Families First & School Readiness

1. Carolyn S. Perchuk RN, MN Winnipeg Regional Health Authority University of Manitoba Families First &School Readiness www.gov.mb.ca/.../familiesfirst/evaluation.html

2. 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 Background Reference:Great Kids Inc.(2004)

3. Parenting • Increased positive parenting (ES 0.81) • Decreased hostile parenting (ES - 0.53) Evaluation of Families First Program ... Reference: Healthy Child Manitoba (2010)

4. NOT Evaluated: Families First effect on School Readiness.

5. 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?

6. Education is a social determinant of health

7. Evidence: academic ability in K predictive of long term school readiness grade 3 success complete grade 9 graduate grade 12

8. Identify family Risk factors Intervene to build skill and improve environment Improve parent child attachment Improve Outcomes

9. 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

10. Methodology

11. Quantitative research design • Secondary data analysis of data from Healthy Child Manitoba Office (HCMO) data base

12. Measurement Tools

13. Screening Tools' Sensitivity and Specificity Specificity Sensitivity Children not in Care Children in Care 83% scored « not atrisk » On Families First Screen 77% scored « at risk » on Screen http://www.umanitoba.ca/centres/mchp/report.htm

14. 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 Family Stress Checklist Reference:Great Kids Inc.(2004) www.ecdip.org/earlylanguage/

15. 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

16. 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

17. Data accessed through data sharing agreement with the MB government SPSS software used for data analysis (alpha .05)

18. 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

19. 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

20. 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.

21. 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

22. 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%)

23. 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 One model for each EDI domain

24. Results of Data Analysis:Multiple Regression AnalysisGender 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

25. 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

26. Domain:Social Competence Low education of mother p=.002 Social Isolation/lack supports p=.030 Mother’s history of child abuse p=.009

27. Domain: Emotional Maturity Low education of mother p= .003 Social isolation/ Lack of supports p= .013 Mother’s history of child abuse p= .041

28. Domain:Language and Cognitive Development Low education of mother p= .002 On social assistance/financial difficulties p= .004 Violence between parents p= .052

29. Domain: Communication and General Knowledge Low education of mom p= .003 Social isolation/lack of supports p= .002 Violence between parents p= .007

30. 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

31. 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

32. 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. Acknowledgement

33. www.clipartof.com/details/clipart/18549.html