Family Safe Zone: Multi-level Parenting Intervention Needs Assessment Data Maria D. McColgan, M.D.

1,2

, Sally Kuykendall, Ph.D.

4

, Stacy Ellen, D.O.

1,2

, Martha Davis MSS

3

, Sandy Dempsey MSS, MLSP

3

, Marcy Witherspoon MSW, LSW

3

Drexel University College of Medicine

1

, St. Christopher

’

s Hospital for Children

2

, Institute for Safe Families

3

, St. Joseph ’s University

4

Background

Physical punishment is a toxic stressor that disrupts normal brain development. Pediatric visits provide opportunity to screen for family violence, intervene and potentially mitigate causes of toxic stress. In 2012 the AAP encouraged pediatricians to adopt a leadership role in educating parents and the community on the long-term consequences of toxic stress and the potential benefits of preventing or reducing sources of significant adversity in early childhood.

The Family Safe Zone (FSZ) Project is a collaboration between the Institute For Safe Families (ISF) and St.

Christopher’s Hospital for Children.

Family Safe Zone strives to increase identification of and intervention in adverse childhood experiences in the pediatric setting.

Program Objectives

• To improve parenting practices through a multi-level intervention in a pediatric setting; • To identify areas of need among at-risk parents in a pediatric healthcare center parenting program; • To increase knowledge of and screening rates for toxic stressors and harsh parenting practices; • To increase intervention and utilization of supportive parenting strategies.

Methods

The Family Safe Zone employs three main strategies to change social norms around child maltreatment at SCHC:

Evaluation

Needs assessment consists of the following components: a) Pre-intervention surveys of health care providers b) Clinic observations of parent-child interactions and staff interventions (completed by a non-clinic staff graduate assistant) c) Pre-intervention surveys of parents using the Adult-Adolescent Parenting Inventory (AAPI2), the Parenting Stress Index (PSI) and the Protective Factor Survey.

Training

Pediatric health care providers (physicians, residents nurses, and social workers) were trained about the effects of toxic stress on the developing brain using ISF ’s

Partnering with Parents

Toolkit.

Providers and ancillary staff are receiving training called

OneKindWord,

which teaches staff to intervene using positive and supportive actions and language when they see a distracted, overwhelmed, stressed, angry or abusive parent.

Intervention

Once an intervention or positive screen occurs, staff can refer parents to an onsite parenting specialist. The Parenting Specialist provides an intervention to give parents of young children information about the impact of violence and stress on early brain development, training on positive parenting strategies, and brief behavioral health intervention.

Results

Providers Survey (n = 185)

Providers observe parents: •

Yelling (90.1%)

•

Using harsh parenting (85.9%)

• •

Cursing (82.3%) Hitting children (69.0%)

Providers reported compassion for: •

The stressed parent (71.6%)

•

The distracted parent (22.7%)

•

The abusive parent (20.6%)

Providers would intervene to support: •

The stressed parent (59.8%)

•

The distracted parent (67.4%)

•

The abusive parent (37.4%)

Providers discuss: •

Positive parenting techniques (69.7%)

•

Spanking (50.4%)

• •

Exposure to domestic violence (57%) Toxic stress effect on brain development (30%)

Clinic observations

(40 hours; n=1460) at baseline, revealed that 25% of caregiver-child interactions were negative with parents using

saying

“

shut up.

” Only

two name-calling, cursing, teasing,

healthcare provider interventions were noted, one positive and one negative.

Parents and caregivers

(n=85) were: • Primarily female (86%), single (68%) • Black (57%), Hispanic (33%), Other (10%) • Earn less than $15,000 per year (41%)

Parenting Stress Index (PSI)

Measures adaptability, “ demandedness, ” mood, attachment, role rigidity, feelings of competence, and social connection.

27% of respondents scored in the high stress category (compared to 15% in the general population).

Protective Factors Survey

Surveys family behaviors and social supports.

8-16% of participants were in families with dysfunctional problem management

AAPI-2 Survey Results

40% 20% 0%

37% 25% 22% 18% 13%

Power and Independence Lack of Empathy Role Reversal Inappropriate Expectations Corporal Punishment Percent of Parents at High Risk

High Risk in:

Power and independence Lack of empathy Reversing family roles Inappropriate expectations Corporal Punishment

The parent…

Does not value children ’ s opinions, expect strict adherence to rules and view independence as threatening. Does not nurture their children, fears spoiling, and has difficulty dealing with the stresses of parenting.

Believes their children should be responsible for taking care of themselves, treat their children as peers, has poor self-esteem.

Does not understand normal developmental timelines, and does not support their children.

Is quick to respond with hitting, rarely uses alternative discipline, and tends to be controlling and authoritative.

Conclusion

• Data suggest that providers knew the impact of harsh parenting on child development, yet needed support to intervene.

• While many providers discussed positive parenting techniques, spanking and exposure to domestic violence, less than one third discussed the effects of toxic stress on brain development.

• Clinic observations also show frequent negative parent child interactions and lack of intervention by pediatric staff.

• Health care providers report more compassion toward the stressed parent than the distracted, abusive or angry parent and were more likely to say something supportive to the distracted or stressed parent than the abusive or angry parent.

Future Directions

The impact of the parenting intervention is currently being measured through post-program surveys with parents and healthcare providers.

Acknowledgements

The Family Safe Zone Work Group:

Carmen Alicia, Vanessa Arce, Heidi Baur, Bruce Bernstein, Mario Cruz, Ife Ford, Elizabeth Grund, Jill Hersh, Lee Pachter, Stephen Sandelich, Jodi Schaffer, Karen Vogel, St. Christopher ’s Hospital for Children, Kevin Henry, St. Joseph's University

Sponsored by the Barra Foundation and Institute for Safe Families

Email: [email protected]