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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: ppolinsky@parentsanonymous.org