Factors that Discriminate Intervention Response to the Family Check-Up: Family and Neighborhood Risk Daniel S. Shaw, William E. Pelham1, Stephanie L. Sitnick2, Thomas J. Dishion1, and Melvin N. Wilson3 Instructions for editing school and department titles: Select from menu: View > Master > Slide Master Click on each text area you wish to edit. Text will become editable. 1ASU 2Caldwell College 3UVA

Family-based interventions that promote school readiness By promoting positive parenting skills, several programs have shown success in increasing school readiness Less is known about factors that promote engagement and treatment response to such interventions The Family Check-Up is one such intervention that promotes positive parenting and numerous child and parent outcomes during early childhood and beyond, with intervention effects documented through age 14 when initiated at age 2 in a large-scale WIC sample. Current study examines two related findings from Early Steps Multisite Trial: predictors of treatment response in relation to child conduct problems from ages 2 to 5 at home Neighborhood deprivation as a moderator of treatment response in relation to conduct problems at age 9.5 at school Family-based interventions that promote school readiness

An issue for basic research is to identify children at risk for early-starting conduct problems An independent issue is for whom the Family Check-Up might be more or less effective Typically “variable-centered” (Aiken & West, 1991) Presumes a homogenous sample Nearly all moderation of parent training findings used this method treatment × moderator interaction terms in a multiple regression equation Perhaps a particular constellation of family conditions presents a context that affects response to the intervention variable-centered approach might fail to detect this effect if no single variable emerges as a predictor Treatment response: For whom does the Family Check-Up seem to be more or less effective? *Pelham et al., in press

“New” approach: a person-centered method Person-centered analytic approaches separate a heterogenous sample into more homogeneous latent subpopulations (Muthen & Muthen, 2000) E.g., LCA, LPA, GMM, pattern mixture models Offer an alternative perspective on moderation of intervention response (Lanza & Rhoades, 2013) Circumvents typical limitations in subgroup analysis (e.g., high Type I error rate, low statistical power, and limited ability to examine higher-order interactions) “New” approach: a person-centered method See Herman et al., 2007, Spilt et al., 2013; Rhoades & Lanza, 2014

Neighborhood disadvantage and poverty is associated with increased risk for multiple negative child and adolescent outcomes: Conduct problems and externalizing (Shaw et al., 2001; Shelby et al.,) Internalizing problems (Beyers, Bates, Pettit, & Dodge, 2003; Caughy, Nettles, & O’Campo, 2008; Milam et al., 2012 ) Academic outcomes (see Leventhal & Brooks-Gunn, 2000 for review) Increased health-risk behaviors (e.g., substance use, high risk sexual behavior; Lambert et al., 2004; Molina et al., 2012; Karriker-Jaffe, 2013; Browning et al., 2008;) Neighborhood risk factors may be more influential on children’s development than family SES (Kalff et al, 2001) Neighborhood Risk

Neighborhood deprivation and parenting Neighborhood disadvantage/poverty may have a negative impact on parent-child interactions. Increased number of stressors may decrease parenting quality (Simmons et al., 1996) Less opportunities for children outside of the home (Dishion & McMahon, 1998) Increased coercive parenting practices (Ceballo & Mcloyd, 2002; Leventhal & Brooks-Gunn, 2000; Silk et al., 2004) and decreased positive parenting (Pinderhughes et al., 2001;Trentacosta et al., 2008) in high-risk neighborhoods. Relationship between parenting and child outcomes may be influenced by neighborhood deprivation Relationship between parental supervision and limit setting and antisocial behavior moderated by living in project neighborhoods with parenting of adolescents in project neighborhoods having nonsignificant effect on antisocial behavior (Shaw et al., 2004) The protective role of positive parenting against negative child outcomes may be more pronounced in high risk neighborhoods (Beyers et al., 2003; Brody, Ge, Conger,& Gibbons, 2001) Neighborhood deprivation and parenting

Neighborhood and intervention Multiple intervention studies have shown differential intervention effectiveness depending on neighborhood risk and/or poverty status Intervention may be more effective in impoverished areas because those families are the most in need E.g., Gardner et al., (2009): Low maternal education predicted greater reductions in children’s problem behavior in response to the FCU. However, the same stressors that make these families the most in need may serve as barriers to the effectiveness of intervention. Meta analyses suggesting that families in adverse conditions have poorer intervention outcomes. (Lundahl et al., 2006; Reyno & McGrath, 2006) Neighborhood and intervention

Current Study: Two Related Aims and Hypotheses Using person-oriented, latent class analysis, use baseline indicators to generate groups that discriminate intervention response to FCU on conduct problems from ages 2 to 5 Intervention would be more helpful to parents with higher levels of family risk Examine whether extreme neighborhood deprivation attenuates intervention response on parenting in early childhood and subsequent effects on child conduct problems at age 9.5 at school Intervention effects on parenting and later child disruptive behavior would be attenuated in extremely vs. moderately deprived neighborhoods Current Study: Two Related Aims and Hypotheses

RCT testing effectiveness of Family Check- Up (731) among 731 families with 2 year olds enrolled at WIC Centers in urban (Pittsburgh), suburban (Eugene, OR), and rural (Charlottesville, VA) communities Annual 2-3 hour assessments through age 9.5 (except age 6), including observations of parent-child interaction and parent & teacher reports of child conduct problems, and census-derived data on neighborhood deprivation FCU offered to intervention group families each year through age 9.5 90% of intervention families had at least one annual FCU by age 5 Research Design

Measures For Latent Class Analysis Age 2 predictors for classes included family income, number of children in house, parental depression, child gender, parental education, single parent status, parental criminality, history of child maltreatment and mental health treatment Parent reports from Achenbach CBCL: Oppositional-Aggressive Behavior from ages 3 to 5 for items that map on to diagnosis of ODD and CD For Neighborhood Deprivation Analysis Observed measure of dyadic positive engagement derived from 50-55 minutes of structured tasks at the age 2 and 3 assessments (e.g., free play, clean-up, teaching tasks, meal preparation) At child age 2, census-based measure of neighborhood deprivation based on 8 items: % of households < poverty level, % of adults with < h.s. education. See details on next slide. Achenbach Teacher report form Aggression factor at age 9.5 Covariates: Child gender and race/ethnicity, family income, parent education, parent report of child problem behavior at age 2 using CBCL Externalizing and Internalizing factor Measures

Neighborhood Deprivation Index Score Based on 8-item measure used in two large-scale studies of public health outcomes (Messer et al., 2006)* Items selected after comprehensive review of neighborhood risk measures & PCA analysis of 20 census variables Z-scores created for each item & averaged to create overall score: Percent of households in poverty; Percent in crowded housing; Percent of males in management & professional occupationsR; Percent of female-headed households; Percent of households on public assistance; Percent of households earning less than $30,000 a year; Percent earning less than a high school education; Percent unemployed

Class 1 (N=181) Class 2 (N=105) Class 3 (N=323) Class 4 (N=29) very high income, low-risk Class 2 (N=105) low income, very high maternal depression, high single parenthood Class 3 (N=323) low income, high single parenthood, otherwise low- risk Class 4 (N=29) high behavior problem, very high number of kids, high neglect, high maternal depression Class 5 (N=93) high law problems, very high neglect, extremely high mental health treatment Step 1: Identification of Latent Classes

Step 2: multiple groups LGMs Pretend the latent classes identified in step 1 are observed Assign each family to its most likely class These become the “multiple groups” Within each group, fit a LGM of growth in parent-rated aggressive/oppositional behavior from age 2 to age 5 Step 2: multiple groups LGMs

PARENT-RATED AGG./OPP. BEHAVIOR STEP 2: LATENT GROWTH MODEL These estimates are then shown graphically on the next two slides

Summary: LCA Treatment Response Analysis Families with distressed parents and distressed situations benefitted most from FCU Maternal depression > 15 Either or both antisocial behavior or mental health treatment History of involvement with child welfare Low-income, two- and single-parent families with low levels of other adversities benefitted least Implications for our screens to predict both risk of later problem behavior and response to FCU and other interventions Summary: LCA Treatment Response Analysis

Multiple group analyses run in Mplus (Estimator= MLR) Used 75th percentile as the cut point for extreme neighborhood deprivation because of sample size concerns. Results replicate using other cut points less than upper ¾ (e.g., upper 1/3, median split). Dyadic positive engagement served as a meditator of FCU and TRF aggression as dependent measure Variables were skewed (0-inflated) To transform, 1 added to all variables and square root obtained Transformed variables are used in all analyses Remember host of covariates No ITT intervention effect for FCU at age 9.5, BUT… Neighborhood Moderation and Parenting Mediation Analyses: Moderated Mediation

Moderated mediation: Effects of the FCU on child aggression by neighborhood deprivation Teacher report of Aggression Age 9.5 -.14* / .10 .13* / .13* .06 / -.27** Δ in Positive Engagement from 2 to 3 Note: Information on the left side of the / indicates results for moderate deprivation group and the right side indicates results for the severe neighborhood deprivation group. Dashed line indicates a constrained pathway. * p < .05, ** p < .01,

Summary: Neighborhood Moderation Results ITT effects of Family Check-Up on children’s school-age conduct problems quite modest according to parents and teachers after age 7.5 However, after accounting for neighborhood deprivation, intervention effects evident for children living in moderately deprived neighborhoods (i.e., 75% of sample) for both parent and teacher reports of conduct problems for parents and teachers at age 9.5, and to lesser extent at age 8.5. Although direct effects of FCU not evident for those children living in the highest-risk neighborhoods (i.e., top 25%), when FCU improves parenting there is an indirect effect on teacher reports of child aggressive behavior at age 9.5 Summary: Neighborhood Moderation Results

Implications from both Studies Results of LCA suggest screens could be beneficial in contexts where child maltreatment has occurred and/or where parent is distressed Using screens in nontraditional platforms serving low- income families with young children WIC, Early Head Start, Head Start, child welfare, primary care currently being tested in Pittsburgh Using FCU with VIP to tailor to specific family needs Results from neighborhood parenting analyses suggest attenuation of FCU effects in extremely deprived neighborhoods, but… If we can change quality of parent-child interaction during early childhood still possible to see intervention effects 7.5 years later on conduct problems at school Implications from both Studies

Questions and Conclusions Will current LCA findings continue to be valid for more nuanced intervention effects in later childhood and in contexts outside of the home? Will neighborhood moderation effects become stronger in adolescence as youth spend more time outside home environment? We continue to have ITT effects on child conduct problems at age 14 according to parent reports Did stopping intervention at age 10 prevent stronger maintenance of FCU effects? Similar to what occurs when Head Start ends after preschool period Despite these caveats, findings suggest higher risk families more likely to respond to FCU in early childhood and if improvements in parenting obtained, result in improved child disruptive behavior at school, even in context of extreme neighborhood deprivation Questions and Conclusions