Carolyn S. Perchuk RN, MN Winnipeg Regional Health Authority University of Manitoba Families First...
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Carolyn S. Perchuk RN, MNWinnipeg Regional Health Authority
University of Manitoba
www.gov.mb.ca/.../familiesfirst/evaluation.html
Families First &School Readiness
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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
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 - 0.53)
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
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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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The Manitoba Families First Program
Nurses and para professionals Working togetherPrenatal and postpartumUniversal screenIn-depth parent survey or fscFamily centeredCurriculum Voluntary3 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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Screening Tools' Sensitivity and Specificity
Children in Care
77% scored « at risk »on Screen
Children not in Care
83% scored « not at risk »
On Families First
Screen
Sensitivity Specificity
http://www.umanitoba.ca/centres/mchp/report.htm
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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 attachmentReference:Great Kids Inc.(2004)
www.ecdip.org/earlylanguage/
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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 programDue to not Enough resources
No programDue to Refused Services
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The Early Development Instrument Five Domains
1. Physical health and wellbeing
2. Social Competence
3. Emotional Maturity
4. Language and Cognitive Development
5. 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
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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 Groupsscreened prenatallylow education level of mother on social assistance/financial difficultymother’s history of depressionhistory of abuse as a child for mother or father of babyno prenatal care before 6 monthsfamily screened prenatally lone parent familyteen parentalcohol or drug use of mom during pregnancycurrent substance use by mothersocial isolation violence between parents.
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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
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Results of Chi SquareSignificant 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%)
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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
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
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ImplicationsPhysical 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
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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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ImplicationsHome VisitingResearch 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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RecommendationsPolicy 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.