increasing retention rates of low-income parents: strategies of partnership and empowerment

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www.childreninwales .org.uk Lynn McDonald, Professor of Social Work Research, Middlesex University, London, Families and Schools Together (FAST) Programme Developer Lynn McDonald, Athro Ymchwil Gwaith Cymdeithasol, Prifysgol Middlesex, Llundain, Datblygydd Rhaglen Teuluoedd ac Ysgolion Ynghyd (FAST)

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Lynn McDonald, Professor of Social Work Research, Middlesex University, London, Families and Schools Together (FAST) Programme Developer Lynn McDonald, Athro Ymchwil Gwaith Cymdeithasol, Prifysgol Middlesex, Llundain, Datblygydd Rhaglen Teuluoedd ac Ysgolion Ynghyd (FAST). - PowerPoint PPT Presentation

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Page 1: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

www.childreninwales.org.uk

Lynn McDonald, Professor of Social Work Research, Middlesex University, London, Families and Schools Together

(FAST) Programme Developer

Lynn McDonald, Athro Ymchwil Gwaith Cymdeithasol, Prifysgol Middlesex,

Llundain, Datblygydd Rhaglen Teuluoedd ac Ysgolion Ynghyd (FAST)

Page 2: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

SEPTEMBER 18 , 2013PARENT ENGAGEMENT CONFERENCE

CARDIFF, WALES

DR. LYNN MCDONALDFAST PROGRAMME FOUNDER

PROFESSOR OF SOCIAL WORK, MIDDLESEX UNIVERSITY, LONDON,

ENGLAND

Increasing Retention Rates of Low-Income Parents:

Strategies of Partnership and Empowerment

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Shared Goal: Enhancing Child Well-Being

Policies being developed are to increase the impact and the reach of positive parenting groups

Review of evidence enables local authorities and national governments to identify what works best

However, evidence is not enough.There must also in addition be Reach. Transparency is needed to identify whether

and how many low-income families living in disadvantaged communities are actually receiving the benefits by completing the parenting groups on offer

Page 5: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Retention Rates for Low-Income Parents

Drop out rates in child mental health clinics: if a family comes once, 40-60% will not complete treatment (Kazdin, 2001);

Drop out rates in child mental health clinics: if a family comes once and the parent is low income or socially marginalized, > 60% drop out early

Reported drop out rates in parenting groups aimed at child mental health promotion for low-income, single and socially marginalized parents are higher: range between 40% to 90%

Page 6: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Families and Schools Together (FAST)

Universal parenting programme for all 3-6 year old children especially in disadvantaged communities

Build relationships, social capital and protective factors for all parents, as all have stress sometimes

Support all parents in practicing positive parentingTransition into school for all kindergarteners If a parent comes once to FAST, 80% return for 8

weekly sessions & 22 monthly multi-family meetings86% of FAST parent graduates report having made

a friend they see years later; reduce stress & isolation

Page 7: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

82% Completed FAST across 13 school sites in Disadvantaged Welsh Communities

0102030405060708090

Cycle 1 Cycle 3 Cycle 5 Cycle 7 Average

Page 8: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Randomised Controlled Trials on FAST

Collaborations with other researchers from medicine, public health, sociology, psychology, who were interested in social work interventions

4 RCTs on FAST completed with low income families Abt Associates, (2001); Kratochwill, et al, (2004);

McDonald et al, (2006), Kratochwill et al.(2009), Gamoran & Turley (2013)

Funding from NIH (NIDA, NICHD), SAMHSA, DOJ, DOE

Positive child behavioural and mental health outcomes over 1 and 2 years, across domains of child social ecology (child, family, school, community)

Page 9: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Low Drop Out Rates for Low Income Parents

FAST average drop out rate in Wales: only 18% drop outRetention rates: if a family comes once, 80% expected to

complete 6 or more of 8 weekly FAST meetings offered & then graduate to 22 parent-led monthly groups; 72% teacher identified, inner city, low income, single parent, African

American families with emotionally disturbed children, age 7 80% Universal: rural, Indian reservations, low-income families of all

first grade children and their families 85% urban, Mexican American immigrants, low income, universal

recruitment of all children 90% universal for all first graders and 50% risk of special education

with behavior problems; all low-income, mixed cultural backgrounds

Page 10: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Teacher Ratingsof Academic Competence

Kratochwill et al,(2004)Journal of School Psychology

N=54

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Partnership

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Reach into Disadvantaged Communities

Over the past 10 years, the issue how to reach more families has been a focus

In 2003, the average number of FAST families who graduated per multi-family group was seven

First multi-hub FAST was tried: 7 per class=21

Replication was harder: grant for 10 sites, only half graduated 20 families, the other stayed at 7 families

Research study to increase reach and build social capital, universal recruitment brought 44 families per school, however, drop out rates were 49%

Page 19: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Building Local Community ‘Social Capital’

James Coleman sociologist Univ of Chicago studied schools and developed a theory of social capital

Children know one another at school and children know their parents

If parents become friends with their children’s school friends, that is ’ intergenerational closure’, a powerful form of social capital

If the average parent at a school knows 4-5 other parents, that school has high social capital

If parents have shared expectations, the norms shift

Page 20: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

NICHD Research Study: Can FAST build social capital and Improve child outcomes

San AntonioPhoenix

FAST

Control

Page 21: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Endogenous Variables

SOCIAL CAPITAL Number of parents known 0 or 1, 2 to 5, 6 or more Shared expectations Not at all, A little, Some, A

lotCHILD OUTCOMES-SDQ Peer problem behaviors Scale alpha=0.58 Total problem behaviors Scale alpha=0.70 Pro-Social behaviors Scale alpha=0.85

Page 22: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Statistical Methods

FAST as an indicator of social capital Intent to Treat: Two-Level Model Treatment on the Treated: Two-Level Complier Average

Causal Effect Model

Intervention Outcomes

Page 23: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Treatment on Treatment: FAST graduates compared w/ similar families in control schools

Across 52 schools, half had FAST; on average 44 families attended at least once

Across 26 randomly assigned control schools, there were no FAST sessions

Of the 22 families who completed FAST (5+ sessions) per school, characteristics were collated

In the control schools, a comparable group was created with similar characteristics

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Methods

COMPLIERS WOULD BE COMPLIERS

NON-COMPLIERS

WOULD BE NON-

COMPLIERS

FAST Comparison

Treatment on the treated(TOT)

Intent to treat(ITT)

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ITT Effects on Social Capital

OutcomeEffect size Est/S.E. P-value

Intergenerational Closure 0.13 3.02 0.003

Shared Expectations with Other Parents 0.33 3.28 0.001

Intervention Social Capital

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TOT Effects on Social Capital

OutcomeEffect size Est/S.E. P-value

Intergenerational Closure 0.35 2.83 0.005

Shared Expectations with Other Parents 0.97 2.93 0.003

Intervention Social Capital

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ITT and TOT Effects of FAST on Parent-Parent Social Capital

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Instrumented Effects of Social Capital on Child Outcomes

Intervention Social Capital Outcomes

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Causal Mediation of FAST Effects by Intergenerational Closure

    Total Problem Behaviors                

Estimate95% CI Lower

95% CI Higher

P-Value

Mediation Effect   -0.11 -0.20 -0.05 <0.01Direct Effect   -0.24 -0.80 0.30 0.38Total Effect   -0.31 -0.91 0.20 0.21Proportion via Mediation

  0.31 -3.35 3.04 0.21

Intervention Social Capital Outcomes

Page 30: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Causal Mediation of FAST Effects by Parents’ Shared Expectations

    Total Problem Behaviors                

Estimate95% CI Lower

95% CI Higher

P-Value

Mediation Effect   -0.08 -0.15 -0.02 <0.01Direct Effect   -0.28 -0.81 0.29 0.32Total Effect   -0.36 -0.88 0.23 0.23Proportion via Mediation

  0.21 -2.03 1.47 0.23

Intervention Social Capital Outcomes

Page 31: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Why Do Retention Rates and Reach Matter?

In Wales, Save the Children has introduced FAST into 13 disadvantaged communities

Whole families participate, and the benefits reach beyond the young focal child

The average number of families graduated per group was 18, for a total of 265 whole families served

The average retention rate was 82%Family conflict reduced, child SDQ increased

at home and school, parent school connections and parent to parent community connections increased

Page 32: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Risk factors of child poverty Poverty, lack of housing, employment, education, health

services Child: low shelter/food, poor parent-bonds, neglect,

cognitive delays Family has chronic stress, worries, anxiety about

resources, conflict, violence, substance abuse, depression, mental health problems

Family is socially isolated from extended family, friends, neighbours

Family experiences social exclusion, racism, health disparities

Parents are oppressed, no control over own life, no respect, no voice

Protective factors: For Child: quality of parent-child bond For Child: one caring relationship over time to turn to when

stressed For Parent: social network of support; social capital;

extended family For Parent: feeling self-efficacious; empowered voice and

agency

Risk and Protective Factors of Child Poverty

Page 33: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Poverty, Child Neglect, High Stress Levels?

Poverty and stress may/or may not go hand and hand for parents and for their children

Stressed and isolated families have higher risk of neglecting a young child

Child neglect causes impaired learning, increased aggression, and risk of drug abuse

Child in poverty has more risk of neglect: If family lives <$15,000 versus

>$30,000, 44 times more likely the child is neglected

Page 34: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

High Stress Effects a Child’s Development

Stress changes the brain and alters chemical neurotransmitters related to violence

Stress changes gene expression of childIf the high stress (high cortisol) is sustained

over time it damages a child’s brain High stress causes low immune systems and

children get sick more often and heal slowlyHigh stress puts child into survival mode, and

stressed children cannot learn new things: academics, mathematic, reading or writing

Page 35: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Caring Relationships Can Buffer the Impact of High Stress on a Child’s Development

Sustained high stress (cortisol) levels are destructive to a child’s brain development and other organs

15 minutes of one to one responsive play reduces stressHigh stress levels can be managed with a responsive

parent who shows their love and Notices child’s emotions and is tuned in to the child Is available to the child under stress Asks questions and listens Is physically soothing and touches the child Plays responsively with no bossing, and follows the child’s lead

(Sue Gerhardt, 2002,Why Love Matters)

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High Stress affects Quality of Parenting

Cannot focus on child’s needs, emotionally intellectually

Not enough time, no time for seeing friends Use of computers, mobile phones, TV Employment insecurity, food insecurity, residential

instability, transport insecurity, chronic stresses of poverty

Fear of inadequate medical and dental care Trapped in a dangerous neighbourhood Trapped in a dangerous relationship Daily experience of stigma and social exclusion,

racism Feelings of helplessness, hopelessness, low sense of

agency Low hope and mood, low patience, irritability, distracted,

anxious

Page 37: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

New Brain Research: Pruning Neurons

Adults have 80 billion neuronsBabies have 200 billion neuronsNeurological pruning happens repeatedly before the

age of 15 yearsStrong neural networks stay & are not pruned awayUse it or lose it!One can always learn and improve, but it takes

longer as you get older to shape new networks

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Neurons Connected by Life Experiences: Synapses & Dendrites

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Neural Networks form with Repetition & Emotional Intensity

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Sculpting: Neurological Pruning of Non-connected Neurons

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Words Heard by Young Child

Words heard by hour week year

Low income 616 62,000 3 million

Working class 1251 125,000 6 million

Professional 2153 215,000 11 million

What you hear, how you talk, how you read and write

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3 months6 months9 months12 months3 years

Ages of Neurological Pruning

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6 years9 years12 years15 years

Ages of Neurological Pruning

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Community Organizing, Social Capital vs. Poverty and Family Stress vs. Child

NeglectChronic stress and social isolation may increase child neglect: stresses of poverty and social exclusion reduce parents’ ability to be responsive and parent positively

Community organizing reduces stresses of poverty

o Social ties and inclusion buffer stress and enhance parent leadership which leads to more positive parenting and less child neglect

Community Development

Reduces Family Stress

Reduces Child

Neglect

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45FAST Builds Protective Factors Against Stress: Relationships

Strengthening family unitParent-child bondParent-to-parent bondEmpowered parent groupParent to community and schoolMulti-systemic, multi-family groups with repeated informal positive exchanges

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Partnership and Respect Engages Parents

Values of respect shifts power into shared governance Service user involvement in partnership with

professionals Multi-systemic. social ecological, local contextual

interventions Anti-oppressive and anti-discriminatory practice

Focus on quality of relationships with coaching and support in multi-family groups of parent leadership Between individuals, parent-child bonds, within families, Lead groups of professionals in multi-agency working With socially marginalized, low income parents: social

inclusionSystemic strategies to build social capital,

community Social cohesion, social trust, networking and social

inclusion Coleman, 1988: ‘intergenerational closure in schools’

Page 47: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

Respect for parent role and knowledge at every level of the FAST programme: ‘nothing about us without us’

Parents participate in training and planning FAST: co-production with multi-agency professionals: 60% flexible

Parents are on FAST teams leading multi-family groupsParents are coached to be in charge of their own familyParents are given time to form informal social networksParents graduates plan the monthly ongoing meetingsParent interview panel for evaluation FAST certificationOver time, FAST parent graduates run local FAST groups

Parents Co-Produce FAST Groups

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Applies 10 Theories & 24 Studies in Multi-Family Groups Which Parents

Can LeadParent groups are built on Paulo Friere’s

ideas of adult education groups in low income communities and these connected small groups are empowering

Family activities are led by parents coached and supported based on Minuchin’s family systems theory empowering executive subsystem of parents

1 -1 responsive play (attachment theory-Bowlby)

Parents ask children to do small tasks as ‘imbedded compliance requests’ (social learning theory)

Family school and community (social ecology theory)

Page 49: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

NICHD Social Capital FAST Project

Social ecological theory of child development (Bronfenbrenner)

CHILD

Page 50: Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

NICHD Social Capital FAST Project

Social ecological theory of child development (Bronfenbrenner)

CHILDfamily

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NICHD Social Capital FAST Project

Social ecological theory of child development (Bronfenbrenner)

CHILDfamily

school

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NICHD Social Capital FAST Project

Social ecological theory of child development (Bronfenbrenner)

CHILDfamily

school

neighborhood

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Social ecological theory of child development (Bronfenbrenner)

family

school

neighborhood

CHILD

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60SubstanceAbuse School

Mental HealthParentLiaison

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Social Capital

SubstanceAbuse School

Mental HealthParentLiaison

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Positive and Flexible FAST Groups Approach

Flexible and ‘manualized’ FAST programme enables ‘deep’ local cultural adaptations of 60% of processes

Positive parenting programme for child well-being Positive parent-led family activities for experiential learning with

weekly repetitions, with coaching and support by team Structured and sequenced parent led family activities interrupt

family conflict and boredom, increases parental efficacy Positive experiences of parental mastery of repeated activities

and routines, reduces family conflict and violence at home Strengths based: values are that ‘every parent loves their child’ Positive energy with families singing, drawing, crafts, laughing,

talking and playing together and building trust over time

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Quality Assurance Structures

Trained teams supervised to lead multi-family groups by Certified FAST Trainers/Supervisors

Teams have parents and multi-agency professionals who culturally represent the families being served

Quality of implementation checklists used weekly

Three site visits with direct observation in 8 weeks

Program Integrity Checklists reviewed for drfit

Pre and post questionnaires for quantitative outcome

Qualitative evaluations with parents, teachers,

Recertification after three years

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64FAST & Experiential LearningMeal at family tablesFamily sing-a-long/greetingsFamily craftsFamily communication exercisesBuddy time/parent support group meetingChildren’s structured activitiesOne to one “responsive play time”Winning as a family/cooking as a familyClosing Circle-Announcements

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Experiential learning through coaching and supporting parents to lead family

activities

Family Scribbles Game

Family Flag

Feeling Charades

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Parent-child bonds built in 1 to 1 responsive play activity with coaching

by the team

Special Play

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FAST as Evidence based Practice

UN United Nations Office of Drugs and Crime (2010) Family skills Programme (FAST is number 11 of 23 on

RCTs) FAST is probably best on retention rates of parents in

povertyUK National Academy of Parenting

Practitioners Amongst top ten parenting programmes in UK

US government lists for evidence based practice Child abuse and neglect prevention Child mental health promotion Substance abuse prevention Juvenile delinquency prevention I3 Dept of Education: to reduce educational inequality

in USA

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“It takes a village to raise a child” Traditional African Proverb

applies theory & research to build that village for all young children by empowering parents in Wales with Communities First and Save the Children-Wales

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For more information on the FAST programme in Wales, please contact:

Mererid Lewis, Head of Programmes, Save the Children WalesEmail: [email protected]: 029 2039 6838