Citizen Review Panels Home Visiting Symposium October 11, 2018 Kristen Kirkland, Ph.D. NYS Office of Children & Family Services Bureau of Research, Evaluation, and Performance Analytics

Supporting Families Right from the Start: Findings from the Healthy Families New York Randomized Controlled Trial

Improved Birth Outcomes Reduction in low birth weight deliveries among women who enrolled before the 31st week of pregnancy (5% vs. 10%) Particularly effective in reducing LBW for black (3% vs. 10%) and Hispanic mothers (5% vs. 9%) Improved Birth Outcomes

Increased Access to Care More target children with health insurance at Y1 (94% vs. 90%) More mothers with primary care provider at Y2 (85% vs. 76%) More mothers with health insurance at Y2 (87% vs. 82%) Fewer target children did NOT receive medical care when needed at Y2 (1% vs. 5%) Increased Access to Care Target Child health insurance coverage remained high across waves (93% vs. 91% at Y2, 93% vs. 94% at Y7).

Prevented Child Abuse and Neglect Mothers engaged in 30% fewer acts of psychological aggression at Y1 Mothers engaged in 31% fewer acts of minor physical aggression at Y1 Mothers engaged in 75%-88% fewer acts of serious physical abuse at Y1, Y2, Y7 Fewer target children reported mothers engaged in minor physical aggression at Y7 (71% vs. 77%) Prevented Child Abuse and Neglect (Self-report) Acts of very serious physical abuse Year 1 (88% reduction: .01 vs. .08) Acts of serious physical abuse Year 2 (75% reduction: .01 vs. .04) Acts of serious physical abuse Year 7 (80% reduction: .03 vs. .15) Acts of Minor Physical Aggression Year 1 (31% reduction: 2.40 vs. 3.46) Acts of Psychological Aggression Year 1 (30% reduction: 3.34 vs. 4.74) Harsh Parenting in the Past week Year 1 (1.21 vs. 1.81) TC report of maternal minor physical aggression (9% reduction: 70.79% vs. 77.23%)

Prevented Child Abuse and Neglect 50% reduction in subsequent confirmed child protective services reports after 7 years for mothers with a confirmed report prior to program entry 49% reduction in the rate at which children of young, first time moms who enrolled early in pregnancy were confirmed as victims in child protective services reports between ages 5 and 7 Prevented Child Abuse and Neglect (Administrative) Average Kempe Score for full sample: 42.4 (25 or less: 13.9%, 30 to 50: 63.6%, over 50: 22.5%) Average Kempe Score for mothers with a confirmed CPS report prior to program entry: 51.49 Average Kempe Score for young, first time mothers who enrolled early in pregnancy: 44.39 Compared to their counterparts in the control group, HFNY mothers in the RRO subgroup had markedly lower rates of involvement—from random assignment to Age 7—in confirmed CPS reports for any type of abuse or neglect (41.5% vs. 60.4%); in confirmed reports involving physical abuse (3.3% vs. 13.4%); and in preventive, protective, and placement services (38.0% vs. 60.0%). Program impacts on confirmed CPS reports began to emerge for the HPO subgroup around Age 5, or at time of entry into school. From Age 5 to 7, the target children of HFNY mothers in the HPO subgroup were less likely to be named as confirmed victims in CPS reports than were their counterparts in the control group (9.9% versus 19.3%).

Promoted Positive Parenting Practices Mothers endorsed more appropriate limit setting strategies at Y2 More mothers observed using strategies that stimulated child’s cognitive skills and were sensitive to child's needs and affective cues at Y3 More mothers used non-violent discipline strategies and used them more often at Y7 Promoted Positive Parenting Practices Limit Setting Strategies: mean 32.26 vs. 31.62 Non-violent discipline: 49.27 vs. 45.27, 100% vs. 98.6% Cognitive Stimulation and Sensitive Structuring: Puzzle: 96.5% vs. 92.8% Delay: 17.2& vs. 10.6% Cleanup: 85.3% vs. 78.3%

Promoted School Success Less likely to repeat 1st grade (4% vs. 7%) More likely to score above grade level in 1st grade on three specific behaviors that promote learning (13% vs. 8%) Lower receipt of special education services at Y7 (17% vs. 12%) Greater participation in gifted programs by Y7 (5% vs. 2%) Promoted School Success BTPL: works or plays cooperatively with others, follows oral directions or classroom rules, completes home or class work on time

By Y7 HFNY returned $3 for every dollar invested for moms who had prior CPS histories $1,000 to serve a family during pregnancy is totally recovered before a child’s birth due to reductions in LBW Additional savings accrue from reductions in grade retention and special education services Saved Money Moms with prior CPS histories has fewer subsequent pregnancies by Year 2 Cost to care for LBW babies is very high Reductions in grade retention explained at least in part by Y2 limit setting $0.20 per dollar invested for HPO $0.16 per dollar invested for Whole sample

Increasing Protective Factors in Other OCFS-funded Home Visiting Programs Trust Fund and Public Private Partnerships funded Home Visiting Programs (9/1/16-8/31/18) Pre-Post Protective Factors Instrument Data Collected via Community-based Prevention Programs Data Management System (N=249, 4 programs)

Protective Factors Instrument Improvements in PFI Subscale/Item Scores from Pretest to Post-test: Protective Factors Instrument Family Functioning: 5% Social Support: 5% Concrete Support: 5% Nurturing & Attachment: 7% Knowledge of Parenting & Child Development Items: 7%-14%

Protective Factors Instrument I know how to help my child learn (10%) I understand why my child behaves the way he/she does (13%) I know what behaviors and abilities are normal for my child’s current developmental stage (13%) I know how to obtain information on what to expect of my child as he/she grows and matures (13%) I know where I can get information about parenting and taking care of children (10%) I praise my child when he/she behaves well (7%) I discipline my child without losing control (7%) I read to or with my child (13%) My child has a routine for daily activities (14%) I help my child figure out a task when he/she is having trouble (10%) I provide activities for my child that will help him/her develop new skills (13%) Protective Factors Instrument KPCD Items

Questions? Kristen Kirkland, Ph.D. kristen.kirkland@ocfs.ny.gov (518) 473-8833 Questions?