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Families First & School Readiness
Carolyn S. Perchuk RN, MN Winnipeg Regional Health Authority University of Manitoba
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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 - Research based practice environment Reference:Great Kids Inc.(2004)
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Evaluation of Families First Program ...
Parenting Increased positive parenting (ES 0.81) Decreased hostile parenting (ES ) Reference: Healthy Child Manitoba (2010)
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NOT Evaluated: Families First effect on School Readiness.
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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?
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Education is a social determinant of health
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Evidence: academic ability in K predictive of long term
school readiness grade 3 success complete grade 9 graduate grade 12 92% complete gr 12 highest income quintile; 56% in lowest income quintile
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Identify family Risk factors Intervene to build skill and improve environment Improve parent child attachment Improve Outcomes
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Families First Program
The Manitoba Families First Program Nurses and para professionals Working together Prenatal and postpartum Universal screen In-depth parent survey or fsc Family centered Curriculum Voluntary 3 years
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Methodology
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Quantitative research design
Secondary data analysis of data from Healthy Child Manitoba Office (HCMO) data base
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Measurement Tools
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Sensitivity and Specificity
Screening Tools' Sensitivity and Specificity Specificity Sensitivity Children not in Care Children in Care 83% scored « not at risk » On Families First Screen 77% scored « at risk » on Screen Family identified by univ screen- +3 FF screen number assigned Provide Handout re Screening Tool- biological and social risk factors such as high or low birth weight, prematurity, mother’s highest level of education, family on social assistance, mental illness of mother or father, current violence between partners, existing file with child protection, parents own history of child abuse or neglect,
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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 attachment ; +ve= +25 based on validation study indicating higher risk level Side Note: 1 x week to age 9 – 15 months 2 x month 1 x month 1 x quater Score of < or > 25* Standards Reference:Great Kids Inc.(2004)
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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 program Due to not Enough resources No program Due to Refused Services
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The Early Development Instrument Five Domains
Physical health and wellbeing Social Competence Emotional Maturity Language and Cognitive Development Communication Skills and General Knowledge Score in each domain 0-10
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Data accessed through data sharing agreement with the MB government
SPSS software used for data analysis (alpha .05)
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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 Best quality predictions with the least biased estimates Use outcome variables for imputation as well, to avoid shrinking prediction toward average
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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
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Chi square to assess for Homogeneity of the 2 Groups
screened prenatally low education level of mother on social assistance/financial difficulty mother’s history of depression history of abuse as a child for mother or father of baby no prenatal care before 6 months family screened prenatally lone parent family teen parent alcohol or drug use of mom during pregnancy current substance use by mother social isolation violence between parents. -of these statistically signif differences
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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 -low education of mom important that is similiar in both groups as came out as significant in all EDI domains so more confidence
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Results of Chi Square Significant 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%) -Prenatally not a surprise as know more likely to accept program by literature -No prenatal might indicate in fact higher risk in this area 16% not in FF, 11% in FF -alcohol 48% in control to 36% -drug in preg 25 % in control to 17% -mom hx child ab 41% control to 29%- this one is a concern as very different and a signif school ready factor so needs more explor -father hx child ab 27% in program to only 12% in control so program grp more at risk- info coming from mom
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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 b- regression coefficient a= constant coefficient 19 independent variables – at 30 observations per variable could have 28.5 Beta= (b) [sq root of SSx / sq root of SSy] standardized regression coefficient - One model for each EDI domain
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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 Gender and month of birth reinforces much other research
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Implications Physical 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 FF related only in one domain but is an important one - Reinforces that we are assessing for signficant risk factors when offering FF= indirect relationship ? Need more exploration
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Domain: Social Competence
Low education of mother p=.002 Social Isolation/lack supports p=.030 Mother’s history of child abuse p=.009
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Domain: Emotional Maturity
Low education of mother p= .003 Social isolation/ Lack of supports p= .013 Mother’s history of child abuse p= .041
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Domain: Language and Cognitive Development
Low education of mother p= .002 On social assistance/financial difficulties p= .004 Violence between parents p= .052
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Domain: Communication and General Knowledge
Low education of mom p= .003 Social isolation/lack of supports p= .002 Violence between parents p= .007
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Implications Low education of mom Significant in all domains
Significant when control for variables recognized in other research as affecting academic success ie. Teen parent at time of first birth, on income assistance (Brownell, 2010) Child welfare system involvement was not used in this study but significant in Brownell’s (2010)
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Implications Home Visiting
Research 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
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Further Research Compare school readiness between children of teen moms who complete high school verses those who don’t Look at dosage of program and effect Does FF influence the variables that were identified as significant Include child protection as a variable to note if it is significant or does it change the significance of others Use propensity scoring to increase group similarity Use School ready verses not ready as outcome variable Qualitative component to explain results- explore with stakeholders and users, including parents Systematic review Peacock Volunteer bias Focus on mother due to data available Including only variables that have and could be more that are significant Significant differences in some variables between program and control group Missing data and use of imputation and the approach used newer so without theoretical justification of some other methods
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Recommendations Policy 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
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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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