healthy families arizona - prevent child abuse...
TRANSCRIPT
Randomized clinical trial of
Healthy Families Arizona home
visiting program
Craig W. LeCroy, Ph.D.
LeCroy & Milligan Associates
Arizona State University
Advice from the Children’s Bureau and
John Watson
“The care of a baby demands rigid discipline.”
“The rule that parents should not play with the baby
many seem hard, but it is without a doubt a safe one.”
“That is not to say that the baby should be left alone too
completely.”
-from Raising a baby the Government Way , M.Ladd Taylor, The psychological care of
the child and infant, J. Watson, 1928
2
History of bad parenting advice
Never hug or kiss your child.
Absolutely no night feedings.
Start potty training at 2 months of age.
Reduce colic by becoming less angry as a
mom.
Smear the baby in lard.
Issues in Healthy Families
Research Outcomes
Poor outcome results from previous studies
Poor Program Implementation
Limited Outcome Measures
Healthy Families Arizona Study
Random Assignment
Given a brochure and asked if they would be
interested in participating in a RCT
Randomly assigned to one of two groups
No interest – provided info on the program
Interested – Met eligibility?
Contacted by research staff
Contact with families
5 interviews over 3 years, each about 90 minutes
Baseline
Child 6 months of age
Child 1 year of age
Child age 2,
Child age 3
Study Objectives
1. Comparing the effectiveness of a home visitation
program (HFAz) and a treatment-as-usual control group on
primary social and behavioral outcomes.
2. Assessing maintenance of treatment gains by
conducting follow-up assessments.
3. Evaluating whether the home visitation program (HFAz)
has positive effects on a broad array of measures related
to program outcome.
Retention
Establishing a positive relationship
Removing all barriers to contact Accurate and thorough contact information for
participant and partner
Asking about plans about moving at each visit
Other contacts (at least two)
$10 incentive for reporting change of contact
Toll free number
Maintaining frequent contact
Study populationRisk Factors of Mothers Arizona Healthy
Families
Teen Births (19 years or
less)
16.4%
Births to Single Parents 66.3%
Less Than High School
Education
38.6%
Not Employed 78.7%
No Health Insurance 6.9%
Receives AHCCCS 82.5%
Late or No Prenatal Care 35.6%
Median Yearly Income $11,640
Risk Factors for Infants Arizona Healthy
Families
Born < 37 weeks gestation 15.6%
Birth Defects 0.9%
Low Birth Weight 13.2%
Positive Alcohol/Drug
Screen
9.4%
Retention in the study
Control Group
N = 147
Experimental
Group
N = 98
Baseline 147 100% 100* 100%
6-month 121 82% 78 78%
12-month 102 69% 65 65%
24-month 88 60% 50 50%
Baseline comparisonsDemographics Healthy Families Group Control Group Significance
White (n, %) 7 (7.2%) 22 (15.0%) nsHispanic (n, %) 72 (74.2%) 110 (74.8%) nsMother’s average age (Mean, SD) 26.9 (6.8) 25.8 (5.9) ns
Prenatal and birth characteristics
Birth weight (Mean, SD) 7.1 (1.5) 7.2 (1.3) nsN of Children before this birth (Mean,
SD)1.4 (1.5) 1.2 (1.2) ns
Smoked during pregnancy (n, %) 6 (6.2%) 11 (7.4%) nsAlcohol during pregnancy (n, %) 5 (5.2%) 8 (5.4%) nsAny prenatal care? (n, %) 95 (97.9%) 146 (98.6%) nsPrenatal care visits (Mean, SD) 12.8 (5.3) 13.1 (5.6) nsHigh School /GED? (n, %) 57 (58.8) 86 (58.1) nsMother employed (n, %) 21 (21.6%) 42 (28.4%) nsOwns a car (n, %) 43 (44.3%) 75 (50.7%) nsPartner (n, %) 80 (82.5) 131 (88.5) nsAHCCCS health insurance (n, %) 69 (71.6%) 92 (62.2%) ns
History of childhood maltreatment nsNeglected by caretakers (n, %) 20 (20.6%) 25 (16.9%) ns
Emotional abuse (n, %) 22 (22.7%) 38 (25.7%) nsSexual abuse (n, %) 12 (12.4%) 19 (12.8%) nsInvolvement with CPS as a parent (n, %) 12 (12.3%) 21(14.1%) ns
Outcomes
Safety practices
Parenting attitudes and practices
Health and maternal outcomes
Mental health and coping
Violent behavior
ScaleEffect size
(Cohen’s d)Significance
Safety scale .44 .003*
Electrical outlets .15 .08*
Locked poisons .17 .06*
Car seat .13 .10*
Poison Control .85 .01*
Healthy Families Significant Findings: Safety practices
ScaleEffect Size
(Cohen’s d)Significance
Regular routines .36 .01*
Reduced Chaotic household .29 .03*
Read to baby .31 .03*
Parenting competence .26 .08*
Parent/child behavior .24 .12
Home Environment .47 .003*
Parenting Efficacy .11 .12
Corporal punishment -.08 .24
Father Involvement .05 .73
Healthy Families Significant Findings: Parenting
ScaleEffect Size
(Cohen’s d)Significance
Breast feeding .29 .04*
Immunizations .04 .79
Well baby visits .06 .70
Contraception use .21(76% HF 66%
Control
Job
training/employment.09 .54
Healthy Families Significant Findings: Health and
Maternal Outcomes
ScaleEffect Size
(Cohen’s d)Significance
Goal Setting/future
orientation.26 .08*
Mental Health Index .44 .003*
Depression -.06 .34
Social Support .17 .26
Personal Care .14 .38
Emotional Loneliness .03 .84
Healthy Families Significant Findings: Mental Health
ScaleEffect Size
(Cohen’s d)Significance
Use of resources .214 .10*
Mobilizing Resources .43* .007*
Substance Abuse Treatment1 in HF group
1 in Control group
Early Intervention Services0 in Control group
2 in the HF group
Healthy Families Significant Findings:
Use of Resources
What didn’t show any
significance
Depression
Emotional loneliness
Immunizations
Well baby checks
Corporal Punishment
Linguistic analysis:
What our words say about us
Language—a new approach to studying
change.
“the words people generate are like
“fingerprints.”
Linguistic analysis-6 month
TREATMENT CONTROL P (d)
Past .94 (1.6) 1.65 (1.4) .10 (.27)*
Present 17.0 (5.8) 14.6 (5.5) .008 (.34)*
Future .18 (.77) .20 (.67) .81
First Person 3.7 (3.5) 3.3 (4.2) .60
Affective 17.4 (8.4) 15.0 (11.4) .15 (.24)*
Positive 15.3 (8.3) 12.0 (9.2) .02 (.37)*
Negative 1.9 (2.4) 2.8 (3.6) .08 (.29)*
Anxiety .20 (.74) .53 (2.9) .35
TREATMENT CONTROL P (d)
Anger .39 (1.1) .47 (1.4) .70
Sad .78 (1.3) 1.5 (2.0) .01 (.42)*
Perceptual
processes
4.2 (3.6) 2.9 (4.1) .04 (.33)*
Feeling
expression
1.6 (1.8) .77 (1.5) .002 (.50)*
Cognitive
mechanism
16.4 (6.5) 13.4 (7.2) .007 (.44)*
Insight 3.2 (3.1) 2.2 (3.0) .05 (.33)*
Cause 2.1 (2.3) 1.3 (1.8) .01 (.39)*
Certainty 1.4 (2.5) .82 (1.6) .08 (.27)*
Outcome Category Positive Findings
Safety Practices
Parenting
Health
Linkages/Referral
Mental Health
Home Environment
Overall Outcomes
ScaleEffect Size
(Cohen’s d)Significance
Use of resources .48 .01*
Mobilizing resources .47 .01*
Home environment .32 .04*
Subsequent pregnancy .25 .10*
Positive affect .35 .06*
Problem solving .19 .10*
One Year Outcomes
Linguistic analysis-12 month
Cohen’s d Significance
First Person .34 .001
Feeling
expression
.39 .02
Negative .54 .03
Cognitive
mechanism
.42 .02
Cause .50 .005
Violence in the home-12 month
Violence Healthy
Families
Mean
SD Control
Group
SD t-score p d
Shouted .06 (.24) .18 (.38) 2.38 .01* .37
Threaten
ed
.04 (.21) .10 (.31) 1.39 .16 .21**
Spanked .01 (.13) .05 (.23) 1.47 .14 .23**
Slapped .09 (.30) .11 (.32) .36 .71 .05
Total
Violence
.22 (.55) .46 (.97) 2.00 .04* .31
Overall Conclusions
Positive results across multiple domains-
Parenting and home environment showed some
of the best results
These are very direct indicators of the home
visitation program
Safety practices were positively impacted and
unintentional injuries are the leading cause of
death for children.
Indicators of violence found a less violent
household
Limitations/Research Issues
Some findings significant by chance.
Small sample size, especially at 12
months
Not a true control group—they received
some “active” aspects of the treatment
Craig W. LeCroy