PRESENTER DISCLOSURES

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Sally Kuykendall

“No relationships to disclose”

EVALUATION OF THE CAREGIVERS HELPING TO

AFFECT AND NURTURE CHILDREN EARLY

(CHANCE) PROGRAM: A FAMILY VIOLENCE PREVENTION PROGRAM

FOR EARLY CARE EDUCATION PROVIDERSAnn Adalist-Estrin

National Resource Center for the Children and Families of the Incarcerated

Martha Davis

Sandy Dempsey

Institute for Safe Families

Sally Kuykendall

Saint Joseph’s University

Project Funded By:

CHILDREN'S TRUST FUND

CHILD MALTREATMENT• Estimates in the US range from:

1 : 100 children (U.S. Department of Health and Human

Services, 2010) 1 : 5 children (Finkelhor, Turner, Ormond & Hamby, 2009)

• Highest risk groups (US DHHS, 2010): General population 10.3 per 1,000 Infants 21.7 per 1,000 Toddlers (11.7-12.9 per 1,000) African-American (16.6 per 1,000)

• In 2008, approximately 1740 children died from maltreatment. Infants and toddlers (<4 years) accounted for 80% of these deaths.

A MAJOR RISK FACTOR FOR MALTREATMENT IS LIVING IN A HOUSEHOLD WITH INTIMATE PARTNER VIOLENCE (IPV)

30-60% of maltreated children live in families with IPV (Edleson, 1999)

3.3 to 17.8 million children in US witness IPV annually

ADVERSE CHILDHOOD EXPERIENCES STUDY (ACES)

ISSUES ASSOCIATED WITH CHILDHOOD EXPOSURE TO DOMESTIC VIOLENCE (CEDV)

• Sleep problems • Increased startle

response• Developmental

delays• Failure to thrive• Highly emotional

Temper tantrums

• Fear /Anxiety• Hyperactive• Withdrawn• Poor bonding• Parentification

IN THE STILL-DEVELOPING BRAIN Neurological demands for hyper vigilance

(fight) Dissociation (freeze/flight) High cortisol, ACTH, and epinephrine levels

cause nerve cells to grow or be cropped to meet demand

Fight/ flight/ freeze behaviors become hard-wired in the brain

LONG-TERM EFFECTS OF CEDV Depression Suicide Substance abuse Liver disease Smoking Chronic Obstructive Pulmonary Disease Heart disease (IHD) Multiple sexual partners Sexually transmitted diseases (STDs) Unintended pregnancies Intimate partner violence

THE MAJOR TYPES OF CHILD ABUSE PREVENTION PROGRAMSBARLOW, SIMKISS, AND STEWART-BROWN (2006)

Home visitingParentingFamily preservation

servicesFamily-focused

interventions Social supportMultimodal

CAREGIVERS HELPING TO AFFECT AND NURTURE CHILDREN EARLY (CHANCE)

• Curriculum developed by Ann Adalist-Estrin, Director, National Resource Center for the Children and Families of the Incarcerated

• Trainings delivered to staff in two Early Childhood Education Centers with regular follow-up trainings (2007-2010)

• Public Awareness Campaign (posters, brochures, presentations)• Partnered with local service providers to facilitate referrals of

children who exhibit signs of CEDV• Development of center policies for children exposed to DV

The goal of the project was to empower the ECE community to respond to family violence in a safe and effective manner.

CHANCE CURRICULUM• Module 1: Domestic Violence in America defines DV and provides

insights into the feelings and experiences of parent victims, and abusers.

• Module 2: Young Children and Domestic Violence examines

trauma, vulnerability and resilience, focusing on protective factors that can buffer children and families from some of the damaging aspects of domestic violence.

• Module 3: The Role of Early Childhood Staff in Responding to Children and Families Impacted by Domestic Violence outlines seven categories of strategies for helping young children and their families cope with domestic violence.

• Module 4: Following or Creating Program Policies & Procedures for Responding to Domestic Violence focuses on agency policies and how agencies can incorporate family safety/family violence policy into their centers.

SELECTION OF CENTERS Desire to improve: At least one star in the

Keystone Stars Program Need: at least 33% of families receiving

childcare subsidy

Actual census data • Black or African American (83.3-95.5%) • High school diploma or higher (69.1-74.2%). • Children below the poverty level (26.5-30.2%)• Median family income $32,709- 36,529 (compared to $50,046 in US)

PROGRAM EVALUATION

• Mixed methods & Process, Impact and Outcome

• Parent Survey• ECE Provider Survey• Feedback from key stakeholders• Child protective services reports

PROGRAM FIDELITY

Program author facilitated all trainings 100% attendance

NEEDS ASSESSMENT(PRETEST N=80; MID N=27; POST-TEST N=40)

CEDV of the parent/ guardian IPV victimization of the parent/ guardian

pre interim post pre interim post

Pushed, grabbed, slapped, or something thrown

47.5 44.4 60.0 40.5 48.1 25.0

Hit repeatedly 35.4 29.6 32.5 25.0 7.4* 7.5

Kicked, bitten, or hit 23.7 29.6 25.0 26.2 7.4* 12.5

Threatened with knife or gun 22.8 11.1 17.5 20.0 11.5 16.6

Forced sexual contact 13.3 7.7 5.0 21.2 3.7* 12.5

Overall 50.0 48.1 67.5 42.5 48.2 30.0

*p<.05

Pre (% correct)

Post (% correct)

% change

Parents who are violent with each other are more likely to be violent with their children. 68.6 73.2 6.7

Children can be exposed to DV even if they do not see it. 77.5 80.5 3.9*Verbal abuse is a form of DV. 79.6 87.8 10.3Many victims of DV are hurt or killed after they leave the relationship. 72.4 80.5 11.2**

The ECE environment is an appropriate place to address DV. 56.5 89.8 58.9***People learn to be abusive when exposed to DV as children. 79.1 90.2 14.0*ECE providers should intervene in conflicts between partners. 51.1 76.9 50.5The ECE curriculum (activities, rules, art, stories, etc.) can help young children to deal with DV. 70.9 82.1 15.8

I know at least three resources of help for victims of DV. 52.9 70.0 32.3I feel comfortable offering resources to a DV victim. 70.1 63.4 -9.6I feel comfortable offering resources to a DV perpetrator. 48.3 75.0 55.3*

* p<.05; **p<.01; *** p<.005

Parent/ Guardian changes in knowledge(pretest n=80; mid n=27; post-test n=40)

PARENT /GUARDIAN REPORTS OF CEDV AS EXPERIENCED BY THEIR OWN CHILD

pre interim post % change

Child hears but does not see fighting 26.8 11.5 23.7 -11.6

Child sees fighting 20.0 7.7 28.9 44.5

Child tries to stop fighting 16.7 4.0 20.5 22.8

Child hears through outside conversation 13.7 3.8 17.9 30.7

Child exposed during pregnancy 13.9 3.8 15.4 10.8

Child sees mother’s injuries 12.7 0 15.8 24.4

Child joins in fighting 8.3 3.8 0 -100.0

Child is physically hurt during fighting 8.3 0 2.6 -68.7

Child experiences aftermath of violence 5.6 3.8 7.7 37.5

QUALITATIVE RESULTS

“They should know that it is OK to ask for help. Help should be offered at place such as doctor office, WIC offices, public assistance and other places that people would feel comfortable going.”

SUMMARY OF PARENT/ GUARDIAN RESULTS• Attitudes toward interventions: 90% of parents

believed the ECE environment is an appropriate place to address CEDV

• Improved knowledge, particularly in helping perpetrators

• Increased recognition: 35% increase in CEDV by the parent (violence against the child’s grandmother)

• Increased reporting: 5% increase in reported CEDV

• Reduced IPV: 29% decrease in reported victimization

CHANGES IN ECE PROVIDER KNOWLEDGE(PRETEST N=140; POST-TRAINING N=69; POST-PROGRAM N=58)

Baseline Post Training

Post Program

% change

Parents who are violent with each other are more likely to be violent with their children compared to parents who are not violent with each other. 80.7 79.4 89.7 11.2

I know the signs of young children in distress. 79.7 92.6 88.9 11.5**Early care and education providers should stay out of conflicts between spouses or partners. 52.9 64.7 64.9 22.7

The early care and education curriculum (activities, rules, art, stories, etc.) can help young children to deal with DV.

88.6 94.1 96.5 8.9

I know at least three resources of help for victims of DV. 71.2 91.3 86.2 21.1*

I feel comfortable offering resources to a parent who may be a victim of DV. 69.6 76.5 79.3 13.9

I feel comfortable offering resources to a parent who may be a perpetrator of DV. 61.7 67.6 70.7 14.6

*p<.05; **p<.001

QUALITATIVE

In December 2008, one of the center directors shared a story. She suspected there was DV in the family. Following CHANCE training, she looked for opportunities to discuss her concerns with the parents. The opportunity came after the child displayed difficult behavior. The father angrily came to the director. She responded to his anger, calmly saying, “Children model what they see at home.” After a conversation, the father expressed interest in seeking help for his behavior. The staff made some adjustments for the child to provide a longer transition to the pre-K group (one month instead of one week).

ECE PROVIDER RESULTS

ECE providers demonstrated a strong knowledge of CEDV at pre-test

Selection bias Improved recognition of children in distress Improved connection with resources

CHILD PROTECTIVE SERVICES REPORTS

Child protective services reports decreased 17.8% from 2006 to 2009 in the two zip codes, an effect size of .34

Note: Other regions of the city showed a 29% decline

STUDY LIMITATIONS

Only two centers Good baseline knowledge of the problem Increased reporting confounds the results Sustainability? Lack of resources

CONCLUSIONS The CHANCE program appeared to have

a moderate impact on knowledge, attitudes, skills and behavior of parents and ECE providers.

At the end of the project, parents and guardians felt that the ECE environment was an appropriate place to address DV.

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