Effective Family Support Programs Early Childhood Iowa Issue Brief by theregoesthatman

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									Effective Family Support Programs
     Early Childhood Iowa, Issue Brief #5
                                      Early Childhood Iowa, Issue Brief #5

                        Families are            Families are more connected to other        visits during the fiscal year 2006. This
                         responsible            families in their communities.              represents 13 percent of the total children
                         for the most           People feel responsible for what            in Iowa.
                         important job in       happens in their neighborhoods and
                         Iowa: raising the      communities.                                Research identifies that children from
                       next generation of                                                   low-income families are at increased risk
                     learners, workers, and    Research has proven family support           for poor health outcomes, lack of school
                                               delivered through home visits is most        readiness and developmental delays.
citizens. All will be affected by              effective when the program adheres to a
how well families today prepare their          recognized model that is evidence-based      Even if all children served by family
children for the future. Throughout time,      and intended outcomes match the families’    support programs would be considered
families have relied on each other, friends,   needs.                                       “at-risk,” the number would represent less
and neighbors, for support, and even                                                        than one third of Iowa’s children thought
material assistance during difficult times.                                                  to be at risk for poor outcomes due to low
                                               Overview of Family Support
Today, a number of factors result in
                                               Programs                                     socio-economic status.

parents having less time and resources         An environmental scan was conducted to       Research indicates specific models are
to devote to their children and families.      determine the number of children served      designed to produce positive results with
There are changes in family structures,        through family support programs whose        the at-risk population. Of the 29,756
increasing numbers of parents in the           primary method of service delivery is home
                                                                                                                   Figure 1
workforce and growing poverty among            visitation. There are 227,0621 children                   Number of Children Served by
families. Families need more support than      zero through five years old. The number                      Family Support Programs

ever before.                                   of these children living in low income
                                               households is 88,621. In 2006, there were                                                29,756

Research studies confirm that supportive        39,255 births in Iowa2.
networks contribute greatly to families’
ability to raise their children. Family
                                               Iowa Children Served by
support is important because children          Family Support Programs
benefit when:                                                                                          191,797

 Programs and services reach families          Of the 227,062 children zero through
                                               five years, 29,756 are served by family
 early.
                                               support programs delivered through home
                                                                                                 Number of Children Served   Number of Children Not Served
                                                                          Early Childhood Iowa, Issue Brief #5

children served, 17, 2543 of them are being                                             visits per month, average length of home                    children and families. In December 2006,
served by models that are not designed                                                  visit and average duration of family                        Early Childhood Iowa4 conducted a cross-
to serve at-risk children. Fidelity to the                                              involvement.                                                sectional statewide study of family support
model is critical to actually achieving                                                                                                             programs whose primary method of service
positive outcomes with families.                                                                                                                    delivery is home visitation.
                                                                                        An Exploratory Study of
Type of Family Support                                                                  Iowa’s Family Support                                       Methods
Programs                                                                                Programs                                                    The study was administered by an online
Figure 2 shows the number of children                                                                                                               tool and was used to solicit information
served by family support programs in
                                                                                        Background
                                                                                                                                                    from family support programs about
Iowa. The pie chart shows evidence that                                                 During the 2006 Iowa General Assembly,                      characteristics of their program and
Iowa has a variety of programs to serve                                                 legislators expressed an interest in funding                staff. The survey was distributed via
families with diverse needs. Each model                                                 family support programs. However, Iowa                      email using a recognized list of family
type varies in average number of home                                                   lacked data that clearly described the                      support programs. In addition, potential
                                                                                        current state of family support programs.                   respondents were asked to recruit other
                                                Figure 2                                                                                            potential respondents to participate in
                                                                                        Family Support                                              the survey. In affect, using the snowball
                                       Number of Children Served
                                               Age 0 - 5
                                                                                        Literature Review                                           technique to increase the number of
                                                                                                                                                    programs participating (125 respondents).
                                                                                                  Early Childhood Iowa stakeholders
                                                 1,457                2,932                               conducted a comprehensive family
                                                                                                                                                    Survey Design
                                  1,298                                            643
                                                                                          233
                                                                                                                support literature review to
                                                                                                                   learn about the research
              6,021                                                                             4,250
                                                                                                                                                    The 41 question online survey was
                                                                                                    249
                                                                                                                   related to family support.       developed by Early Childhood Iowa,
                                                                                                     685          There is no research that shows   which include public and private
                                                                                                 755            a one time home visit produces      partners of the Early Care, Health,
                                                                                    3,636
                                                                                                             significant outcomes for families       and Education system. Components
                                 7,597
                                                                                                        of newborns. The research shows             within the survey included staff profiles,
                                                                                                                       comprehensive family         program model, service delivery, data
 Early ACCESS                   EHS home based option    Even Start                     FaDSS
                                                                                                                       support programs produce     collection, screening and referral, and
 Head Start home based option   Healthy Start            HOPES                          HOPES like

 Other                          Parents as Teachers      PCAI parent ed programs        Shared Visions Parent Support  desired outcomes for         agency characteristics.
                                      Early Childhood Iowa, Issue Brief #5

Limitations of the Family                       Results of the Study                          Of the 125 survey respondents:
Support Survey                                                                                 80 percent of the family support agencies
                                                Quality of Programs                            are using tools for monitoring children’s
There was a high response rate from
health partners which should be taken into      About half (65                                 development
consideration when viewing the results.         programs)                                      97 percent refer children to Early
                                                of the                                         ACCESS if needed
Because the study was intended to be            respondents                                    47 percent of the respondents make
broad and exploratory rather than focused       reported their                                 referrals for specialized care for issues
and definitive, the findings generally fall       program is                                     such as mental health, domestic violence
short of providing clear answers to specific     recognized by a                                and substance abuse
questions. However, they often provide          national or
considerable insight into the type of details   state level                                   Competencies of the Home
that future surveys should address with         organization.                                 Visitor
respect to various issues. Given this, the
                                                                                              The study showed there are 581
more important results are conclusions          Linkages and Referrals                        professionals and 128 paraprofessionals
about how the findings of this study, and
                                                In the study, 36 out of the 125 respondents   employed by family support programs.
the insights they generate, can be used
                                                reported providing a universal, one time      Forty-eight of the respondents are using
to develop more focused and definitive
                                                assessment to all families and continued      professional staff only, five are using
studies of this type in the future.
                                                family support services based on the          paraprofessional staff only, and 35 are
Because of the exploratory nature of the        assessment.                                   using a combination of professional and
survey it can not be certain that it is                                                       paraprofessional staff. There were 37
representative of all Iowa’s family support     Of the survey respondents, 99 percent of      respondents that did not complete the
programs whose primary method of service        the programs received referrals from other    questions. The professional staff was
delivery is home visitation.                    community organizations. The top three        defined as early childhood teacher/educator,
                                                referrals sources include: Department of      health education, human service degree,
                                                Human Services, hospitals and maternal        registered nurse, occupational therapist,
                                                and child health agencies.                    physical therapist, and social worker.
                                    Early Childhood Iowa, Issue Brief #5

Professional Development                     Discussion                                    Analysis confirmed other studies5 in
                                                                                           recognizing there is not a one-size-fits-
Of the 125 respondents:                              The results from the survey           all approach to family support programs.
 79 family support programs                              suggest a wide variety of         Rather there is room for different
 require continuing education                              family support programs         programs emphasizing different goals for
 for direct service providers                                operate in Iowa with a        families. At the same time, it is critical to
 8 reported they do not                                       mix of models and desired    find the right fit between families’ needs
 require continuing education                                 outcomes. It also appears    and goals of different programs.
 38 programs did not answer                                   that program models do
 the question                                                 not necessarily align with   The research shows that no single
                                                            the needs of the families      educational discipline of the home visitor
Gaps and Barriers                                          they are serving. When          is more effective than another. Research
                                                         we do not match the family        does demonstrate the effectiveness of a
The three barriers identified from the               to the model that can best meet        mix of professional and paraprofessional
study include: 1) professional development    their needs, we are not maximizing the       home visitors. However, there is evidence
opportunities for staff; 2) knowledge         resources.                                   that at-risk families need home visitors
of evidence-based programs; and 3)                                                         with higher level competencies. Programs
development of a statewide family support    There is no research that shows a one time    need to support the continued professional
network.                                     home visit produces significant outcomes       development of their home visitors
                                             for families of newborns. The research        by offering professional development
Outcome Data                                 shows comprehensive family support            opportunities to be able to respond to the
                                             programs produce desired outcomes for         complex needs of today’s families.
Of the 125 respondents, 102 identified
                                             children and families.
their program collects outcomes, six
                                                                                           The study also shows the need for a
respondents do not collect outcomes and 17   The survey revealed that national or state    comprehensive, integrated professional
respondents did not answer the questions.    recognized program models show evidence       development system to support home
The top two parent outcomes collected        of program drift. This would suggest          visitors to enhance specific program model
are parent knowledge and referrals. The      that programs have drifted from program       training for those programs affiliated or
top two child health outcomes are health     fidelity which impacts their effectiveness.    credentialed with a recognized model,
related issues (immunizations, insurance,
                                                                                           which is supported by research.
etc.) and referrals.
                                    Early Childhood Iowa, Issue Brief #5

The results from the study confirmed that   adjustment within and across programs.        towards improving the effectiveness of
local supports were needed to improve      The study showed a disconnect between         family support programs in Iowa. The
programming and staff development.         the primary purpose of the program, the       standards would address four critical
Identified supports include professional    outcomes collected and the program model      components:
development for staff and supervisors,     used.                                               A. solid program adherence and
knowledge of evidence-based programs and                                                         organizational capacity to provide
the development of a statewide network
for family support programs.
                                           Recommendations                                       the program,
                                                                                               B. family engagement by forming
                                           Iowa has a variety of many types of family            an established relationship
These local supports are beginning to
                                           support programs and funding streams                  for a sufficient period of time to
be addressed through the work of Early
                                           from the federal, state and local levels.             accomplish meaningful change in
Childhood Iowa – Quality Services and
                                           However, there is a lack of coordination              parent knowledge and skills,
Programs (QSP). A statewide family
                                           at the state and local level. There is a
support leadership group was formed in                                                         C. competencies of a home visitor,
                                           need for the programs to meet quality
2005. Over 30 programs were represented                                                          cultural competency between the
                                           standards. Quality programs takes
and included the state and local level                                                           family and program, and
                                           rigorous supervision and a strong technical
managers and direct service providers                                                          D. high quality supervision6.
                                           assistance system. Adherence to a quality
from each program.
                                           model takes a comprehensive, integrated
Through QSP and the Family Support         system to assure many steps are in place      2. Develop and implement comprehensive
Coordinator, 18 technical assistance       to assure success of the program. A              training strategies
sessions have been provided across Iowa    challenge for Iowa is to implement                  A. A comprehensive professional
for early care, health and education       evidence-based components into their                  development system for all family
providers on evidence-based family         family support practices.                             support providers is needed to
support components.                                                                              provide the continuing education
                                           In order to fully develop a comprehensive
                                                                                                 on early care, health and
Analysis also confirmed other studies5      family support system to meet the needs
                                                                                                 education issues.
that the best chance for success of the    of families the following activities are
                                           recommended:                                        B. A training program would also
programs and for an integrated statewide
                                                                                                 be developed for family support
service delivery system depends on an      1. Develop a set of basic standards
                                                                                                 supervisors. Research emphasizes
environment that values and supports          for family support programs. The
                                                                                                 the importance of having a highly
ongoing monitoring, assessment and            standards would be the first step
                                     Early Childhood Iowa, Issue Brief #5

      qualified, trained supervisor
      promoting the fidelity of
      the program. Current
      supervisors have limited access to          Three needs at the local level:
      training.                                    Professional development
3. Continue to provide funding support             Knowledge of evidence-based          Policymakers
   for the Family Support Coordinator              programs                           should act on the
   to provide technical assistance and             Development of a statewide
                                                                                  potential for improving
   training to family support programs             family support network
                                                                                     the effectiveness of
   across the state and to provide
   assistance to programs moving toward
                                                                                 family support programs
   evidence-based models.
                                                                                 by requiring a set of basic
                                                                                  standards for all family
                                                                                     support programs.
Resources
1 Woods and Poole Data, 2005.
2 Iowa Department of Public Health, Vital Statistics, 2005.
3 Data are from the number of children served from HOPES-like, PAT and other programs.
4 Early Childhood Iowa is an alliance of stakeholders working to implement a comprehensive early care, health, and
education system.
5 Rapoport, Dana and O’Brien-Strain, Margaret. (September 2004). In Home Visitation Programs and A Review of the
Literature. Sphere Institute Report (pp. 51 –52) Sept 24, 2001.
6 Gombey, Deanna (2005). Home Visitation in 2005: Outcome for Children and Parents.
7 Hebbler, Kathleen, Gerlach-Downies, Suzanne (2002) Inside the black box of home visiting: a qualitative analysis of why
intended outcomes were achieved. Early Childhood Quarterly.
8 Bilukha, O., Hahn, R., Crosby, A., Fullilove, M., Liberman, A., Moscicki, E.,Snyder, S., Tuma, F., Corso, F., Schofield,
A., Briss, P., (2005). The effectiveness of early childhood visitation in preventing violence. American Journal of Preventive
Medicine, 28, 11-39.
        Quality Services & Programs Workgroup Members
AEA 9                            Des Moines Public Schools     Prevention Concepts
Joyce Leavell                    Sylvia Becerra                Jovanka Westbrook

AEA 13                           Drake University Head Start   Office of Empowerment
Connie Gronstal                  Georgia Sheriff               Janet Gartin

CCR&R                            Iowa Chapter of Academy of    South Iowa Economic
Cathy Wheatcraft                 Pediatrics                    Development Agency
                                 Becky White                   Pat McReynolds
Child Health Specialty Clinics
Erin Kongshaug                   Iowa State University         State Library
Brenda Moore                     Extension                     Mary Cameron
                                 Kim Greder
Child & Family Policy Center     Sharon Mays                   Young Parents Network
Carrie Fitzgerald                Peggy Miller                  Danielle Leeser

Community Empowerment            Iowa State University
Deb Schrader (Warren & Adair)    Sue Hegland

Department of Education          Lutheran Services of Iowa
Dee Gethmann                     Mary Odell
Judy Knox
                                 MATURA Action Corporation
Department of Public Health      PJ West
Sally Clausen
Gretchen Hageman                 Mid-Iowa Community Action
Jenny Hodges                     Ruth Krueger
Heather Miller
Jan Steffen                      Parent
Jane Stockton                    Kathy Grossman
Sonni Vierling
                                 Prevent Child Abuse Iowa
                                 Christy Thies

								
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