findings from our kidsfirst evaluation: 2012 presentation to ahvna

8/3/2019 Findings from our KidsFirst Evaluation: 2012 presentation to AHVNA

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Early childhood intervention in the

communityfindings from ourthree year collaborative study

Fleur Macqueen Smith, MA

Knowledge Transfer Manager, Healthy Children Research Team

Saskatchewan Population Health and Evaluation Research Unit

(University of Saskatchewan office)


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Background KidsFirst:provincial government early

childhood intervention programestablished in 2002

nine program sites in Saskatchewan uses intensive home visiting model

promotes healthy development connects families to existing

services, advocates for services


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Meadow

LakeNipawin

North

BattlefordMoose Jaw

Yorkton

Selectedneighbourhoods in:

Saskatoon

Regina

Prince Albert

All of Northern

Saskatchewan


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www.kidskan.ca/kidsfirst

clients enter the program duringpregnancy or after birth of a child

factors determining eligibility include lowmaternal education levels, mental health

issues, financial instability, substance

issues


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Lay home visitors support families by:

informally teaching parenting and life skills

(using Growing Great Kids curriculum)

helping them interact with their children

connecting them with otherKidsFirstfamilies

advocating for them with service agencies

connecting families with existing services,

and helping establish needed services


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Examples of typical families

Complex-needs: Sarah is an unemployed mother of two. She hasFASD, a history of drug addiction, and her children have been

apprehended once. Her boyfriend is occasionally abusive. Her

children have FASD and developmental disorders.

Intermediate needs: Patricia is a single mother of three who hasfinished high school and works part-time. She joined KidsFirsttohelp with her postpartum depression

Low-needs: Cecilia has a one-year old. She is unemployed butupgrading her high school as she wants to go to nursing school. She

lives with her boyfriend Kurt. Sometimes they struggle with money,

but they always pay bills and can buy groceries. They also have a

car so transportation isnt a problem.


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Immigrant families: Thiri is originally from Burma and came toSaskatchewan when first pregnant. Her home visitor took her to the

hospital and stayed with her when her son was born and helped her

register for English classes. She also connected her to a settlement

agency, where Thiri has made friends.

Northern families: June has lived in northern Saskatchewan all herlife. Her parents were in a residential school, and she had her first

child at 16. She has had three more children since then. Her homevisitor helped her leave an abusive relationship. She would like to go

back to school but is staying at home with her kids for now. She is

learning parenting skills, and notices herKidsFirstbabies seem

more contented.


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KidsFirstevaluation focuses on child development in

vulnerable families

integrates findings from multiple methods

is driven by clear framework developed

with program staff


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Evaluation development initially government unit responsible for

KidsFirstapproached SPHERU with someevaluation funds

SPHERU researchers secured additional

peer-reviewed funding from the Canadian

Population Health Initiative (2007-2010)


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Integrated knowledgetranslation

decision makers involved from the outset research team included researchers from

various disciplines, government decisionmakers

program managers were collaborators with

whom researchers interacted frequently


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KFResearch

Questions

WhateffecthasKidsFirsthadonparticipatingparentsand

children?

1.Arethereimprovementsinperinatal andearlychildhood

healthoutcomesforchildrenparticipatinginKidsFirst?

2.Do

children

involved

in

KidsFirstfare

better

in

terms

of

early

developmentaloutcomes?

3.DoesKidsFirst increaseparentsconfidenceandknowledge

andenhance

the

quality

of

parent

child

interactions?

4.HowhasKidsFirst producedtheseimprovements?Whatsite

specificprocesses,practices,andpoliciesappearto

contribute mostto

positive

short

term

outcomes?


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Phase 1 Foundational work Evaluation framework,

including programlogic model,

developed withprogram managers

linked program

operation, objectives

to theory in a

background paper


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Program Component Home VisitingProgram Goals

ProgramComponent

s

Component

Objective

KeyActivities

Short-term

OutcomesFamily

Engage families in home visitingprogramEstablish a trusting & nurturingrelationship with familyWork with families to identify

strengths, resources, and neededsupportsAssist families to set goals andidentify steps to achieve goalsDevelop personalized plans foreligible familiesProvide learning opportunitiesOffer Growing Great KidscurriculumDeliver group programmingProvide emotional and socialsupportAsses family vulnerability on anongoing basisEnsure pregnant women have

access to prenatal nutritionsupplementsModel advocacy skills andadvocate for families

FamilyFamilies accept home visitsand are retained in programFamilies are able to identifytheir own strengths and needsParents have a better

understanding of childrensgrowth and developmentParenting skills/knowledgeare strengthenedFamilies utilize neededresources and supportsSelf-reliance of families isincreasedSocial networks aredeveloped/strengthenedPregnant women identify riskconditions having a potentialhealth impactPrenatal nutritional status isimproved

SystemAdvocate with appropriategovernment agencies

SystemVulnerable families are bettersupportedProvincial policy is informed

KidsFirstfamilies areprovided withintensive supportand mentoring

Casefinding

In-depth FamilyAssessment

Home Visiting

MentalHealth &Addictions Services

EarlyLearning &Child Care

ProgramP

rinciples


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Community profiles

developed with inputfrom program managers

comprehensive homevisiting (HV) literature

review

systematic review of HV

effectiveness

Phase 1 Foundational work


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Mixed Methods quantitative study

analyzed program data,used control group to

analyze vital statisticsand health services data

qualitative study

conducted 84 interviews,

27 focus groups (242

program clients, staff,government officials)


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Methods: Quantitative studies Child health:

Saskatchewan administrative health data

Comparison group In-Hospital Birth

Questionnaire data (with score 9) Family functioning:

Family assessment tool

In-depth Assessment and Ongoing Assessments

Child development:

Ages and Stages Questionnaires


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N=3779 families Primary caregivers mostly female (98%)

Age of caregiver at enrolment Mostly in teens (28%) and twenties (55%)

Education of caregiver 55% had not completed high school

Methods: Quantitative studiesProgram management data


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Methods: Qualitative study


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What the Evaluation FoundImprovements in risk conditions within the first

six months for families withoutcomplex needsin all eight areas measured:

availability of social supports

food security

expectations of child

parent motivation

family identity and interactions

living conditions

housing suitability

housing stability


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Families with complex needs* haddecreased risk scores in only two

categories:

availability of social supports

food security

* challenges with domestic violence, mental illness,substance abuse, extreme parenting stress


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The percentage of woman who enrolled in the

program during their prenatal period grewfrom 15% in the first years of the program (2002,

2003) to 35-40% in more recent years

demonstrated community acceptance of

program, improved outreach to vulnerablefamilies during a critical time in their lives


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84% of children had at least onedevelopmental screen (Ages and Stages

Questionnaire, ASQ-SE) within the firstyear of life.

According to the ASQ, most of the

children appear to be developing

normally. However, there was norelationship found between families length

of enrolment in KidsFirstand their ASQscores.


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No differences in adverse outcomes at

birth between KidsFirstchildren and

comparison children

Children in the program had fewer well-child physician visits (regular checkups)

than children from a comparison grouphad during their first 13 months of life.


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KidsFirstchildren had relatively fewerphysician visits for perinatal conditions

such as jaundice

but more hospital visits for respiratory

conditions and more physician visits forinfectious diseases than comparison

children had

also, many KidsFirstfamilies do not havea regular family physician


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From Qualitative Findings Improved prenatal/parenting knowledge

and practices

Better parent-child interaction

Greater assertiveness and self-confidence

More reaching out, accessing services

Reduced smoking, quit drinking or

addressed addictions issues Made gains in personal development, life

skills, and other areas


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Before KidsFirst, if I had a problem, Idrather run away from it than deal with it.But now I just feel like, okay. Now Ithink, How am I going to deal with it?

Ill kind of cool myself down, and thenIll deal with it, or talk to this personabout it, or talk to my kids about it.

parent


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Some KidsFirst families that haveparticipated in different programs that I am

involved in have developed such goodskills that they are networking away from

here with each other. They providetransportation for each other; they helpwith child care for each other; they invite

other families to their [kids] birthdayparties.

program staff member


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Parents have more realistic expectationsabout what their children can do for theirage, probably more awareness of healthand safety, and more knowledge of child

development home visitor


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Challenges

families with the most complex needswere the ones least likely to stay in

program

home visitors found they were helping

families in moments of crisis, not providing

regular program support

home visitors felt they did not have

enough time with some families


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low pay, safety concerns at some homes makehome visiting challenging

turnover of home visitors undermines families

trust in the program

challenges with programs computerized data

management system confusion about roles, overlap with Social

Services

cultural challenges, especially with residentialschool legacy

challenges with service acccess, family andcommunity poverty


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14 recommendations developed, refinedin day-long stakeholder consultation

intake should focus more on increasing prenatal

recruitment, particularly in sites with relatively low

prenatal recruitment

parents should be encouraged to take their children for

well-child visits within the first vear, possibly through new

partnerships with medical clinics or public health

services


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families with complex needs should be offered a

modified (specialized) program involving specialized

home visitors

working with appropriate agencies, increased effortshould be made to help families find suitable, affordable

and safe housing

a thorough review of all existing data and collection

procedures should be undertaken in order to enhance

data quality, reliability, completeness, and relevance

the database used to collect data should be reviewed

and adjusted to reflect the needs of all user groups, and

more training on its use provided


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the Growing Great Kids curriculum should be evaluatedto see whether it was presented, received, learned, and

implemented

children screened and referred for additional psycho-educational assessment and/or interventions should be

followed and their outcomes recorded

the intensity of services provided in the first year should

increase

targeted area restrictions should be reviewed andupdated or eliminated


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guidelines on the roles of various agencies and staffmembers who are involved in KidsFirstprogrammingshould be better defined

community agencies should be encouraged to share

information in an effort to streamline case management

families should be encouraged to progress through the

participation levels within the program, taking into

consideration their particular situation

efforts to retain home visitors should be increased


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KT Activities used integrated knowledge translation

knowledge from evaluation shared inpresentations throughout project

produced 7 public reports, and site-specific reports for each site (16 in all)

presented findings to 90+ stakeholders at

provincial meeting

www.kidskan.ca(select KidsFirst from projects menu)
http://www.kidskan.ca/http://www.kidskan.ca/


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produced seven fact sheets on the

evaluation: overall findings, process,literature review on home visiting

effectiveness, challenges such as staff

training, housing produced short video to introduce

evaluation and share KT products wrote several KT cases for publications


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Challenges geographic distances separating partners

partners differing views of the research

concerted effort needed to maintain contact,

diligence to avoid misunderstanding

good faith needed to work through issues


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Impact despite high level of decision maker-

researcher interactions, difficult to know if

results will produce large-scale policy

change more likely to encourage changes in

community practices, small-scale policychange

researchers situated between local

program staff, provincial officials


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Implications

community-based intervention research

can be a unifying process

ideal partners are those who are

committed to participating fully early instudy, committed to acting on evidence

research needs to be both highly valid,highly policy relevant to maximize impact


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Finallywhile working this way is much harder

than conducting researcher-driven studies,it can be more energizing, and more likely

to make a difference


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AcknowledgementsResearch TeamNazeem Muhajarine Community Health and Epidemiology, U of S

Gail Russell Early Childhood Development Unit, Ministry of Education

David Rosenbluth Research & Evaluation Branch, Ministry of Social Services

Angela Bowen Nursing, U of SJody Glacken Community Health and Epidemiology, U of S

Kathryn Green Community Health and Epidemiology, U of S

Bonnie Jeffery Social Work, U of R

Fleur Macqueen Smith Saskatchewan Population Health & Evaluation Research UnitThomas McIntosh Political Science, U of R

Darren Nickel Saskatchewan Population Health & Evaluation Research Unit

Nazmi Sari Economics, U of S

Early Childhood Development Unit staff

KidsFirstProgram Managers and staff, and parents

Government of Saskatchewan, Inter-Ministerial Committee

Funders

Canadian Institute for Health Information-Canadian Population Health InitiativeGovernment of Saskatchewan

MITACS; College of Medicine


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For more information:

[email protected]

[email protected]

download KidsFirst reports from


findings from our kidsfirst evaluation: 2012 presentation to ahvna

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