Transcript Slide 1

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)
www.childreninwales.org.uk
Increasing Retention Rates of LowIncome Parents: Strategies of
Partnership and Empowerment
SEPTEMBER 18, 2013
PARENT ENGAGEMENT CONFERENCE
CARDIFF, WALES
DR. LYNN MCDONALD
FAST PROGRAMME FOUNDER
PROFESSOR OF SOCIAL WORK, MIDDLESEX
UNIVERSITY, LONDON, ENGLAND
Shared Goal: Enhancing Child Well-Being
 Policies being developed are to increase the impact
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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
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%
Families and Schools Together (FAST)
 Universal parenting programme for all 3-6 year old
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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 parenting
Transition into school for all kindergarteners
If a parent comes once to FAST, 80% return for 8
weekly sessions & 22 monthly multi-family meetings
86% of FAST parent graduates report having made a
friend they see years later; reduce stress & isolation
82% Completed FAST across 13 school sites
in Disadvantaged Welsh Communities
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Cycle 1
Cycle 3
Cycle 5
Cycle 7
Average
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
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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)
Low Drop Out Rates for Low Income Parents
 FAST average drop out rate in Wales: only 18% drop out
 Retention 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;
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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
Teacher Ratings
of Academic Competence
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FAST
Control
N=54
Baseline
Post
1 Year
Kratochwill et al,(2004)Journal of School Psychology
Partnership
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Reach into Disadvantaged Communities
 Over the past 10 years, the issue how to reach more
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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%
Building Local Community ‘Social Capital’
 James Coleman sociologist Univ of Chicago studied
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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
NICHD Research Study: Can FAST build
social capital and Improve child outcomes
Phoenix
FAST
Control
San Antonio
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 lot
CHILD OUTCOMES-SDQ
Peer problem behaviors
Scale alpha=0.58
Total problem behaviors
Scale alpha=0.70
Pro-Social behaviors
Scale alpha=0.85
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
Treatment on Treatment: FAST graduates
compared w/ similar families in control schools
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 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
Methods
Treatment on the
treated
(TOT)
COMPLIERS
WOULD BE
COMPLIERS
Intent to treat
(ITT)
NON-COMPLIERS
FAST
WOULD BE
NON-COMPLIERS
Comparison
ITT Effects on Social Capital
Outcome
Effect
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
Outcome
Effect
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
Instrumented Effects of Social
Capital on Child Outcomes
Intervention
Social Capital
Outcomes
Causal Mediation of FAST Effects
by Intergenerational Closure
Total Problem Behaviors
Mediation Effect
Direct Effect
Total Effect
Proportion via Mediation
Intervention
95% CI 95% CI
PEstimate Lower Higher Value
-0.11
-0.20
-0.05 <0.01
-0.24
-0.80
0.30
0.38
-0.31
-0.91
0.20
0.21
0.31
-3.35
3.04
0.21
Social Capital
Outcomes
Causal Mediation of FAST Effects
by Parents’ Shared Expectations
Total Problem Behaviors
Mediation Effect
Direct Effect
Total Effect
Proportion via Mediation
Intervention
95% CI 95% CI
PEstimate Lower Higher Value
-0.08
-0.15
-0.02 <0.01
-0.28
-0.81
0.29
0.32
-0.36
-0.88
0.23
0.23
0.21
-2.03
1.47
0.23
Social Capital
Outcomes
Why Do Retention Rates and Reach Matter?
 In Wales, Save the Children has introduced FAST
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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
Risk and Protective Factors of Child Poverty
 Risk factors of child poverty
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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:
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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
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
High Stress Effects a Child’s Development
 Stress changes the brain and alters chemical
neurotransmitters related to violence
 Stress changes gene expression of child
 If 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 slowly
 High stress puts child into survival mode, and
stressed children cannot learn new things:
academics, mathematic, reading or writing
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 stress
 High 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
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(Sue Gerhardt, 2002,Why Love Matters)
High Stress affects Quality of Parenting
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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
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Low hope and mood, low patience, irritability, distracted, anxious
New Brain Research: Pruning Neurons
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 Adults have 80 billion neurons
 Babies have 200 billion neurons
 Neurological pruning happens repeatedly before the
age of 15 years
 Strong neural networks stay & are not pruned away
 Use it or lose it!
 One can always learn and improve, but it takes
longer as you get older to shape new networks
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
Ages of Neurological Pruning
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years
3
63months
12
months
9
Ages of Neurological Pruning
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12
years
69 years
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Community Organizing, Social Capital vs.
Poverty and Family Stress vs. Child Neglect
 Chronic stress and social isolation may increase child
neglect: stresses of poverty and social exclusion reduce
parents’ ability to be responsive and parent positively
Community
Development
Reduces
Family Stress
Reduces Child
Neglect
 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
FAST Builds Protective Factors
Against Stress: Relationships
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 Strengthening family unit
 Parent-child bond
 Parent-to-parent bond
 Empowered parent group
 Parent to community and school
Multi-systemic, multi-family groups with
repeated informal positive exchanges
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
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Between individuals, parent-child bonds, within families,
Lead groups of professionals in multi-agency working
With socially marginalized, low income parents: social inclusion
 Systemic strategies to build social capital, community
 Social cohesion, social trust, networking and social inclusion
 Coleman, 1988: ‘intergenerational closure in schools’
Parents Co-Produce FAST Groups
 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: coproduction with multi-agency professionals: 60% flexible
 Parents are on FAST teams leading multi-family groups
 Parents are coached to be in charge of their own family
 Parents are given time to form informal social networks
 Parents graduates plan the monthly ongoing meetings
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 Parent
interview panel for evaluation FAST certification
 time, FAST parent graduates run local FAST groups
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Applies 10 Theories & 24 Studies in MultiFamily Groups Which Parents Can Lead
 Parent groups are built on Paulo Friere’s ideas of
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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)
Social ecological theory of child
development (Bronfenbrenner)
CHILD
NICHD Social Capital FAST Project
Social ecological theory of child
development (Bronfenbrenner)
family
CHILD
NICHD Social Capital FAST Project
Social ecological theory of child
development (Bronfenbrenner)
school
family
CHILD
NICHD Social Capital FAST Project
Social ecological theory of child
development (Bronfenbrenner)
neighborhood
school
family
CHILD
NICHD Social Capital FAST Project
Social ecological theory of child
development (Bronfenbrenner)
neighborhood
school
family
CHILD
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Substance
Abuse
Parent
Liaison
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School
Mental Health
Substance
Abuse
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School
Social Capital
Parent
Liaison
Mental Health
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
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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
Quality Assurance Structures
 Trained teams supervised to lead multi-family
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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
FAST & Experiential
Learning
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 Meal at family tables
 Family sing-a-long/greetings
 Family crafts
 Family communication exercises
 Buddy time/parent support group meeting
 Children’s structured activities
 One to one “responsive play time”
 Winning as a family/cooking as a family
 Closing Circle-Announcements
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Experiential learning through coaching and
supporting parents to lead family activities
Family Scribbles Game
Family Flag
Feeling Charades
Parent-child bonds built in 1 to 1 responsive
play activity with coaching by the team
Special Play
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 poverty
 UK 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
“It takes a village to raise a child”
Traditional African Proverb
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applies theory &
research to build
that village for all
young children by
empowering
parents in Wales
with Communities
First and Save the
Children-Wales
For more information on the FAST programme in
Wales, please contact:
Mererid Lewis, Head of Programmes,
Save the Children Wales
Email: [email protected]
Tel: 029 2039 6838