Carolyn S. Perchuk RN, MN Winnipeg Regional Health Authority University of Manitoba Families First...

Carolyn S. Perchuk RN, MNWinnipeg Regional Health Authority

University of Manitoba

www.gov.mb.ca/.../familiesfirst/evaluation.html

Families First &School Readiness

Background Family First Program

Home visiting program in Public Heath

1999

Health Child Manitoba

Research based

The purpose of the program is to decrease child maltreatment

Reference:Great Kids Inc.(2004)

Evaluation of Families First Program ...

Parenting

Increased positive parenting (ES 0.81)

Decreased hostile parenting (ES - 0.53)

Reference: Healthy Child Manitoba (2010)

NOT Evaluated: Families First effect on

School Readiness.

Research Question

Is there a relationship between families participating in the Families First home visiting program and an increase in their child’s school readiness on entering

kindergarten as assessed by the EDI?

Education is a social determinant of health

Evidence: academic ability in K predictive of long term

school readiness

grade 3 success

complete grade 9

graduate grade 12

Identify family Risk factors

Intervene to build skill and improve environment

Improve parent child attachment

Improve Outcomes

The Manitoba Families First Program

Nurses and para professionals Working togetherPrenatal and postpartumUniversal screenIn-depth parent survey or fscFamily centeredCurriculum Voluntary3 years

Methodology

Quantitative research design

Secondary data analysis of data from Healthy Child Manitoba Office (HCMO) data base

Measurement Tools

Screening Tools' Sensitivity and Specificity

Children in Care

77% scored « at risk »on Screen

Children not in Care

83% scored « not at risk »

On Families First

Screen

Sensitivity Specificity

http://www.umanitoba.ca/centres/mchp/report.htm

Family Stress Checklist

Parent's childhood experience

Lifestyle behaviours and mental health

Parenting experience

Coping skills and support systems

Current stresses

Anger management skills

Expectations of infant's development,

milestones, and behaviours

Plans for discipline

Perception of new infant

Bonding and attachmentReference:Great Kids Inc.(2004)

www.ecdip.org/earlylanguage/

2003/2004

Program Group Control Group

Positive screen +3

Positive FSC +25

Was enrolled in the FF program

Positive screen +3

Positive FSC +25

Receive NO program

No programDue to not Enough resources

No programDue to Refused Services

The Early Development Instrument Five Domains

1. Physical health and wellbeing

2. Social Competence

3. Emotional Maturity

4. Language and Cognitive Development

5. Communication Skills and General Knowledge

Score in each domain 0-10

Data accessed through data sharing agreement with the MB government

SPSS software used for data analysis (alpha .05)

Imputation For Missing Data

Used Sequential regression multiple imputation (SRMI)where other variables are used as predictors for missing values

Multiple imputations (10 cycles) as accounts for statistical uncertainty in the imputations- cycles improve outcome variables

T test to Assess for Homogeneity of 2 Groups

- Child’s age at time of EDI

-FSC score

-Age of mother at the birth of the child

-Last two statistical difference but not clinical

Chi square to assess for Homogeneity of

the 2 Groupsscreened prenatallylow education level of mother on social assistance/financial difficultymother’s history of depressionhistory of abuse as a child for mother or father of babyno prenatal care before 6 monthsfamily screened prenatally lone parent familyteen parentalcohol or drug use of mom during pregnancycurrent substance use by mothersocial isolation violence between parents.

Results of Chi Square

Important to consider not significantly different:

•Teen mother

•Lone parent

•Low education mom

•Social isolation

•On social assistance/financial difficulties

•Depression of mom

•Violence between parents

Results of Chi SquareSignificant differences:

-no prenatal care (16%:11%)

-alcohol use by mother in pregnancy-higher control (48%:36%)

-drug use by mom during pregnancy-higher control (25%:17%)

-mother has history of child abuse- more in control (41%:29%)

-father has history of child abuse- more in program (12%:27%)

Multiple Linear Regression – Effect Independent Variables

Y= a + (b1)(x1) + (b2)(x2) + (b3)(x3)+ (b4)(x4)

Independent Variables: child’s gender; age of child at EDI; screened prenatally; maternal age; alcohol use by mother in pregnancy; drug use by mother during pregnancy; teen parent; low education mother; lone parent; on social assistance/financial difficulty; no prenatal care before 6 mos; mother hx depression; current substance use by mother; social isolation; violence between parents; mother has hx of being abused as child; father has hx of being abused as a child; fsc score; in families first program.

FF Program No FF Program

One model for each EDI domain

Results of Data Analysis:Multiple Regression Analysis

Gender and child’s month of birth at EDI significant for all

DOMAIN:

Physical Health and Wellbeing

-In Families First p=.057

-low education mother p=.005

-alcohol use by mother p=.043

ImplicationsPhysical Health and Wellbeing

In Families First (FF) marginal significance

Answer research question that there is only a threshold relationship between FF and one domain of the EDI school readiness tool

Domain:Social Competence

Low education of mother p=.002

Social Isolation/lack supports p=.030

Mother’s history of child abuse p=.009

Domain: Emotional Maturity

Low education of mother p= .003

Social isolation/ Lack of supports p= .013

Mother’s history of child abuse p= .041

Domain:Language and Cognitive Development

Low education of mother p= .002

On social assistance/financial difficulties p= .004

Violence between parents p= .052

Domain: Communication and General Knowledge

Low education of mom p= .003

Social isolation/lack of supports p= .002

Violence between parents p= .007

ImplicationsHome VisitingResearch identifies difficulty to achieving consistency may be affecting outcomes ie. varying dosage- early in program

If enrol in program but don’t ever engage or engage sporadically could affect outcomes

Decreased number enter prenatally and research has shown greater success with prenatal

RecommendationsPolicy and Program

Explore strengthening FF’s influence on areas that promote school readiness

Consider increased resources to help parents complete high school- ? More childcare or baby labs in high schools

Query if could strengthen FF’s influence on mother’s returning to or staying in high school

Transportation for mother/child to school program

Tutoring programs for mothers who are struggling to upgrade their skills

Acknowledgement

The presenter would like to acknowledge the Healthy Child Manitoba Office including Teresa Meyer, Senior Research Analyst, and the Manitoba Government’s contribution, in providing access to the Research Project Data Set. The results and conclusions are those of the authors and no official endorsement by Manitoba Government is intended or should be inferred.

The presenter would like to acknowledge the supportive direction and guidance of committee members Dr. Benita Cohen and Dr. Christine Ateah, University of Manitoba Faculty of Nursing. Dr. Mariette Chartier, Manitoba Centre for Health Policy, University of Manitoba.

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