adolescent parenting programs: assessing parent-infant interaction

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Evaluation and Program Planning, Vol. 14, pp. 87-95, 1991 Printed in the USA. All rights reserved. 0149-7189/91 $3.00 + .OO Copyright 0 1991 Pergamon Press plc ADOLESCENT PARENTING PROGRAMS: ASSESSING PARENT-INFANT INTERACTION SYDNEY L. HANS and VICTOR J. BERNSTEIN The University of Chicago CANDICE PERCANSKY The Ounce of Prevention Fund ABSTRACT With the increasing awareness that the offspring of adolescent parents are at high risk for de- velopmental problems, programs serving adolescent parents are introducing services designed to improve the quality of interaction between adolescent mothers and their infants. Since most program planners and evaluation researchers have had little training or experience in the highly specializedfield of parent-infant interaction, this paper will provide orientation to some aca- demic and applied issues in this area. First we will give evidence documenting the key role that the parent-infant relationship plays as a foundation for the child’s later development-and in particular the evidence suggesting that adolescent parent-infant relationships place the child at risk. Second, by drawing upon experiences with the Ounce of Prevention Fund adolescent parenting programs, we will describe some of the challenges in selecting a parent-infant inter- action assessment instrument for use in community-based programs. INTRODUCTION In western society, adolescent pregnancy and parent- hood have serious negative consequences for the devel- opment of both mother and child. Becoming a mother too soon seriously limits a young woman’s opportuni- ties for personal development, educational attainment, and economic achievement (cf. Alan Guttmacher Insti- tute, 1981; Furstenberg, 1976; Hofferth & Hayes, 1987). The children of adolescent mothers are at risk for academic and behavior problems (Baldwin & Cain, 1980; Brooks-Gunn & Furstenberg, 1986; Elster, McAnarney, & Lamb, 1983; Roosa, Fitzgerald, & Carl- son, 1982b; Simkins, 1984); and even when young mothers are able to achieve educational and economic success, this success may be at a cost for their children (Furstenberg, Brooks-Gunn, & Morgan, 1987). In the past decade, numerous community-based pro- grams have been established whose goals are to improve life chances for pregnant and parenting adolescents. Typically, such programs offer teenage mothers psy- chosocial support, crisis intervention, encouragement to continue education and vocational training, and family planning education. While, in theory, most programs for adolescent parents include among their goals the en- hancement of opportunities for both parent and child, in practice, their focus has rarely been on helping the child (Musick, Bernstein, Percansky, & Stott, 1987). Prevention programs targeted at infants or at parents as parents, usually are limited to helping teenage parents learn to provide basic care for their children. While providing health, education, and support ser- The initiation of the Ounce of Prevention Fund’s Developmental Program was in large part due to the leadership of Irving B. Harris, Judith S. Musick, and Judy L. Carter. Funding was generously provided through the Harris Foundation and the Smith Richardson Foundation. The development of the Parent-Infant Observation Guide was the collaborative effort of many people including Linda Henson from the University of Chicago and staff from Ounce of Prevention programs around the state of Illinois. Inquiries about the Parent-Infant Observation Guide should be directed to Victor J. Bernstein, Department of Psychiatry, Box 411, The University of Chicago, Chicago, IL 60637. Requests for reprints should be sent to Sydney L. Hans, Department of Psychiatry, The University of Chicago, Chicago, IL 60637. 87

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Page 1: Adolescent parenting programs: Assessing parent-infant interaction

Evaluation and Program Planning, Vol. 14, pp. 87-95, 1991 Printed in the USA. All rights reserved.

0149-7189/91 $3.00 + .OO

Copyright 0 1991 Pergamon Press plc

ADOLESCENT PARENTING PROGRAMS: ASSESSING PARENT-INFANT INTERACTION

SYDNEY L. HANS and VICTOR J. BERNSTEIN

The University of Chicago

CANDICE PERCANSKY

The Ounce of Prevention Fund

ABSTRACT

With the increasing awareness that the offspring of adolescent parents are at high risk for de- velopmental problems, programs serving adolescent parents are introducing services designed to improve the quality of interaction between adolescent mothers and their infants. Since most program planners and evaluation researchers have had little training or experience in the highly specializedfield of parent-infant interaction, this paper will provide orientation to some aca- demic and applied issues in this area. First we will give evidence documenting the key role that the parent-infant relationship plays as a foundation for the child’s later development-and in particular the evidence suggesting that adolescent parent-infant relationships place the child at risk. Second, by drawing upon experiences with the Ounce of Prevention Fund adolescent parenting programs, we will describe some of the challenges in selecting a parent-infant inter- action assessment instrument for use in community-based programs.

INTRODUCTION

In western society, adolescent pregnancy and parent- hood have serious negative consequences for the devel- opment of both mother and child. Becoming a mother too soon seriously limits a young woman’s opportuni- ties for personal development, educational attainment, and economic achievement (cf. Alan Guttmacher Insti- tute, 1981; Furstenberg, 1976; Hofferth & Hayes, 1987). The children of adolescent mothers are at risk for academic and behavior problems (Baldwin & Cain, 1980; Brooks-Gunn & Furstenberg, 1986; Elster, McAnarney, & Lamb, 1983; Roosa, Fitzgerald, & Carl- son, 1982b; Simkins, 1984); and even when young mothers are able to achieve educational and economic success, this success may be at a cost for their children (Furstenberg, Brooks-Gunn, & Morgan, 1987).

In the past decade, numerous community-based pro- grams have been established whose goals are to improve life chances for pregnant and parenting adolescents. Typically, such programs offer teenage mothers psy- chosocial support, crisis intervention, encouragement to continue education and vocational training, and family planning education. While, in theory, most programs for adolescent parents include among their goals the en- hancement of opportunities for both parent and child, in practice, their focus has rarely been on helping the child (Musick, Bernstein, Percansky, & Stott, 1987). Prevention programs targeted at infants or at parents as parents, usually are limited to helping teenage parents learn to provide basic care for their children.

While providing health, education, and support ser-

The initiation of the Ounce of Prevention Fund’s Developmental Program was in large part due to the leadership of Irving B. Harris, Judith S. Musick, and Judy L. Carter. Funding was generously provided through the Harris Foundation and the Smith Richardson Foundation. The

development of the Parent-Infant Observation Guide was the collaborative effort of many people including Linda Henson from the University

of Chicago and staff from Ounce of Prevention programs around the state of Illinois. Inquiries about the Parent-Infant Observation Guide should be directed to Victor J. Bernstein, Department of Psychiatry, Box 411, The University of Chicago, Chicago, IL 60637.

Requests for reprints should be sent to Sydney L. Hans, Department of Psychiatry, The University of Chicago, Chicago, IL 60637.

87

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88 SYDNEY L. HANS, VICTOR J. BERNSTEIN, and CANDICE PERCANSKY

vices to adolescent parents may help parents deal with their own developmental issues, such services are not likely to be sufficient to improve opportunities for their children. Recently, there has been an increasing aware- ness that family support programs-a rubric that in- cludes most adolescent parenting programs-may not be providing the infants and young children with all the support they need (Musick et al., 1988; Powell, 1988). Many programs for adolescent parents are beginning to develop service components that encourage greater emphasis on the children and, in particular, on &he in- teraction between children and their parents. Parent- infant interaction program components fit naturally with the family support philosophy of working with family members as part of a system. By focusing on parent-infant interaction, programs potentially are able to impact the dyadic relationship, as well as aspects of the child’s social development and the parent’s com- munication skills and feelings of enjoyment and success in the role of parent.

The addition of parent-child relationship program components to adolescent parenting programs presents tremendous new challenges not only to the programs themselves, but also to researchers who need to docu-

ment program success and to evaluate relevant out- comes. Since models for helping support parent-infant relationships are relatively new and originated in psychi- atric helping settings, those working in community-based programs often find themselves needing to develop new helping models that fit the character of their programs. Yet researchers and program staff-including lay helpers as well as professionals trained in both social service, chnical psychology, and the medical professions-are unlikely to have had previous experience with parent- infant interaction program models or even to have had basic academic training in parent-infant interaction the- ory and assessment.

The aim of the present paper is to share some issues relevant to the implementation and evaluation of par- ent-infant interaction program models. First, we will provide some theoretical and empirical rationale for de- veloping parent-infant interaction services in programs whose goals are to serve the children of adolescent par- ents. Second, we will recount some practical lessons fearned during the development and implementatiorl of a parent-infant interaction component for adolescent parenting programs in Illinois.

THE IMPORTANCE OF STRENGTHENING PARENT-INFANT RELATIONSHIPS: AN UNDERSTANDING FROM THEORY AND RESEARCH

From the earliest days of life, parents and infants par- ticipate in a complex social relationship in which the infant is a sophisticated partner (cf. Sander, Chappeli, & Snyder, 1982; Thomas & Trotter, 1978). Even very young infants are able to respond to subtle social cues, to signal their needs and wants, to adapt to the partic- ular styIe of their mother, and to cause mothers to adapt to their unique characteristics. From the first days after birth, patterns of synchrony and mutual reg- ulation can be observed in the eye movements, vocali- zations, and body movements of mothers and infants. The early infant caregiver relationship is the source of most of the child’s knowledge about the world. It is through this relationship that the infant learns to mod- ulate and sharpen his or her experiences of pleasure and unhappiness. This relationship is the context in which the baby develops a sense of regularity, security, and ef- ficacy that are the roots of self-esteem and competence (cf. Mahler, Pine, & Bergman, 1975; Stern, 1985).

The quality of parent-infant interaction is sensitive to a variety of parent and family characteristics-character- istics of the sort that family support programs generally hope to impact. Social risk factors such as inadequate maternal social supports, life stresses, and mental illness all relate to how a woman interacts with her infant and to how the infant learns to communicate with her (cf. Bernstein & Jeremy, 1984; Crnic, Greenberg, Ragozin,

Robinson, & Basham, 1983; Crockenberg, 1981; Trad, 1986). In fact, dyadic interaction is the channel through which an infant experiences social factors and the fam- iIy ecology. Most conditions that are social risk factors for infant development are distal to the child’s experi- ence and are ultimately communicated to an infant through the more proximal dyadic exchange with a par- ent. A baby’s principal way of experiencing the stress of a father’s unemployment or the hopelessness of a mother’s depressed state is through how that parent in- teracts with him or her.

Much developmental research indicates that measures of the child’s early social competence and relationship with mother are the most important markers of behav- ioral development during infancy, more important than traditional infant tests and assessments that focus on cognitive and motoric behavior. Cognitive and motoric behavior - unless extremely poor - has a disappointing record for predicting developmental success or impair- ment after infancy (Emde & Harmon, 1984; Lewis, 1983). On the other hand, infants’ early social behavior is a good predictor of later child competence. Longitu- dinal studies of children’s behavior indicate that the roots of children’s competence- both social and intel- lectual - are in early social relationships, particularly in the interaction between parent and infant. Many investi- gators report that problems in parent-infant communi-

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Parent-Infant Interaction 89

cation -in either the parent or the infant -are predictive of later developmental problems in both low- and high- risk populations (Bee et al., 1982; Coates & Lewis, 1984).

Perhaps the most impressive body of research on the early sources of child competence has come from those who study attachment (Egeland & Sroufe, 1981; Erick- son, Sroufe, & Egeland, 1985)-the affectional tie with the caregiver that develops around the time of the in- fant’s first birthday. This tie is inferred from the in- fant’s increasingly active role in maintaining proximity with the mother and in using the mother to reduce stress. Infants who develop secure attachments to their mothers in the first year of life are more competent as toddlers in peer interaction, exploration, and play be- havior, and are more enthusiastic and persistent in ap- proaching probiem-solving tasks (Matas, Arend, & Sroufe, 1978; Sroufe, Fox, & Pancake, 1983; Waters, Wippman, & Sroufe, 1979). The higher levels of ego re- silience and social competence of securely attached in- fants persist through 5 years of age (Arend, Gove, & Sroufe, 1979).

Thus, theory and research suggest that early social re- lationships are the basis of later social competence. Yet, do the relationships between adolescent mothers and their infants place such infants at risk? Helpers work- ing with adolescent parents often express concerns about the exchanges they observe between adolescent mothers and their infants. They describe many teenage parents as nonresponsive, lacking in warmth, or intru- sive with their infants. They describe a high proportion of the infants and especially the toddlers as problem- atic. Even some toddlers who may be cognitively com- petent seem aggressive; others seem “un~onne~ted,‘~ remaining passive even when their parents are hostile or intrusive (Musick et al., 1987).

The limited body of well-controlled research on the nature of mother-infant interactions with adolescent mothers tends to support these clinical observations. When compared with older mothers from control groups or normative samples, adolescent mothers generally show less desirable behavior in their interactions with their infants. Compared to older mothers, adolescent mothers demonstrate less optimal positioning and han-

dling of infants (Field, 1980; Hans & Berstein, 1987), less intimate body contact (Field, 1980; Sandler, Vietze, & O’Connor, 1981), a less positive affective environment (Levine, Garcia Coil, & Oh, 1985; Ragozin, Basham, Crnic, Greenberg, & Robinson, 1982), less sensitive and responsive behavior (Field, 1980; Hans & Bernstein, 1987; Jones, Green, & Krauss, 1980; Roosa, Fitzgerald, & Carson, 1982a; Ruff, 1987), less frequent or less con- tingent vocalization (Culp, Culp, & Levy, 1986; Field, 1980; Johnson, 1988; Levine, Garcia Coil, & Oh, 1985; Roosa, Fitzgerald, & Carson, f982a; Sandler, Vietze, & O’Connor, 1981), less visual regard during close inter- action (Culp et al., 1986), and a narrower range of cog- nitive growth-fostering activities in the home (Ruff, 1987; Stevenson, Colbert, & Roach, 1985).

The effects of adolescent parenting on the social be- havior of the infants has been less well documented. Many studies examining parent-infant interaction did not assess the infant’s contribution to the interaction, and of those that did, few reported effects of adolescent parenting in the behavior of the infants. Studies that did find effects tended to be those that assessed infants aider than 6 months of age. Levine, Garcia Coil, and Oh (1985) observed adolescent mothers and their eight- month-old infants and mothers in a teaching situation and found that infants of older mothers vocalized al- most twice as much as those with teenage mothers. Lamb, Hopps, and Elster (1987) observed adolescent mothers and their 14-month-old infants in Ainsworth’s Strange Situation in order to assess attachment behav- ior. Compared to norms gathered for other American infants, the adolescent mother-infant dyads had a dis- proportionately high number of infants showing inse- cure attachment behavior. Specifically, these children avoided contact with their mothers when reunited after a brief separation- behavior that in other samples has been associated with intrusively insensitive maternal be- havior, as well as later child adjustment problems dur- ing the preschool years. While these data are limited, they confirm clinical impressions that adolescent par- ent-infant dyads are at risk for problematic interaction and that the problematic interaction is of the type that may lead to increasing developmental difficulties as the child matures.

IMPLEMENTING PARENT-INFANT INTERACTION PROGRAM MODELS: AN UNDERSTANDING FROM PROGRAM PRACTICE

Since 1986, the authors have been working with Ounce vention programs throughout the state of Illinois, in- of Prevention Fund (OPF) agencies to develop a new eluding a diverse set of programs serving adolescent initiative, known as the Developmental Program, for parents with young children. Most OPF agencies adopt enabling adolescent parenting programs to help around a family support helping model and many rely heavily issues of parent-infant relationships. The OPF is a on lay helpers from the community for provision of ser- pubiic-private partnership that has funded and helped vices (Larner & Halpern, 1987; Musick & Stott, 1990). develop a network of community-based primary pre- As child development researchers and clinicians, we

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90 SYDNEY L.. HANS, VICTOR J. BERNSTEIN, and CANDICE PERCANSKY

worked to develop a program for the Ounce of Preven- tion Fund that would serve two objectives: (1) to give programs a structure for helping around parent-infant interaction and (2) to set criteria for the evaluation of program outcomes in parent-infant interaction.

Early in this work with OPF programs, we learned that the selection of an assessment tool would be nec- essary for meeting both objectives. While it is obvious why an instrument for assessing parent-infant interac- tion is important for purposes of outcome evaluation research, such an instrument is equally important as a tool for program staff. For staff of all levels, and espe- cially for those who are new to helping with parent- child relationships, an assessment tool is important for helping to structure observations of parents and infants, for giving staff confidence in their observation and helping skills, and for planning individualized helping strategies.

The choice of a particular assessment instrument is a critical one for programs because it will determine the tone of the helping model that is used and the standards by which program outcome is judged. While measures for assessing parent-infant interaction exist in the child development literature (cf., Howrigan, 1988), they of- ten do not match well the research and assessment and planning needs of community-based programs. While easy to administer, nonobservational methods such as questionnaires lack validity for assessing parent-infant interaction. It has been well documented that what par- ents say they do differs greatly from what they actually do (e.g., Yarrow, CampbelI, & Burton, 1968). Parents may, in fact, be most unaware of those aspects of their own and their children’s behavior around which help is most needed. On the other hand, observational tech- niques that have been successfully and widely used by basic child development researchers to assess parent- infant interaction (such as the Strange Situation and a variety of molecular methodologies) are cumbersome in the context of community-based programs and scales developed for clinical purposes are often based on com- plex theoretical models that do not match well the relatively simpIe helping models employed in commu- nity-based programs.

In working with the Ounce of Prevention Fund pro- grams, we made the decision to develop a new instrument that would be tailored to the needs of community-based programs-an instrument that would meet the pro- grams’ assessment, planning, and research needs. The outcome of this process was the Parent-Infant Obser- vation Guide (PIOG) (Bernstein, Percansky, & Hans, 1987; Hans & Bernstein, 1990)-a tool for understand- ing parent-infant relationships for identifying strengths and possible concerns around which help can occur. The development of this instrument was a lengthy pro- cess involving more than 2 years of collaboration by the authors, community program staff from three OPF

sites, and the young mothers at these sites. Designing this instrument was not a simple matter of meeting cri- teria for reliability and validity. It required reconciling the different needs and perspectives of the parties in- volved in the development: researchers versus practitio- ners, professionals versus lay helpers. During this process we Iearned a number of lessons about how to achieve a fit between an instrument that must serve both research purposes and meet the service needs of community-based programs. Nine of these lessons are

described below.

I. A Common Theory of Parent-Infant Relationships The content of an instrument needs to be a set of ideas that will be acceptable to child development research- ers-ideas that have been shown to be important in ba- sic research but also, ideas that are viewed as important by community-based staff. We found that we could generally educate staff with little formal training in child development theory to understand the meaning of many key theoretical constructs in child development. Yet we also learned that unless a construct had emerged naturally from their daily experiences observing and helping families, such education was unlikely to carry over to their work with families.

The model we eventually chose for using with the PIOG had intuitive appeal for those who work with families as well as considerable psychological theory and research behind it. The model is based on the no- tion that competence is central to an individual’s good development and feelings of well-being (White, 1959). Similarly, a good parent-child relationship is one in which parent and child feelings of competence grow out of their interaction with one another (Goldberg, 1977). Our operating definition is a simple one:

Any interaction that enables either the child or the parent to feel secure, successful, or valued; to enjoy each other or to enjoy learning is good for the development of the child.

The importance of specific characteristics of mutual competence child development are documented exten- sively in the literature on parent-child interaction. We chose to focus on a limited number of components of competence that can be derived from such a model and that we felt could be actually observed in routine par- ent-infant interaction: parent’s responsiveness to child’s needs, sensitivity to child’s interests, affection for in- fant, helping child to learn; infant’s expression of needs, use of parent’s help, interest in parent, and affection for parent.

2. Observation of Behavior in Context Observations of dyads need to be at a level of observa- tion that is meaningful to those making the observation. Instruments for assessing parent-child relationships that rate only discreet behaviors (e.g., number of times child

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Parent-infant Interaction 91

gazes at mother during a period) lack meaning for pro- gram staff. Instruments that assess higher-order theoret- ical constructs (e.g., symbiosis) are difficult for program staff to make reliably and sometimes seemed artificial without a grounding in behavior.

For the PIOG, we adopted a compromise between ratings of isolated behavior and ratings of higher-order theoretical constructs. All items that were selected re- quired observers to look for specific patterns of behav- ior. However, each item is identified as representing a particular category of behavior (e.g., maternal sensitiv- ity, infant expression of affection). Raters are trained so that they note the occurrence of a behavior pattern only if from the context of the observation they think it fits with the particular category.

3. Emphasis on Dyadic Strengths Family support programs generally take the stance of building from the strengths of families. This differs from traditional therapeutic models that tend to empha- size problems or deficits. An instrument used in prac- tice in a family support program needs to be one that enables service providers to focus on families’ strengths in the course of helping them.

In working with OPF programs, we found that lay helpers showed a subtle resistance to items we proposed that focused on family pathology. Although commu- nity workers were astute observers of parent-infant in- teraction when making observations from training videotapes of families unknown to them, when observ- ing videotapes of families from their own caseloads, the accuracy of their observations decreased. At first, it seemed paradoxical that helpers were least reliable with those families they should have known best, until we observed that their observations were distorted by an unwillingness to attribute negative or problematic be- havior to their case families. We learned that in a good program, staff loyalty lies with their participants. Lay helpers, in particular, may have a strong identification with their participants. These heIpers showed an appro- priate reluctance to label their families, but this reluc- tance diminished not only their reliability as sources of information but also, their capacity to be effective agents of change.

In devefoping the PIOG, our primary solution to this problem was to develop items that were worded in a positive sense. It was easier for program staff to rate without bias the absence of a positive behavior than the presence of a negative behavior. We also developed nonjudgmental summary scores. Instead of labeling the extremes of summary scales with labels such as good or poor, we labeled the extremes as “Observed” and “Ask Questions.” These simple changes not only freed lay helpers to describe a fuller range of family variation but also have given use greater confidence in their judg- ments as a source of reliable data for assessment of par-

ticipants. By focusing on positive aspects of behavior, program staff have actually been able to share and dis- cuss their PIOG observations with families in a non- threatening manner.

Lest this all sound naive, the PIOG contains a sup- plemental checklist of problematic behaviors that could be markers of serious problems such as child abuse or serious developmental delays. The issues raised by this problems list are obviously implant but so serious and complex that they cannot be deah with only by program efforts aimed at strengthening parent-infant relation- ships or only by lay helpers. Such issues require addi- tional assessment and intervention by a team that includes professionals from multiple disciplines.

4. ~i~irnjzi~g C~ltu~l Bias IdealIy, an instrument should not measure aspects of re- lationships that are valued differently in nonmajority cultures or where validity has not been established for the particular group the program serves. We found that many basic practices we endorsed or disapproved of were viewed differently by staff who were not from a white America middle-class background. For example, language that seemed derogatory and hostile to one ob- server seemed neutral or even affectionate to someone tied more closely to the cultural experience of a partic- ular parent. A child’s expression of distress at separa- tion from the mother seemed normal and desirable to some observers and problematic to others depending on their own cultural background.

The issue of cultural bias was and remains a contin- uous challenge. As child development professionals, we know that child-rearing practices are adapted to cultural contexts and that to understand a practice one must un- derstand the culture in which the child lives. However, we also felt that because a certain practice or child be- havior is endorsed within a culture does not mean that it is in the child’s best interest. Child development re- search has clearly documented that many widely ac- cepted “lay child development theories” such as “picking up a crying baby wiI1 only make him cry more” are false. In the PIOG, we tried to eliminate or modify items around which there were strong cultural debates, such as whether a mother’s use of seemingly derogatory words to refer to her child was a concern. Perhaps more importantly, in training people to use the PIOG we place an emphasis on the genera1 principles behind the subscales. We have found that most issues of cultural bias come not at the level of principles behind the sub- scales, but from how these principles are translated into actual behavior in a specific context. Focusing training on these general principles, rather than specific exam- ples of behavior, allows raters to make sensible judg- ments within their own cultural context about the desirability or appropriateness of specific behaviors. We encourage raters who are uncertain about how to rate

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92 SYDNEY L. HANS, VICTOR J. BERNSTEIN, and CANDICE PERCANSKY

a specific behavior to always refer back to these genera1 principles.

5. Flexibility with Respect to Observation Setting An instrument needs to be suitable for observation in a number of different settings, The OPF programs are typical of most community-based programs; they are designed to meet the needs of famiiies and not the needs of researchers. The OPF programs have widely varying types of facilities available to them. Few center-based programs have special rooms for observation of inter- action; some have no private rooms at all. Some home- based programs have no central facilities in which fam- ilies can be observed. The assessment instrument must be one that can use information gathered from any set- ting in which normal program operations occur.

In order that the scale could be used in as wide a va- riety of settings and tasks as possible, we included in the PIOG only descriptions of behavior that can be ob- served across many settings. While the clinical validity of the observations will be increased by observing a va- riety of routine interactions (such as diapering or feed- ing) and play interactions, in the PIOG, observations need not be made in any particular setting.

6. Applicability to Children of Differing Ages

An instrument needs to be flexible enough that an as- sessment can be made whenever a child is available to the observer-no matter what his or her age. OPF pro- grams, like most community-based operations, enroll children at differing ages and observe them whenever they can. Staff need to be able to make assessment of infants from a wide variety of ages without having to master unrelated assessment instruments.

In developing the PIOG, we eliminated many behav- ioral markers that would only be relevant to or impor- tant for a limited range of infant ages. As much as possible, items are ones that are appropriate to all ages from 4 to 15 months. Important developmental shifts occur, beginning at 4 months, in which the child is a much more active partner in social interaction, and, beginning around 1.5 months, most children enter a new phase of interaction in which their needs for auton- omy begin to change the dynamics of parent-child interactions.

7. Focus on Both Members of Dyad An instrument needs to provide information about both the parent and the infant. From a theoretical point of view, mother and child are a system and cannot be Iooked a& as independent of one another. Yet, a num- ber of widely used assessment instruments focus exclu- sively on either parenting behavior or infant social development.

Through our work with OPF programs, it became in- creasingly clear that family support programs work

through the parent in helping reach the children and, therefore, must have strong assessments of parents be- havior. Also, however, it was clear that program staff are already highly parent-focused and must be sensi- tized to issues around children’s needs and given confi- dence in their abilities to help around child issues. Yet, once trained in the use of the PIOG, staff often report that it is easier and more natural for them to work with parents by starting with a focus on the infant. The PIOG assesses aspects of both parent and child be- havior - one member of the dyad always in relation to the other.

8. Immediate Feedback and Easy Use An instrument for use in programs cannot be too dif- ficult or too cumbersome. It must be used easily by staff with various levels of academic and clerical skills. Program staff have very little time for paperwork and feel that paperwork takes away from their effectiveness in heIping families. They need to seize opportunities to help and support whenever they arise, and they need an instrument that requires littie time for scoring and from which they can get quick feedback. After observing a parent, they needed to be able to immediately discuss what they observed in order to have the greatest impact.

The final version of the PIOG is a brief set of items that can be rated and scored in approximately 10 min and whose scoring can be done on the spot. We strove for simplicity in the development of the instrument so that all staff, after training, could use it. In the final version, wording is in lay terminology with no psycho- logical or social work jargon. AI1 items require a simple dichotomous decision (observed/not observed) rather than ratings on more complex scales. The items are summed into a limited number of subscales around which observations can be discussed with parents and plans can be made with parents to increase their skills and their children’s skills.

9. Acceptable Psychometric Characteristics Finally, an instrument that is to be used as an outcome measure for program evaluation must meet acceptable standards for reliabiIity and vaIidity (cf. Standardsfor E~~cat~~~ai and ~syc~olog~ca[ Testing, 1985). In gen- eral, we found that as revisions suggested by program staff were incorporated into the instrument, the psycho- metrics of the instrument also improved.

In developing the PIOG, we have examined formal indices of reliability and validity using four sampies of high-risk mother-infant dyads that included (I) a sample of 82 low-income black mothers and their lZmonth-old infants that included a group of heroin and metha- done-addicted mothers (Hans & Bernstein, 1990), (2) a sample of 42 low-income black mothers and their 6- month-old infants that included adolescent and older mothers (Hans & Bernstein, 1987), (3) a sample of 48

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low-income black mothers and their I2-month-old in- fants that included adolescent and older mothers, and (4) a sample of 5 1 adolescent parents from a variety of racial and ethnic groups and their infants between the ages of 4 and 15 months. In the first three samples, ob- servations were made by college students from video- tapes of 45min laboratory interactions. In the fourth sample, observations were made by 10 paraprofessional workers, who observed parents in their own homes dur- ing regular program visits.

To assess the reliability of the PING, in each of the four samples, Cronbach’s coefficient alpha was com- puted for all five-item subscales. The subscale internat consistency measures ranged from . 11 to .78 with a me- dian of between 52 and .75 for each of the subscales. In the third sample, where two raters observed all of the videotapes, Pearson correlations were computed be- tween raters for each subscale. These interrater reliabil- ity coefficients ranged between A4 and .95,

In estabi~shing the validity of the instrument, we have been able to demonstrate correlations between parent subscales and various parental risk factors. Perhaps most interestingly, PlOG subscales are related differen- tially to risk factors. Par example, parent’s sensitivity to infant’s interests was related in each of our samples to older maternal age, parent’s affection for child was re- lated to maternal life satisfaction and well-being, and the maternal problems checklist which included items related to hostility to child was related to maternal drug abuse and adolescent delinquent b~hav~or. Thus far, we have less evidence of validity of infant summary scores, primariiy because we have fewer external infant vari- ables with which to relate them. Nevertheless, child’s in- terest in parent has shown moderate correlations with the Bayley Mental development Index, and child’s af- fection for parent has been related to some Bayley ln- fant Behavior Record social variables.

In the present paper, we reviewed some of the empiri- cal and theoretical rationale for introducing parent- infant interaction helping components to programs for adolescent parents. We also described some of the challenges we experienced in implementing parent- infant interaction program components and evaluation research in such programs, particularly, challenges in finding an assessment tool well matched to the speciaf characteristics of community-based programs,

In addition, from our experience developing and implementing models for helping to strengthen parent- infant relationships, we learned a lesson about the re- lationship between researchers and frontline program staff that is broadly applicable to evaluation research. While all good evaluation researchers will acknowledge the importance of coordination between program and research staff, such coordination is rarely fully imple- mented. In the OFF programs we had the luxury of time to follow through with this coordination process, and we were amazed at the enormous benefits to pro- gram and research.

Those who intervene with parent-child relationships are familiar with the “chain of enablement” (Musick ef a/. , 1987), by which help givers enable parents to function as parents who, in turn, enable their children to develop successfully. We found a similar process of “mutual enablement” by which program staff and researchers support each other in achieving their individual goals.

Researchers must not only listen to program staff but also, give to staff something that enables them to achieve their own goals and meet their own needs. In

our work, program staff each came to the OPF Devel- opmental Program with an agenda for their own work. They were motivated by a need to help the children they served and to organize their observations. Some staff members were anxious or insecure about making obser- vations and needed a tool that would give them confi- dence. Research staff enabled them to acquire and master such a tool.

In return, the program staff clearly enabled researchers to collect data of better quality. The final instrument was far more suitabie for evaluation of commu- nity-based programs than existing instruments or than anything that we as researchers would have developed independently. By adapting to the needs of the pro- gram, the inst~me~t became simple and sensible. Sim- ple and sensible instruments generate reliable data. When an instrument is useful to program staff, they are willing to collect data and are invested in insuring the accuracy of the data. In our experience, most program staff will never see the value of research to their pro- gram, but with the Ounce of Prevention Fund pro- grams they were at least able to see the value of one tool generated with the help of researchers. By having incor- porated the input of program staff in such a way that they found the scale useful, we now find that they are enthusiastically and carefully collecting data. This en- thusiasm is clearly related to the process we went through of developing a shared set of values around parent-infant interaction and of developing an assess- ment tool that was of benefit to both program imple- mentation and outcome evaluation.

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94 SYDNEY L. HANS, VICTOR J. BERNSTEIN, and CANDICE PERCANSKY

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