1 it works! findings from the national evaluation of parents anonymous ® mutual support groups...
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IT WORKS! FINDINGS FROM THE NATIONAL EVALUATION OF PARENTS ANONYMOUS® MUTUAL SUPPORT GROUPS
Margaret (Peggy) L. Polinsky, MSW, PhDDirector of Research & EvaluationSilvia Franco, Parent Leader
Parents Anonymous® Inc.Claremont, California
California Child Welfare Evidence-Based Practice SymposiumJanuary 30, 2009 – San Diego, California
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Overview for Today Background Research Questions & Heuristic Methodology Sample Research Findings Implications Discussion
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BACKGROUND – OJJDP/NCCD
Office of Juvenile Justice and Delinquency Prevention (OJJDP) awarded 2 grants, 1 in 2000 and 1 in 2005, to The National Council on Crime and
Delinquency (NCCD) in Oakland, CA To conduct an evaluation study of
Parents Anonymous®
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BACKGROUND–PARENTS ANONYMOUS®
Parents Anonymous® Precept Parents Anonymous® Group Elements Parents Anonymous® Group Goals 4 Therapeutic Principles of Parents
Anonymous® Groups: Mutual Support Shared Leadership Parent Leadership Personal Growth
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OJJDP OBJECTIVES & GOALS
Explore efficacy of Parents Anonymous®
Update previous studies
Increase methodological rigor
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PARTICIPATORY EVALUATION APPROACH
Project Advisory Board, with Parent Leader
NCCD: Madeline Wordes, PhD; Raelene Freitag, PhD; Angie Wolf, PhD
Consultants: Keith Humphreys, PhD; Julian Rappaport, PhD
Parents Anonymous® Inc.: Peggy Polinsky, PhD; Tanya Long, Parent Leader
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OVERARCHING RESEARCH QUESTION
Does Parents Anonymous® work to reduce the risk of child maltreatment and, if so, for all parents or for some more than others?
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RESEARCH QUESTIONS Do Parents Anonymous® group
participants improve their parenting behaviors and/or reduce their child maltreatment behaviors?
Does Parents Anonymous® group participation reduce the potential risk factors for child maltreatment?
Does Parents Anonymous® group participation increase the potential protective factors for child maltreatment?
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RESEARCH QUESTIONS (con’t) Are there differences in outcomes
related to child maltreatment, risk factors, and protective factors among different types of group participants?
What characteristics distinguish parents who continue group participation from those who do not?
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EVALUATION HEURISTIC
Group Characteristics
Group Facilitator
Characteristics
Processes of Change Shared Leadership Mutual Support Parents Anonymous® Ethos
Intermediate Outcomes
Intervening Characteristics
Organization Characteristics
Individual Parent
Characteristics
Primary Outcome Prevent Child Maltreatment
Parent Group Leader
Characteristics
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STUDY PHASES & DESIGN Process Evaluation (2001-2003) Outcome Evaluation (2003-2007)
Quasi-experimental time-series design 3 telephone interviews over 6 months
Outcome Evaluation (2005-2007) One-time face-to-face interviews with
Spanish-speaking Parents Anonymous® parents
Uniqueness
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16 MEASURES
MEASURES OF CHILD MALTREATMENT OUTCOMES
Parenting Distress – CAPI
Parenting Rigidity – CAPI
Psychological and Physical Aggression Towards Children – CTSPC
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MEASURES (con’t)
MEASURES OF RISK FACTORS Life Stress Scale - Kanner, et al. Parenting Stress Index-Short Form (PSI-SF) Emotional and Physical Violence between
Partners – Conflict Tactics Scale (CTS) Alcohol Use-Short Michigan Alcoholism
Screening Test (SMAST) Drug Use-Drug Abuse Screening Test (DAST)
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MEASURES (con’t)
MEASURES OF PROTECTIVE FACTORS Quality of Life Scale - Andrews & Withey Social Support – NSSQ
Emotional/Instrumental General
Parenting Sense of Competence (PSOC) Nonviolent Discipline Tactics (CTSPC) Family Functioning - McMaster Family
Assessment Device (FAD)
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STUDY PROCEDURES 100 groups randomly selected from 230 Group Facilitators contacted, consented and
trained to recruit parents Study goals and benefits explained to parents
new to group Interested parents contacted Study 800# or
mailed in information Researchers called parents, conducted
informed consent, assigned ID #, conducted first interview within week
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STUDY BENEFITS TO PARENT PARTICIPANTS
Talk to an interested person Confidentiality $50 for first interview $75 for second interview $100 for third interview
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PARTICIPANT ELIGIBILITY REQUIREMENTS
At least 18 years old Living with at least 1 child between
birth and 17 New to Parents Anonymous® (had not attended more than 5
Parents Anonymous® group meetings during the month or year prior to recruitment date)
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INTERVIEW DESIGN Computer Assisted Telephone Interview
(CATI) – data entered directly into database One-hour structured interview 5 domains:
Demographics & background Child maltreatment outcomes Child maltreatment risk factors Child maltreatment protective factors Experience with Parents Anonymous®
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PARTICIPANTS
232 parents completed 3 interviews 206 included in analysis (due to
retroactive determination that 26 had attended group more than 5 times)
From 54 groups in 19 states Sample was representative of the
general population of Parents Anonymous® parents
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DATA ANALYSIS SPSS data files each double-checked for
accuracy, then merged into single file Descriptive statistics, histograms,
frequency distributions, examination of outliers
Regression analysis assessing scale score change over time and differential influence on variability in scale score change by parent and group characteristics Few significant findings led to scrapping plans
for higher order analyses Only t-test results
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ANALYSIS GROUPINGS
Demographic and Background variables coded as binary
Parents who continued through the study period (6 months): n=188
Parents who dropped out after first interview: n=18
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BINARY CODING (N=206)
Gender: Female (91%) /Male (9%) Ethnicity: African American (48%)/White
(42%)/Other(10%) Education: <HS (21%)/HS or more (79%) Income: Low (<$13,000 annually) (48%)/High (52%) Child with special needs: Yes (50%) Prior help-seeking for parenting: Yes (72%) Physical or mental illness history: Yes (49%) Alcohol or drug abuse history: Yes (18%) History of CPS Contact: Yes (27%) Mandated attendance: Yes (15%)
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LOW RISK OF CHILD MALTREATMENT
Baseline: Parents reported little abusive behavior CTSPC average scores (scale: 1-5)
0.71 for psychological aggression 0.21 for physical aggression
Average Risk Factors scores low Average Protective Factors scores high
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STATISTICALLY SIGNIFICANT
RESULTS
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REDUCED CHILD MALTREATMENT OUTCOMES
73% 65%56%
83%
DecreasedParentingDistress
DecreasedParentingRigidity
Reduced Useof
PsychologicalAggression
StoppedPhysicallyAbusingChildren(n=52)*
*Only for those who reported physically abusing their children.
N=188
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REDUCED RISK FACTORS
86%
71%
40%32%
High StressedParents ReducedParental Stress
(n=46)*
Reduced LifeStressors
Reduced Any Formof Domestic
Violence
Reduced Drug/Alcohol Use
*Only for those in top 25% of Parental Stress scores.
N=188
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INCREASED PROTECTIVE FACTORS
67%
90% 88%84%
69% 67%
Quality of Life(N=188)
Emotional andInstrumental
Support(n=43)*
ParentingSense of
Competence(n=49)*
General SocialSupport(n=49)*
Use of Non-Violent
DisciplineTactics (n=51)*
FamilyFunctioning
(n=44)*
*Only for those 25% scoring"worst" on these scales.
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GENERAL FINDINGS All parents benefited, but benefit was
especially consistent for those parents most in need on each measure at baseline.
The parents most in need at baseline showed statistically significant improvement on all child maltreatment, risk, and protective factors.
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ONE PARENT’S EXPERIENCE WITH PARENTS ANONYMOUS®
Silvia Franco Parent Parent Leader Parent Group Leader Group Facilitator
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FINDINGS FOR SPANISH-LANGUAGE PARENTS
In a separate segment of the study, 36 parents from Spanish-language Parents Anonymous® groups in 2 states were assessed with semi-structured, in-person, qualitative interviews.
At the beginning of Parents Anonymous® group attendance: The parents reported isolation, mental
health issues, stress, and dysfunctional family life
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Spanish-Language Parents (con’t)
After attending Parents Anonymous® groups: Parents reported more social support, better
parenting practices, greater satisfaction with parenting, higher family functioning, and a higher sense of their own worth and capabilities.
The interviewees also reported that the Parents Anonymous® group provided confidentiality and respect and a willingness to share, explore and resolve personal problems.
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WHY PARENTS DECIDED TO ATTEND PARENTS ANONYMOUS®
Want to be a better parent (40%) Want to meet other parents (34%) Mandated (15%) To get help coping with stress (14%) Help others (7%) Help with childcare (7%) Be in a place where others listen (5%) Help to stop hurting their children (1%)
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IMPACT OF PARENTS ANONYMOUS® ATTENDANCE – PARENT REPORTING
Received the services needed to raise healthy children (96%)
Formed relationships with other Parents Anonymous® group members (77%)
Parenting became easier (77%)
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IMPACT OF ATTENDANCE (con’t)
Changed the way they parent (71%) Improved problem solving skills (43%) Learned new parenting and discipline
ideas and methods (43%) Became more patient (11%) Learned more about child development
(11%) Improved communication skills (9%)
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STUDY LIMITATIONS
Not a randomized controlled trial Effects may have been due to other
factors besides Parents Anonymous® Participants were volunteers, who may
have been different from non-volunteers. Few parents were at-risk for child
maltreatment at baseline, limiting the statistical analyses.
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STUDY STRENGTHS
Longitudinal, time-series design Inclusion of child maltreatment risk
factors not studied before in relation of effects of parent support groups: alcohol/drugs mental health family functioning domestic violence
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SUMMARY & IMPLICATIONS The broad-based approach to family
strengthening offered by Parents Anonymous® appears to allow parents to address their most pressing needs while at the same time providing a safety net, buffering the impact of the process of change across other factors.
Parents Anonymous® seems to allow parents with differing backgrounds and differing needs to address and solve their particular issues, especially parents with the most acute needs upon entry.
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DISCUSSION QUESTIONS
EPB designation is mandated these days, creating an even greater need for evaluation studies such as the one presented here, but it is still difficult to get funding. How has your organization dealt with this issue?
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DISCUSSION QUESTIONS
When referring parents for services, do Child Welfare staff know how to find EBP programs? If not, what can be done to increase awareness of ways to identify EBP programs?
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DISCUSSION QUESTIONS This study provides information
showing that Parents Anonymous® mutual support groups are an effective strategy for preventing child abuse and neglect. What do you think Child Welfare staff attitudes are about the parent mutual support group approach, in relation to other child maltreatment prevention approaches?
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CONTACT INFORMATION
Peggy Polinsky, MSW, PhDDirector of Research & EvaluationParents Anonymous® Inc.675 West Foothill Blvd., Suite 220Claremont, CA 91101Tel: 909-621-6184, Ext. 213E-mail: [email protected]