Presenter Disclosures

1. Presenter Disclosures Sally Kuykendall “No relationships to disclose” (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

2. Evaluation of The Caregivers Helping to Affect and Nurture Children Early (CHANCE) Program: A family violence prevention program for early care education providers Ann Adalist-Estrin National Resource Center for the Children and Families of the Incarcerated Martha Davis Sandy Dempsey Institute for Safe Families Sally Kuykendall Saint Joseph’s University Project Funded By: CHILDREN'S TRUST FUND

3. Child Maltreatment • Estimates in the US range from: 1 : 100 children (U.S. Department of Health and Human Services, 2010) 1 : 5 children (Finkelhor, Turner, Ormond & Hamby, 2009) • Highest risk groups (US DHHS, 2010): General population 10.3 per 1,000 Infants 21.7 per 1,000 Toddlers (11.7-12.9 per 1,000) African-American (16.6 per 1,000) • In 2008, approximately 1740 children died from maltreatment. Infants and toddlers (<4 years) accounted for 80% of these deaths.

4. A major risk factor for maltreatment is living in a household with Intimate Partner Violence (IPV) • 30-60% of maltreated children live in families with IPV (Edleson, 1999) • 3.3 to 17.8 million children in US witness IPV annually

5. Adverse Childhood Experiences Study (ACES)

6. Issues associated with Childhood Exposure to Domestic Violence (CEDV) • Sleep problems • Increased startle response • Developmental delays • Failure to thrive • Highly emotional Temper tantrums • Fear /Anxiety • Hyperactive • Withdrawn • Poor bonding • Parentification

7. In the still-developing brain • Neurological demands for hyper vigilance (fight) • Dissociation (freeze/flight) • High cortisol, ACTH, and epinephrine levels cause nerve cells to grow or be cropped to meet demand • Fight/ flight/ freeze behaviors become hard-wired in the brain

8. Long-term effects of CEDV • Depression Suicide • Substance abuse Liver disease • Smoking Chronic Obstructive Pulmonary Disease • Heart disease (IHD) • Multiple sexual partners • Sexually transmitted diseases (STDs) • Unintended pregnancies • Intimate partner violence

9. The major types of child abuse prevention programsBarlow, Simkiss, and Stewart-Brown (2006) Home visiting Parenting Family preservation services Family-focused interventions Social support Multimodal

10. Caregivers Helping to Affect and Nurture Children Early (CHANCE) • Curriculum developed by Ann Adalist-Estrin, Director, National Resource Center for the Children and Families of the Incarcerated • Trainings delivered to staff in two Early Childhood Education Centers with regular follow-up trainings (2007-2010) • Public Awareness Campaign (posters, brochures, presentations) • Partnered with local service providers to facilitate referrals of children who exhibit signs of CEDV • Development of center policies for children exposed to DV The goal of the project was to empower the ECE community to respond to family violence in a safe and effective manner.

11. CHANCE Curriculum • Module 1: Domestic Violence in America defines DV and provides insights into the feelings and experiences of parent victims, and abusers. • Module 2: Young Children and Domestic Violence examines trauma, vulnerability and resilience, focusing on protective factors that can buffer children and families from some of the damaging aspects of domestic violence. • Module 3:The Role of Early Childhood Staff in Responding to Children and Families Impacted by Domestic Violence outlines seven categories of strategies for helping young children and their families cope with domestic violence. • Module 4:Following or Creating Program Policies & Procedures for Responding to Domestic Violence focuses on agency policies and how agencies can incorporate family safety/family violence policy into their centers.

12. Selection of centers • Desire to improve: At least one star in the Keystone Stars Program • Need: at least 33% of families receiving childcare subsidy • Actual census data • Black or African American (83.3-95.5%) • High school diploma or higher (69.1-74.2%). • Children below the poverty level (26.5-30.2%) • Median family income $32,709- 36,529 (compared to $50,046 in US)

13. Program Evaluation • Mixed methods & Process, Impact and Outcome • Parent Survey • ECE Provider Survey • Feedback from key stakeholders • Child protective services reports

14. Program Fidelity • Program author facilitated all trainings • 100% attendance

15. Needs Assessment(pretest n=80; mid n=27; post-test n=40) *p<.05

16. Parent/ Guardian changes in knowledge (pretest n=80; mid n=27; post-test n=40) * p<.05; **p<.01; *** p<.005

17. Parent /guardian reports of CEDV as experienced by their own child

18. Qualitative Results “They should know that it is OK to ask for help. Help should be offered at place such as doctor office, WIC offices, public assistance and other places that people would feel comfortable going.”

19. Summary of Parent/ Guardian Results • Attitudes toward interventions: 90% of parents believed the ECE environment is an appropriate place to address CEDV • Improved knowledge, particularly in helping perpetrators • Increased recognition: 35% increase in CEDV by the parent (violence against the child’s grandmother) • Increased reporting: 5% increase in reported CEDV • Reduced IPV: 29% decrease in reported victimization

20. Changes in ECE provider knowledge(pretest n=140; post-training n=69; post-program n=58) *p<.05; **p<.001

21. Qualitative In December 2008, one of the center directors shared a story. She suspected there was DV in the family. Following CHANCE training, she looked for opportunities to discuss her concerns with the parents. The opportunity came after the child displayed difficult behavior. The father angrily came to the director. She responded to his anger, calmly saying, “Children model what they see at home.” After a conversation, the father expressed interest in seeking help for his behavior. The staff made some adjustments for the child to provide a longer transition to the pre-K group (one month instead of one week).

22. ECE Provider Results • ECE providers demonstrated a strong knowledge of CEDV at pre-test • Selection bias • Improved recognition of children in distress • Improved connection with resources

23. Child Protective Services Reports • Child protective services reports decreased 17.8% from 2006 to 2009 in the two zip codes, an effect size of .34 • Note: Other regions of the city showed a 29% decline

24. Study Limitations • Only two centers • Good baseline knowledge of the problem • Increased reporting confounds the results • Sustainability? • Lack of resources

25. Conclusions • The CHANCE program appeared to have a moderate impact on knowledge, attitudes, skills and behavior of parents and ECE providers. • At the end of the project, parents and guardians felt that the ECE environment was an appropriate place to address DV.

26. Next Steps Parenting classes