as much weight as depression as a predictor of
parent reports of child maladjustment at the one year assessment.
5. Marital status and socioeconomic status at one year post-treatment remained as significant
predictors of maternal criticisms and physically negative behaviors with their children.
6. For fathers, socioeconomic status emerged as the significant predictor of long-term outcome of
negative behavioral interactions with their children.
7. For children at the one-year assessment, marital status made the most significant contribution
to the prediction of children's behaviors with their mothers.
8. For children at the one-year assessment" negative life stress made a more significant
contribution to their children's behaviors.
9. Teacher reports at one-year follow-up indicated that marital status made the greatest significant
contribution to the prediction of children's adjustment.
Important Points:
1. The study confirmed earlier studies using similar predictors regarding the importance of
socioeconomic disadvantage, negative life stress, single-parent status and depression as
important predictors of treatment outcome.
2. Depression is just as important a predictor for paternal reports of child adjustment as it is for
maternal reports.
3. Marital status was the best predictor of the amount of child deviance according to home
observations and teacher reports.
4. In homes where a father was present, the amount of negative life stress reported by fathers was
the best predictor of the amount of observed child deviance.
Recommendations:
1. There is a need to identify and treat conduct problem children when they are young, especially
those who come from socio-economically disadvantaged families with highly stressed and
depressed mothers or fathers.
2. There is a need to bolster the impact of parent training programs both by lengthening the
programs and by providing ongoing expanded therapy which focused on families' specific
needs such as life crisis management, depression, problem-solving, budget planning, marital
therapy, etc.
-D 6Improving the Life-Course Development of Socially Disadvantaged Mothers: A Randomized Trial
of Nurse Home Visitation
David L. Olds, Charles R. Henderson, R. Tatelbaum, and R. Chamberlin
American Journal of Public Health, November 1988, Vol. 78, No. 11, pp. 1436-1445
This study discusses results of a home visitation program in the Appalachian region of New York State
that focused its interventions on young (under age 19) first-time mothers, who were unmarried and
were classified as low socioeconomic status. The majority of the mothers were Caucasian, and the
results were only reported for white participants. Four conditions were randomized—(1) assessment of
the infants at ages 12 and 24 months, (2) assessment plus transportation to well-baby visits until age 2,
(3) assessment, transportation and prenatal home visits and, (4) assessment, transportation, prenatal
and post natal home visits until the baby was two.
Beginning during pregnancy, the nurses attempted to form an effective therapeutic relationship with
the women by emphasizing the women’s personal strengths. They encouraged the women to clarify
plans for completing their education, returning to work, and bearing additional children. They stressed
that the decision to return to school or seek employment after delivery should be made after fully
considering what was in the women’s own and their babies’ best interests. They helped interested
women find appropriate educational and vocational training services and make concrete plans for child
care. They advised them in finding jobs and interviewing and showed the women and their partners
birth control devices and discussed the advantages of different methods of family planning.
Results four years after the birth of their target child, nurse-visited women who had not completed their
high school education at the time they registered in the study returned to school more rapidly than
comparison women in conditions 1 and 2. The nurse-visited women who were poor and unmarried
were employed 82% more of the time, had 43% fewer subsequent pregnancies and delayed the birth of
their second child an average of 12 months longer than mothers in conditions 1 and 2.
This is an earlier review of the same program reviewed at the 15-year mark, which discussed results for
the mothers and did not evaluate benefits or risks for the toddlers themselves.
- D 7Long-term Effects of Nurse Home Visitation on
Children’s Criminal and Antisocial Behavior: 15-year Follow-up of a Randomized Trial
D. Olds, C. R. Henderson Jr., R. Cole, J. Eckenrode,
H. Kitzman, D. Luckey, L. Pettitt, K. Sidora, P. Morris, P., and J. Powers
Journal of the American Medical Association, October 14, 1998,
pp. 1238-1244, Vol 280, No. 14
This article provided results of a 15-year follow-up of a randomized controlled trial of home visitation by
nurses. Participants in the original study were young (under age 19 at the time of birth of their first
child, unmarried and of low SES. Four conditions were created and 400 mothers were enrolled
randomly to one of the 4 conditions. In the first condition, families were provided sensory and
developmental screening for the child at 12 and 24 months of age. Based on these screenings, they
were referred for further clinical evaluation and treatment as needed. In condition 2, families were
provided with the screening services offered in condition 1 in addition to free transportation for
prenatal and well-child care through the child’s second birthday. Condition 3 families were provided
with the screening and transportation and in addition, were provided a nurse who visited them at home
during pregnancy. Condition 4 included all of the above but in addition, the nurse continued to visit
through the child’s second birthday. Nurses provided parenting support, linked families with needed
health care and human services and attempted to involve other family members and friends in the
pregnancy, birth and early care of the child. The nurses completed an average of 9 visits during
pregnancy and 23 visits from birth to the child’s second birthday.
At the 15 year follow-up assessment, the now adolescents completed a series of interviews regarding
adjudication, truancy, running away from home, school behavior, school suspensions, delinquent and
aggressive behavior outside school, experience of sexual intercourse, rates of pregnancy, lifetime
number of sexual partners and frequency of using cigarettes, alcohol and illegal drugs during the 6
month period prior to the 15 year interview. Court records, school records, and parent/legal guardian
reports regarding these variables were also accessed when available.
Results showed that adolescents born to women who received nurse visits during pregnancy and
postnatally reported fewer instances of running away, fewer arrests, fewer convictions and violations of
probation, fewer lifetime sex partners, fewer cigarettes smoked per day and fewer days having
consumed alcohol in the last 6 months. Parents of nurse-visited children reported that their children
had fewer behavioral problems related to use of alcohol and other drugs.
In general, these findings are consistent with program effects on early-onset antisocial behavior rather
than on the more common and less serious antisocial behavior that emerges with puberty. It appears
that this program affected aspects of maternal child and family functioning at earlier phases in the
child’s development. In condition 3, prenatal home visitation alone was shown to be effective in
preventing criminal behavior among children born to low SES, unmarried women.
This program appeared to prevent only the more serious forms of antisocial behavior leading to arrests
and convictions. Other types of prevention programs may be necessary to reduce more normative
types of disruptive behavior among young adolescents.
Prenatal home visitation focusing on positive health-related behaviors during pregnancy, maternal
personal development (family planning, educational achievement) and competent care of children,
along with linkage to family and a support network is a very simple inexpensive way to work with high
risk mothers
-D 8Infant Mental Health Interventions in Juvenile Court:
Ameliorating the Effects of Maltreatment and Deprivation
C.S. Lederman, J.D. Osofsky
Psychology, Public Policy and Law. January-March, 2004. Vol. 10, No. 1, 162-177
This article restates many of the findings of other articles we have reviewed regarding the number
of infants and toddlers coming to dependency court, the intergenerational transmission of abuse
(30% according to a report by the National Research Council in 1993) and the lack of focus on the
youngest and largest cohort of children in the child welfare system. The report cites three examples
of early intervention programs which all include home visitation. They are:
•
•
•
Infant Health and Development Program (IHDP), a clinical trial designed to test the efficacy of
early childhood educational intervention including parental involvement and home visitation
with low birth weight, premature babies in eight different sites.
Elmira Home Visitation Study, an intensive home visitation program
Ramey and Ramey, 1998, an early intervention program with mothers that had little education
and lived in poverty.
The article also states that home visitation and other types of intervention programs exist in every
community funded by state and federal funds, and these programs can be accessed by the juvenile
court. The development of appropriate evaluation and treatment strategies for infants and toddlers is
emphasized.
The article then went on the review the prevention and early intervention work being done through
a collaboration between the Miami-Dade County Juvenile Court and its early intervention partners.
•
•
•
The PREVENT program that evaluates all infants, toddlers and preschoolers who are
adjudicated dependent by the court. During assessment sessions in a playroom setting, the
parent and child are observed and videotaped engaging in a number of tasks during play
interaction. Beyond this videotaped session, the Bayley Scales of Infant Development, the
Peabody Picture Vocabulary Test, the MacArthur Communicative Development Inventories,
the Beck Depression Inventory II, the Parenting Stress Index Short Form, and the Ages and
Stages Questionnaire are also utilized in the assessment.
The Infant and Young Children’s Mental Health Pilot Project (IMHPP) includes parents and
toddlers in the dependency court system who participate in an evaluation and a dyadic
therapy program for 25 weekly sessions with a trained clinician. Here again, assessment
instruments include the Beck Depression Inventory II, the Parenting Stress Index Short
Form, the Ages and Stages Questionnaire and a Parent-Child Observational Assessment
and Manual.
As a result of the Miami Safe Start Initiative, the first Juvenile Court Early Head Start
program for maltreated toddlers was established in Miami. The program enrolls children in
a comprehensive Early Head Start Program during the day and concurrently provides dyadic
therapy with the child’s primary caregiver.
Conclusions and recommendations for policy include the need for the court to change the focus from
the older child to the infant and toddlers in the system. This would necessitate modifications to federal
entitlements to include maltreated children as a priority for services. Comprehensive assessments
required of children in the child welfare systems often are only available to children five years of age
and older. Ignored as the children who can be helped immeasurably by early identification and
immediate intervention with problems that are just beginning to emerge. The authors say they believe
that Neurons to Neighborhoods should take its place beside the statute book.

Section 8 - FIRST 5 Santa Clara County

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