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IT WORKS! FINDINGS FROM THE NATIONAL EVALUATION OF PARENTS ANONYMOUS® MUTUAL SUPPORT GROUPS Margaret (Peggy) L. Polinsky, MSW, PhD Director of Research & Evaluation Silvia Franco, Parent Leader Parents Anonymous® Inc. Claremont, California California Child Welfare Evidence-Based Practice Symposium January 30, 2009 – San Diego, California 1 Overview for Today Background Research Questions & Heuristic Methodology Sample Research Findings Implications Discussion 2 BACKGROUND – OJJDP/NCCD Office of Juvenile Justice and Delinquency Prevention (OJJDP) awarded 2 grants, 1 in 2000 and 1 in 2005, to The National Council on Crime and Delinquency (NCCD) in Oakland, CA To conduct an evaluation study of Parents Anonymous® 3 BACKGROUND–PARENTS ANONYMOUS® Parents Anonymous® Precept Parents Anonymous® Group Elements Parents Anonymous® Group Goals 4 Therapeutic Principles of Parents Anonymous® Groups: Mutual Support Shared Leadership Parent Leadership Personal Growth 4 OJJDP OBJECTIVES & GOALS Explore efficacy of Parents Anonymous® Update previous studies Increase methodological rigor 5 PARTICIPATORY EVALUATION APPROACH Project Advisory Board, with Parent Leader NCCD: Madeline Wordes, PhD; Raelene Freitag, PhD; Angie Wolf, PhD Consultants: Keith Humphreys, PhD; Julian Rappaport, PhD Parents Anonymous® Inc.: Peggy Polinsky, PhD; Tanya Long, Parent Leader 6 OVERARCHING RESEARCH QUESTION Does Parents Anonymous® work to reduce the risk of child maltreatment and, if so, for all parents or for some more than others? 7 RESEARCH QUESTIONS Do Parents Anonymous® group participants improve their parenting behaviors and/or reduce their child maltreatment behaviors? Does Parents Anonymous® group participation reduce the potential risk factors for child maltreatment? Does Parents Anonymous® group participation increase the potential protective factors for child maltreatment? 8 RESEARCH QUESTIONS (con’t) Are there differences in outcomes related to child maltreatment, risk factors, and protective factors among different types of group participants? What characteristics distinguish parents who continue group participation from those who do not? 9 EVALUATION HEURISTIC Individual Parent Characteristics Organization Characteristics Group Processes of Change Characteristics Shared Leadership Mutual Support Parents Anonymous® Ethos Group Facilitator Characteristics Intervening Parent Group Characteristics Leader Intermediate Characteristics Outcomes Primary Outcome Prevent Child Maltreatment 10 STUDY PHASES & DESIGN Process Evaluation (2001-2003) Outcome Evaluation (2003-2007) Quasi-experimental time-series design 3 telephone interviews over 6 months Outcome Evaluation (2005-2007) One-time face-to-face interviews with Spanish-speaking Parents Anonymous® parents Uniqueness 11 16 MEASURES MEASURES OF CHILD MALTREATMENT OUTCOMES Parenting Distress – CAPI Parenting Rigidity – CAPI Psychological and Physical Aggression Towards Children – CTSPC 12 MEASURES (con’t) MEASURES OF RISK FACTORS Life Stress Scale - Kanner, et al. Parenting Stress Index-Short Form (PSI-SF) Emotional and Physical Violence between Partners – Conflict Tactics Scale (CTS) Alcohol Use-Short Michigan Alcoholism Screening Test (SMAST) Drug Use-Drug Abuse Screening Test (DAST) 13 MEASURES (con’t) MEASURES OF PROTECTIVE FACTORS Quality of Life Scale - Andrews & Withey Social Support – NSSQ Emotional/Instrumental General Parenting Sense of Competence (PSOC) Nonviolent Discipline Tactics (CTSPC) Family Functioning - McMaster Family Assessment Device (FAD) 14 STUDY PROCEDURES 100 groups randomly selected from 230 Group Facilitators contacted, consented and trained to recruit parents Study goals and benefits explained to parents new to group Interested parents contacted Study 800# or mailed in information Researchers called parents, conducted informed consent, assigned ID #, conducted first interview within week 15 STUDY BENEFITS TO PARENT PARTICIPANTS Talk to an interested person Confidentiality $50 for first interview $75 for second interview $100 for third interview 16 PARTICIPANT ELIGIBILITY REQUIREMENTS At least 18 years old Living with at least 1 child between birth and 17 New to Parents Anonymous® (had not attended more than 5 Parents Anonymous® group meetings during the month or year prior to recruitment date) 17 INTERVIEW DESIGN Computer Assisted Telephone Interview (CATI) – data entered directly into database One-hour structured interview 5 domains: Demographics & background Child maltreatment outcomes Child maltreatment risk factors Child maltreatment protective factors Experience with Parents Anonymous® 18 PARTICIPANTS 232 parents completed 3 interviews 206 included in analysis (due to retroactive determination that 26 had attended group more than 5 times) From 54 groups in 19 states Sample was representative of the general population of Parents Anonymous® parents 19 DATA ANALYSIS SPSS data files each double-checked for accuracy, then merged into single file Descriptive statistics, histograms, frequency distributions, examination of outliers Regression analysis assessing scale score change over time and differential influence on variability in scale score change by parent and group characteristics Few significant findings led to scrapping plans for higher order analyses Only t-test results 20 ANALYSIS GROUPINGS Demographic and Background variables coded as binary Parents who continued through the study period (6 months): n=188 Parents who dropped out after first interview: n=18 21 BINARY CODING (N=206) Gender: Female (91%) /Male (9%) Ethnicity: African American (48%)/White (42%)/Other(10%) Education: <HS (21%)/HS or more (79%) Income: Low (<$13,000 annually) (48%)/High (52%) Child with special needs: Yes (50%) Prior help-seeking for parenting: Yes (72%) Physical or mental illness history: Yes (49%) Alcohol or drug abuse history: Yes (18%) History of CPS Contact: Yes (27%) Mandated attendance: Yes (15%) 22 LOW RISK OF CHILD MALTREATMENT Baseline: Parents reported little abusive behavior CTSPC average scores (scale: 1-5) 0.71 for psychological aggression 0.21 for physical aggression Average Risk Factors scores low Average Protective Factors scores high 23 STATISTICALLY SIGNIFICANT RESULTS 24 REDUCED CHILD MALTREATMENT OUTCOMES N=188 83% 73% 65% 56% Decreased Decreased Reduced Use Stopped Parenting Parenting of Physically Distress Rigidity Psychological Abusing Aggression Children (n=52)* *Only for those who reported physically abusing their children. 25 REDUCED RISK FACTORS N=188 86% 71% 40% 32% High Stressed Reduced Life Reduced Any Form Reduced Drug/ Parents Reduced Stressors of Domestic Alcohol Use Parental Stress Violence (n=46)* *Only for those in top 25% of Parental Stress scores. 26 INCREASED PROTECTIVE FACTORS 90% 88% 84% 67% 69% 67% Quality of Life Emotional and Parenting General Social Use of Non- Family (N=188) Instrumental Sense of Support Violent Functioning Support Competence (n=49)* Discipline (n=44)* (n=43)* (n=49)* Tactics (n=51)* *Only for those 25% scoring"worst" on these scales. 27 GENERAL FINDINGS All parents benefited, but benefit was especially consistent for those parents most in need on each measure at baseline. The parents most in need at baseline showed statistically significant improvement on all child maltreatment, risk, and protective factors. 28 ONE PARENT’S EXPERIENCE WITH PARENTS ANONYMOUS® Silvia Franco Parent Parent Leader Parent Group Leader Group Facilitator 29 FINDINGS FOR SPANISH- LANGUAGE PARENTS In a separate segment of the study, 36 parents from Spanish-language Parents Anonymous® groups in 2 states were assessed with semi- structured, in-person, qualitative interviews. At the beginning of Parents Anonymous® group attendance: The parents reported isolation, mental health issues, stress, and dysfunctional family life 30 Spanish-Language Parents (con’t) After attending Parents Anonymous® groups: Parents reported more social support, better parenting practices, greater satisfaction with parenting, higher family functioning, and a higher sense of their own worth and capabilities. The interviewees also reported that the Parents Anonymous® group provided confidentiality and respect and a willingness to share, explore and resolve personal problems. 31 WHY PARENTS DECIDED TO ATTEND PARENTS ANONYMOUS® Want to be a better parent (40%) Want to meet other parents (34%) Mandated (15%) To get help coping with stress (14%) Help others (7%) Help with childcare (7%) Be in a place where others listen (5%) Help to stop hurting their children (1%) 32 IMPACT OF PARENTS ANONYMOUS® ATTENDANCE – PARENT REPORTING Received the services needed to raise healthy children (96%) Formed relationships with other Parents Anonymous® group members (77%) Parenting became easier (77%) 33 IMPACT OF ATTENDANCE (con’t) Changed the way they parent (71%) Improved problem solving skills (43%) Learned new parenting and discipline ideas and methods (43%) Became more patient (11%) Learned more about child development (11%) Improved communication skills (9%) 34 STUDY LIMITATIONS Not a randomized controlled trial Effects may have been due to other factors besides Parents Anonymous® Participants were volunteers, who may have been different from non-volunteers. Few parents were at-risk for child maltreatment at baseline, limiting the statistical analyses. 35 STUDY STRENGTHS Longitudinal, time-series design Inclusion of child maltreatment risk factors not studied before in relation of effects of parent support groups: alcohol/drugs mental health family functioning domestic violence 36 SUMMARY & IMPLICATIONS The broad-based approach to family strengthening offered by Parents Anonymous® appears to allow parents to address their most pressing needs while at the same time providing a safety net, buffering the impact of the process of change across other factors. Parents Anonymous® seems to allow parents with differing backgrounds and differing needs to address and solve their particular issues, especially parents with the most acute needs upon entry. 37 DISCUSSION QUESTIONS EPB designation is mandated these days, creating an even greater need for evaluation studies such as the one presented here, but it is still difficult to get funding. How has your organization dealt with this issue? 38 DISCUSSION QUESTIONS When referring parents for services, do Child Welfare staff know how to find EBP programs? If not, what can be done to increase awareness of ways to identify EBP programs? 39 DISCUSSION QUESTIONS This study provides information showing that Parents Anonymous® mutual support groups are an effective strategy for preventing child abuse and neglect. What do you think Child Welfare staff attitudes are about the parent mutual support group approach, in relation to other child maltreatment prevention approaches? 40 CONTACT INFORMATION Peggy Polinsky, MSW, PhD Director of Research & Evaluation Parents Anonymous® Inc. 675 West Foothill Blvd., Suite 220 Claremont, CA 91101 Tel: 909-621-6184, Ext. 213 E-mail: email@example.com 41
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