Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment

1. 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)

2. Increasing Retention Rates of Low-Income Parents: Strategies of Partnership and Empowerment September 18, 2013 Parent engagement conference Cardiff, wales DR. LYNN MCDONALD FAST PROGRAMME FOUNDER PROFESSOR OF SOCIAL WORK, MIDDLESEX UNIVERSITY, LONDON, ENGLAND

4. 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

5. 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%

6. 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 parenting • Transition into school for all kindergarteners • If a parent comes once to FAST, 80% return for 8 weekly sessions & 22 monthly multi-family meetings • 86% of FAST parent graduates report having made a friend they see years later; reduce stress & isolation

7. 82% Completed FAST across 13 school sites in Disadvantaged Welsh Communities

8. 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)

9. Low Drop Out Rates for Low Income Parents • FAST average drop out rate in Wales: only 18% drop out • Retention 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

10. Teacher Ratingsof Academic Competence N=54 Kratochwill et al,(2004)Journal of School Psychology

16. Partnership

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18. 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%

19. 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

20. NICHD Research Study: Can FAST build social capital and Improve child outcomes Phoenix San Antonio FAST Control

21. Endogenous Variables

22. 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 Outcomes Intervention

23. 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

24. Methods Treatment on the treated (TOT) Intent to treat (ITT) FAST Comparison

25. ITT Effects on Social Capital Social Capital Intervention 25

26. TOT Effects on Social Capital Social Capital Intervention 26

27. ITT and TOT Effects of FAST on Parent-Parent Social Capital

28. Instrumented Effects of Social Capital on Child Outcomes Social Capital Outcomes Intervention

29. Causal Mediation of FAST Effects by Intergenerational Closure Outcomes Social Capital Intervention

30. Causal Mediation of FAST Effects by Parents’ Shared Expectations Outcomes Social Capital Intervention

31. 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

32. Risk and Protective Factors of Child Poverty • 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

33. 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

34. High Stress Effects a Child’s Development • Stress changes the brain and alters chemical neurotransmitters related to violence • Stress changes gene expression of child • If 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 slowly • High stress puts child into survival mode, and stressed children cannot learn new things: academics, mathematic, reading or writing

35. 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 stress • High 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)

36. 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

37. New Brain Research: Pruning Neurons • Adults have 80 billion neurons • Babies have 200 billion neurons • Neurological pruning happens repeatedly before the age of 15 years • Strong neural networks stay & are not pruned away • Use it or lose it! • One can always learn and improve, but it takes longer as you get older to shape new networks

38. Neurons Connected by Life Experiences: Synapses & Dendrites

39. Neural Networks form with Repetition & Emotional Intensity

40. Sculpting: Neurological Pruning of Non-connected Neurons

41. 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

42. Ages of Neurological Pruning 3 years 3 months 6 months 12 months 9 months

43. Ages of Neurological Pruning 9 years 12 years 6 years 15 years

44. 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 • 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

45. FAST Builds Protective Factors Against Stress: Relationships • Strengthening family unit • Parent-child bond • Parent-to-parent bond • Empowered parent group • Parent to community and school Multi-systemic, multi-family groups with repeated informal positive exchanges

46. 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 inclusion • Systemic strategies to build social capital, community • Social cohesion, social trust, networking and social inclusion • Coleman, 1988: ‘intergenerational closure in schools’

47. Parents Co-Produce FAST Groups • 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 groups • Parents are coached to be in charge of their own family • Parents are given time to form informal social networks • Parents graduates plan the monthly ongoing meetings • Parent interview panel for evaluation FAST certification • Over time, FAST parent graduates run local FAST groups

48. Applies 10 Theories & 24 Studies in Multi-Family Groups Which Parents Can Lead • Parent 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)

49. Social ecological theory of child development (Bronfenbrenner) child NICHD Social Capital FAST Project

50. Social ecological theory of child development (Bronfenbrenner) child family NICHD Social Capital FAST Project