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www.childreninwales.org.uk
Lynn McDonald, Professor of Social Work Research, Middlesex University, London, Families and Schools Together
(FAST) Programme Developer
Lynn McDonald, Athro Ymchwil Gwaith Cymdeithasol, Prifysgol Middlesex,
Llundain, Datblygydd Rhaglen Teuluoedd ac Ysgolion Ynghyd (FAST)
SEPTEMBER 18 , 2013PARENT ENGAGEMENT CONFERENCE
CARDIFF, WALES
DR. LYNN MCDONALDFAST PROGRAMME FOUNDER
PROFESSOR OF SOCIAL WORK, MIDDLESEX UNIVERSITY, LONDON,
ENGLAND
Increasing Retention Rates of Low-Income Parents:
Strategies of Partnership and Empowerment
Shared Goal: Enhancing Child Well-Being
Policies being developed are to increase the impact and the reach of positive parenting groups
Review of evidence enables local authorities and national governments to identify what works best
However, evidence is not enough.There must also in addition be Reach. Transparency is needed to identify whether
and how many low-income families living in disadvantaged communities are actually receiving the benefits by completing the parenting groups on offer
Retention Rates for Low-Income Parents
Drop out rates in child mental health clinics: if a family comes once, 40-60% will not complete treatment (Kazdin, 2001);
Drop out rates in child mental health clinics: if a family comes once and the parent is low income or socially marginalized, > 60% drop out early
Reported drop out rates in parenting groups aimed at child mental health promotion for low-income, single and socially marginalized parents are higher: range between 40% to 90%
Families and Schools Together (FAST)
Universal parenting programme for all 3-6 year old children especially in disadvantaged communities
Build relationships, social capital and protective factors for all parents, as all have stress sometimes
Support all parents in practicing positive parentingTransition into school for all kindergarteners If a parent comes once to FAST, 80% return for 8
weekly sessions & 22 monthly multi-family meetings86% of FAST parent graduates report having made
a friend they see years later; reduce stress & isolation
82% Completed FAST across 13 school sites in Disadvantaged Welsh Communities
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10
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60
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90
Cycle 1 Cycle 3 Cycle 5 Cycle 7 Average
Randomised Controlled Trials on FAST
Collaborations with other researchers from medicine, public health, sociology, psychology, who were interested in social work interventions
4 RCTs on FAST completed with low income families Abt Associates, (2001); Kratochwill, et al, (2004);
McDonald et al, (2006), Kratochwill et al.(2009), Gamoran & Turley (2013)
Funding from NIH (NIDA, NICHD), SAMHSA, DOJ, DOE
Positive child behavioural and mental health outcomes over 1 and 2 years, across domains of child social ecology (child, family, school, community)
Low Drop Out Rates for Low Income Parents
FAST average drop out rate in Wales: only 18% drop outRetention rates: if a family comes once, 80% expected to
complete 6 or more of 8 weekly FAST meetings offered & then graduate to 22 parent-led monthly groups; 72% teacher identified, inner city, low income, single parent, African
American families with emotionally disturbed children, age 7 80% Universal: rural, Indian reservations, low-income families of all
first grade children and their families 85% urban, Mexican American immigrants, low income, universal
recruitment of all children 90% universal for all first graders and 50% risk of special education
with behavior problems; all low-income, mixed cultural backgrounds
Reach into Disadvantaged Communities
Over the past 10 years, the issue how to reach more families has been a focus
In 2003, the average number of FAST families who graduated per multi-family group was seven
First multi-hub FAST was tried: 7 per class=21
Replication was harder: grant for 10 sites, only half graduated 20 families, the other stayed at 7 families
Research study to increase reach and build social capital, universal recruitment brought 44 families per school, however, drop out rates were 49%
Building Local Community ‘Social Capital’
James Coleman sociologist Univ of Chicago studied schools and developed a theory of social capital
Children know one another at school and children know their parents
If parents become friends with their children’s school friends, that is ’ intergenerational closure’, a powerful form of social capital
If the average parent at a school knows 4-5 other parents, that school has high social capital
If parents have shared expectations, the norms shift
NICHD Research Study: Can FAST build social capital and Improve child outcomes
San AntonioPhoenix
FAST
Control
Endogenous Variables
SOCIAL CAPITAL
Number of parents known 0 or 1, 2 to 5, 6 or more
Shared expectations Not at all, A little, Some, A lot
CHILD OUTCOMES-SDQ
Peer problem behaviors Scale alpha=0.58
Total problem behaviors Scale alpha=0.70
Pro-Social behaviors Scale alpha=0.85
Statistical Methods
FAST as an indicator of social capital Intent to Treat: Two-Level Model Treatment on the Treated: Two-Level Complier Average
Causal Effect Model
Intervention Outcomes
Treatment on Treatment: FAST graduates compared w/ similar families in control schools
Across 52 schools, half had FAST; on average 44 families attended at least once
Across 26 randomly assigned control schools, there were no FAST sessions
Of the 22 families who completed FAST (5+ sessions) per school, characteristics were collated
In the control schools, a comparable group was created with similar characteristics
23
Methods
COMPLIERS WOULD BE COMPLIERS
NON-COMPLIERS
WOULD BE NON-
COMPLIERS
FAST Comparison
Treatment on the treated(TOT)
Intent to treat(ITT)
2525
ITT Effects on Social Capital
OutcomeEffect size Est/S.E. P-value
Intergenerational Closure 0.13 3.02 0.003
Shared Expectations with Other Parents 0.33 3.28 0.001
Intervention Social Capital
2626
TOT Effects on Social Capital
OutcomeEffect size Est/S.E. P-value
Intergenerational Closure 0.35 2.83 0.005
Shared Expectations with Other Parents 0.97 2.93 0.003
Intervention Social Capital
Causal Mediation of FAST Effects by Intergenerational Closure
Total Problem Behaviors
Estimate95% CI Lower
95% CI Higher
P-Value
Mediation Effect -0.11 -0.20 -0.05 <0.01Direct Effect -0.24 -0.80 0.30 0.38Total Effect -0.31 -0.91 0.20 0.21Proportion via Mediation
0.31 -3.35 3.04 0.21
Intervention Social Capital Outcomes
Causal Mediation of FAST Effects by Parents’ Shared Expectations
Total Problem Behaviors
Estimate95% CI Lower
95% CI Higher
P-Value
Mediation Effect -0.08 -0.15 -0.02 <0.01Direct Effect -0.28 -0.81 0.29 0.32Total Effect -0.36 -0.88 0.23 0.23Proportion via Mediation
0.21 -2.03 1.47 0.23
Intervention Social Capital Outcomes
Why Do Retention Rates and Reach Matter?
In Wales, Save the Children has introduced FAST into 13 disadvantaged communities
Whole families participate, and the benefits reach beyond the young focal child
The average number of families graduated per group was 18, for a total of 265 whole families served
The average retention rate was 82%Family conflict reduced, child SDQ increased
at home and school, parent school connections and parent to parent community connections increased
Risk factors of child poverty Poverty, lack of housing, employment, education, health
services Child: low shelter/food, poor parent-bonds, neglect,
cognitive delays Family has chronic stress, worries, anxiety about
resources, conflict, violence, substance abuse, depression, mental health problems
Family is socially isolated from extended family, friends, neighbours
Family experiences social exclusion, racism, health disparities
Parents are oppressed, no control over own life, no respect, no voice
Protective factors: For Child: quality of parent-child bond For Child: one caring relationship over time to turn to when
stressed For Parent: social network of support; social capital;
extended family For Parent: feeling self-efficacious; empowered voice and
agency
Risk and Protective Factors of Child Poverty
Poverty, Child Neglect, High Stress Levels?
Poverty and stress may/or may not go hand and hand for parents and for their children
Stressed and isolated families have higher risk of neglecting a young child
Child neglect causes impaired learning, increased aggression, and risk of drug abuse
Child in poverty has more risk of neglect: If family lives <$15,000 versus
>$30,000, 44 times more likely the child is neglected
High Stress Effects a Child’s Development
Stress changes the brain and alters chemical neurotransmitters related to violence
Stress changes gene expression of childIf the high stress (high cortisol) is sustained
over time it damages a child’s brain High stress causes low immune systems and
children get sick more often and heal slowlyHigh stress puts child into survival mode, and
stressed children cannot learn new things: academics, mathematic, reading or writing
Caring Relationships Can Buffer the Impact of High Stress on a Child’s Development
Sustained high stress (cortisol) levels are destructive to a child’s brain development and other organs
15 minutes of one to one responsive play reduces stressHigh stress levels can be managed with a responsive
parent who shows their love and Notices child’s emotions and is tuned in to the child Is available to the child under stress Asks questions and listens Is physically soothing and touches the child Plays responsively with no bossing, and follows the child’s lead
(Sue Gerhardt, 2002,Why Love Matters)
High Stress affects Quality of Parenting
Cannot focus on child’s needs, emotionally intellectually
Not enough time, no time for seeing friends Use of computers, mobile phones, TV Employment insecurity, food insecurity, residential
instability, transport insecurity, chronic stresses of poverty
Fear of inadequate medical and dental care Trapped in a dangerous neighbourhood Trapped in a dangerous relationship Daily experience of stigma and social exclusion,
racism Feelings of helplessness, hopelessness, low sense of
agency Low hope and mood, low patience, irritability, distracted,
anxious
New Brain Research: Pruning Neurons
Adults have 80 billion neuronsBabies have 200 billion neuronsNeurological pruning happens repeatedly before the
age of 15 yearsStrong neural networks stay & are not pruned awayUse it or lose it!One can always learn and improve, but it takes
longer as you get older to shape new networks
37
Words Heard by Young Child
Words heard by hour week year
Low income 616 62,000 3 million
Working class 1251 125,000 6 million
Professional 2153 215,000 11 million
What you hear, how you talk, how you read and write
Community Organizing, Social Capital vs. Poverty and Family Stress vs. Child
Neglect
Chronic stress and social isolation may increase child neglect: stresses of poverty and social exclusion reduce parents’ ability to be responsive and parent positively
Community organizing reduces stresses of poverty
o Social ties and inclusion buffer stress and enhance parent leadership which leads to more positive parenting and less child neglect
Community Development
Reduces Family Stress
Reduces Child
Neglect
45FAST Builds Protective Factors Against Stress: Relationships
Strengthening family unitParent-child bondParent-to-parent bondEmpowered parent groupParent to community and schoolMulti-systemic, multi-family groups with repeated informal positive exchanges
Partnership and Respect Engages Parents
Values of respect shifts power into shared governance Service user involvement in partnership with
professionals Multi-systemic. social ecological, local contextual
interventions Anti-oppressive and anti-discriminatory practice
Focus on quality of relationships with coaching and support in multi-family groups of parent leadership Between individuals, parent-child bonds, within families, Lead groups of professionals in multi-agency working With socially marginalized, low income parents: social
inclusionSystemic strategies to build social capital,
community Social cohesion, social trust, networking and social
inclusion Coleman, 1988: ‘intergenerational closure in schools’
Respect for parent role and knowledge at every level of the FAST programme: ‘nothing about us without us’
Parents participate in training and planning FAST: co-production with multi-agency professionals: 60% flexible
Parents are on FAST teams leading multi-family groupsParents are coached to be in charge of their own familyParents are given time to form informal social networksParents graduates plan the monthly ongoing meetingsParent interview panel for evaluation FAST certificationOver time, FAST parent graduates run local FAST groups
Parents Co-Produce FAST Groups
Applies 10 Theories & 24 Studies in Multi-Family Groups Which Parents
Can LeadParent groups are built on Paulo Friere’s
ideas of adult education groups in low income communities and these connected small groups are empowering
Family activities are led by parents coached and supported based on Minuchin’s family systems theory empowering executive subsystem of parents
1 -1 responsive play (attachment theory-Bowlby)
Parents ask children to do small tasks as ‘imbedded compliance requests’ (social learning theory)
Family school and community (social ecology theory)
NICHD Social Capital FAST Project
Social ecological theory of child development (Bronfenbrenner)
CHILD
NICHD Social Capital FAST Project
Social ecological theory of child development (Bronfenbrenner)
CHILD
family
NICHD Social Capital FAST Project
Social ecological theory of child development (Bronfenbrenner)
CHILD
family
school
NICHD Social Capital FAST Project
Social ecological theory of child development (Bronfenbrenner)
CHILD
family
school
neighborhood
Positive and Flexible FAST Groups Approach
Flexible and ‘manualized’ FAST programme enables ‘deep’ local cultural adaptations of 60% of processes
Positive parenting programme for child well-being Positive parent-led family activities for experiential learning with
weekly repetitions, with coaching and support by team Structured and sequenced parent led family activities interrupt
family conflict and boredom, increases parental efficacy Positive experiences of parental mastery of repeated activities
and routines, reduces family conflict and violence at home Strengths based: values are that ‘every parent loves their child’ Positive energy with families singing, drawing, crafts, laughing,
talking and playing together and building trust over time
Quality Assurance Structures
Trained teams supervised to lead multi-family groups by Certified FAST Trainers/Supervisors
Teams have parents and multi-agency professionals who culturally represent the families being served
Quality of implementation checklists used weekly
Three site visits with direct observation in 8 weeks
Program Integrity Checklists reviewed for drfit
Pre and post questionnaires for quantitative outcome
Qualitative evaluations with parents, teachers,
Recertification after three years
64FAST & Experiential LearningMeal at family tablesFamily sing-a-long/greetingsFamily craftsFamily communication exercisesBuddy time/parent support group meetingChildren’s structured activitiesOne to one “responsive play time”Winning as a family/cooking as a familyClosing Circle-Announcements
Experiential learning through coaching and supporting parents to lead family
activities
Family Scribbles Game
Family Flag
Feeling Charades
FAST as Evidence based Practice
UN United Nations Office of Drugs and Crime (2010) Family skills Programme (FAST is number 11 of 23 on
RCTs) FAST is probably best on retention rates of parents in
povertyUK National Academy of Parenting
Practitioners Amongst top ten parenting programmes in UK
US government lists for evidence based practice Child abuse and neglect prevention Child mental health promotion Substance abuse prevention Juvenile delinquency prevention I3 Dept of Education: to reduce educational inequality
in USA
73
“It takes a village to raise a child” Traditional African Proverb
applies theory & research to build that village for all young children by empowering parents in Wales with Communities First and Save the Children-Wales
For more information on the FAST programme in Wales, please contact:
Mererid Lewis, Head of Programmes,
Save the Children Wales
Email: m.lewis@savethechildren.org.uk
Tel: 029 2039 6838
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