AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
LORI FRIEDMAN: I just had a couple of things I wanted to add before I start in on my piece of the presentation. One of the things that’s been really kind of interesting and rewarding about working with CDC as the grantees, you kind of get pulled into all these other projects that they’re doing. They really sort of utilize the entities that they fund, and when you were asking the question about partnering with other federal agencies, like they are in the process. They’ve just completed a parenting mental analysis, so they’re putting together this panel about how best to get the information out there and they’ve got representation from the Office of Child Abuse and Neglect, which I think is a step towards working towards furthering those relationships. And we’re on that. And it’s also an opportunity for us to work with other entities that are doing similar work and strengthen our relationships with those. So it’s really fantastic from that perspective.
The other thing I wanted to add, I was going to jump up and say something on our work group slide but didn’t. We were very sort of strategic about selecting other entities that kind of have a national reach, because our hope is that when we identify recommendations, that everyone can sort of find their own piece in the puzzle and that they might say, okay. Well, what’s the purpose for the National Child Indian Welfare Association to do, and what can parents as teachers do? So that their reach extends beyond the PCA America network.
I also wanted to add that this information, our tools, we essentially had two tools, our inventory and our assessment. And if anyone is interested in those tools, when we’ve presented on this before, I was just at the, oh, I forget the name of it. There was a conference at the Chadwick Center, a conference in San Diego that was in January and we were talking about this project. If there’s anyone that’s interested in getting a copy of these tools, they’re not proprietary. We can share them with you and you can take them and adapt them as you see fit. Of course, you know, every time you do it, it’s definitely a lesson learned, because you think, oh, that was a really bad question. We should have, you know, we’ll need to ask it differently the next time but. So if you’re interested, you can email me. Our contact information is at the end of the presentation.
So, I wanted to tell you about what we’re finding so far from the inventory. And, you know, as Ben said, we would absolutely love your feedback at the end to see what’s interesting. What sort of stood out at you? What do you think is missing? What surprised you, that type of thing? We were blown away by our response rate. I don’t know how many of you do surveys, but getting a 98 percent response rate was really, especially with the intensity of the manpower that it involved. So we were really thrilled with that. We got information on over 375 strategies. Now, those are not mutually exclusive. They’re definitely, you know, clusters of things. And as you can see, we asked, you know, we found out that they were doing, and this was no surprise to us, obviously, because we were asking our chapter networks. So this is the work that we know that they’re doing. But it just sort of provided an opportunity to get more comprehensive information on what they were doing. So, you know, advocacy and pulling together coalitions and councils and doing public awareness and providing professional training and technical assistance.
We were asking about the amount of money that went into this and we learned that, you know, the next time we ask this we need to ask it slightly differently. But our first time around we, you know, learned that there’s about 60 million dollars that are going into these strategies. And this is over the course of a year. And that the cost really ranged from very minimal $200 to, you know, multi million. And then, of course, as you would expect, it’s a mix of public and private.
These are just sort of some overview slides. We-- Oh yeah.
UNKNOWN: I’m sorry. What do you attribute your phenomenal response rate, because that really is amazing?
LORI FRIEDMAN: You know, we gave everybody a $100, no. I’m just kidding. I think.
BEN TANZER: But we would have.
LORI FRIEDMAN: I think, well, it’s interesting because the incentive thing was a big discussion amongst Ben and myself and the other grantees, because, I mean, for us we had to hope that our chapters were all in this together. We want the information. You hope they’re going to be willing to share it without necessarily getting something in return, other than the information that the rest of their colleagues are doing. And I think we intentionally were very inclusive with people, from the beginning when the RFA came out and we were talking to our network. As we got the money and we were talking about what we were going to do, we included them. At every step along the way, we prepared them. We had TA calls before the inventory went out to kind of walk through it. A lot of people are sort of techniphobes and we’re like, a web-based survey. Ooo, I don’t know about this. You know, so we make sure that we provided the assistance to them so that we could get the, you know, the response rate that we thought that we needed. CDC set the bar really high, too. And they said, you know, we really want a hundred percent and we’re thinking, huh, okay. We’ll try, you know. And so we were thrilled with this. But I think it was the inclusiveness. There’s also been a lot, our network has been saying to us, this is the information that we’ve been needing for a long time. So, I think that that really helped, too. And the assessment, which we’re just closing data collection for, it’s been a little bit more of a struggle, but I think that’s because it’s been more involved, which we’ll talk about in a little bit more of a struggle, but I think that’s because it’s been more involved, which we’ll talk about in a little bit. Were there other questions before I-- all righty.
So we were interested in how services were being delivered and where they were being delivered and who they were being delivered to. And, as you can see, it’s tremendous. We’re, you know, reaching people on multiple levels in the community through sort of community presentations, through faith-based organizations, over the phone, in people’s homes and schools, through the media, you know, and legislative offices, doing (inaudible) days, and the target populations are very broad, you know, from everyone in a given community to very specific populations at lets say parents with children with a certain disability. We asked them about the catalyst for why they selected that strategy, because we were curious to know. And it was, I have to say, it was nice to see that need was sort of the driving factor because so often it tends to be money, because money was available, which was indeed a reason and it’s valid, but, you know, we were pleased to see that need and because it fit with the organization’s strategic plan, tended to be a stronger catalyst for why they were doing that.
As far as the other, because that was still a pretty significant amount of responses, it was because there has been evaluation that’s been done about the strategy because they’ve done it in the past or because there is utilization of the service or interest in the community. So that was why this particular strategy was selected. There’s been a lot, there’s always a lot of talk especially within our network about, well, is this, they sort of model and what exactly does this look like? So, we wanted to ask the question about, well, what exactly is it that you’re doing? Is it based on a model? And as you can see, the largest percent are not based on a model. But we think that that probably has something to do with the fact that, models tend to be for something that expects service. And there’s a lot of other things that are going on within our network, well, on public awareness and advocacy that aren’t necessarily conducive to being based on a model. So, we think that that’s the reason. There are 22 percent that were based on the model and I’ll talk about which ones on the next slide.
As far as something else, this was interesting, too, is that a lot of strategies were based on let’s say a curriculum that was out there that’s not necessarily defined as a model, or that there was research that was out there, again, that’s not a model. So I think that our network is definitely in the mindset of thinking, I can’t just necessarily do something because it sounds good. I need more justification. I need more rationale for why I’m doing that. So, it sort of gets into the whole evidence based discussion of, you have to be very thoughtful and strategic about the work that you’re doing.
As far as models, the largest percent or the largest number of strategies were based on this mutual self-help support group. Either it being Parent’s Anonymous or Circle of Parents, which was, used to be an effort under Prevent Child Abuse America and about two years ago, one year ago, they became their own separate 501C3, but they are very close partners with us. Healthy Families America, of course, makes sense because that’s a Prevent Child Abuse America program. So a lot of our chapters are involved with that. Steven Bavolex nurturing program and he has it targeted towards different populations, nurturing parent, nurturing family, nurturing father is one that’s utilized within the program. Parents as teachers, Mark Dias, the shaken baby syndrome, that’s what SBS says, SBS model is.
Chicago Doula was, you know, some people might be saying, was that really child abuse prevention? But when you think about sort of the nurturing and bonding and making sure that a child is not being neglected and gets their needs met, you know, yes. That is a child abuse prevention strategy. Safety is our child sexual prevention program, (inaudible). And I have to say there’s a much longer list of other models, and I’m going, I’ve never heard of this Ben. Have you heard of this? You know, which doesn’t mean that they don’t exist. It just means that they’re probably not as; we’re just not as familiar with what they are.
We wanted to know when the strategies were taking place. Were they happening before abuse occurs or after abuse occurs? And again, CDC was very interested in just kind of getting a handle on this. And this did not surprise us at all, because that’s kind of a, you know, a big focus for us, is that our chapters are preventing child abuse before it occurs. But it was interesting to see that there’s even nine percent of the strategies that are targeting after.
We were also interested in who we were reaching. And are you, you know, is it primary prevention or universal prevention or whatever phrase that’s, you know, and go do whatever right now. And again, you know, more than three quarters of our strategies that were reported on are for those who, you know, are at no risk, have no respecters.
All righty. When we were first embarking on this everyone was like, bravo, good effort. But, wow, how are you going to make sense of all this information? And the CDC sort of pointed us to the social ecological model, which we had some familiarity with, but are learning a lot more about it. And I was curious actually how familiar you all are. Have you heard of this model? Are you, does anyone use it? I see a couple of hands. So it’s somewhat new to people in the room. Essentially it’s addressing an issue on multiple levels and sort of the underlying belief is that you, an effort is going to be more effective if you’re coming at it from different angles. Sort of like circling the wagons. So it’s looks ate individual that you’re looking at individual knowledge and attitudes and skills and behavior. And that you’re focusing on relationships, like the relationship between a parent and a child or between a mother and a father, or between two children in school if you’re looking at a bullying prevention program. And you’re also looking at the community level that you’re sort of addressing, community tolerance, or that you’re doing, you know, sort of development around an issue that if you want to bring in an initiative into a community, you’re sort of focusing on that. And at the societal level that you’re making changes in legislation and policies.
So when we looked at what aspects of social ecological model being reached within our network, this is what we found. And it was encouraging to see that there was actually activities taking place across all levels, because a lot of times you’re just targeting individual level, which is great but, you know, we believe also that you need to just kind of come at it from multiple perspectives. So, you know, most of the, just under half were addressing individual level and we found that this tended to be direct service programs and also some training and technical assistance fell at the individual level. Some community education and public awareness fell at the level, too. I should also say that we asked people to place themselves in this, and we gave them this description. So, you know, I went through and looked at it and thought, well, from what I’m gathering from what they’re sharing with me, would I put it in the same level? And sometimes there are some places where I would have put people differently, but it’s hare to make judgment calls when you don’t have the full information. So we decided to go with what they shared with us. At the relationship level, some examples from our network were home visiting programs that would address this. The bullying prevention program. Communication between parents. At the community level, public awareness tends to fall into this. You know, where you’re promoting a particular type of behavior or, you know, shaken baby. What are you supposed to do when your child is screaming and you’re at your wits end? You know, what can you do? Walk away or, you know, call a friend or whatever. In that society they tend to be, you know, advocacy activities and policy changes. So a Capital Hill Day, or legislator education were what tended to fall under that level.
But because, you know, you like to explore all different models; we also came across the spectrum of prevention. Has anyone heard of that one? Okay. A few more. This one, I think was created by Larry Cohen, who’s with the Prevention Institute out in, in Oakland, California. And, I think it was created in the 80’s, so it’s been around for a while and I think it was initially started for the, if you had an injury prevention. So it fits kind of nicely with child abuse prevention. And I like this one it addresses a couple of things that the social ecological model doesn’t being, you know, educating providers and the coalitions and the networks. So, this is a different one that we are sort of looking at the information from just to kind of see if there are any, any differences. And we found that, you know, again a lot of activity was sort of happening at the, at the individual level. But that, you know, a fair amount of work is actually happening with educating our providers and, and the coalitions. And that’s a really critical piece that’s just kind of a, it never fits all that nicely with other models. So we sort of are trying to figure out what we want to do with this. Yeah.
UNKNOWN: On the spectrum of urban (inaudible) where childcare providers are, did you categorize that on your strengthening individuals models and skills?
LORI FRIEDMAN: For childcare providers?
UNKNOWN: Uh huh.
LORI FRIEDMAN: You mean if they were running like a childcare center, is that what you’re saying?
UNKNOWN: In home or licensed, you know.
LORI FRIEDMAN: I think it would tend to be at the, yes, that one for sure in the spectrum you’re asking about not the social ecological, yes it would be in the strengthening individual. Unless it was, had to do with, I think there were one or two strategies that had to do with training childcare providers to do home visits. And so then they would be categorized in the educating providers one.
UNKNOWN: Okay.
LORI FRIEDMAN: So, and, you know, this was, it’s somewhat subjective, you know, where things go because it seems, you know, like using the information that’s presented in the model and using information that somebody shared on the survey and trying to see where it best fits. So, you can have a discussion about where it actually belongs, but, you know, you only have so much time in a day, too, so it sort of trying to balance that. Did you have a thought about, about your question that, you’re just curious?
UNKNOWN: Well, yeah, because I just feel like it’s essential, too, on prevention and then teaching childcare providers, especially the in home. I’m the mother of shaken babies appointments.
LORI FRIEDMAN: Okay. So you think it’s important that everyone who’s, you know, handling a child should know about the dangers of, yeah. I would agree with you. Are there other questions? All righty. Then we were trying to look at the strategy type. Again, this was a challenge of having all this wonderfully rich information but you know, how do you sort of organize it in a way that you can share it with people? So, and I have two slides worth of this information. So, you know, public awareness seemed to be a very common strategy that was utilized by our networks. They also are doing a lot of professional training and technical assistance and capacity building and those types of things, which also make sense. I think that there were, let’s see, between home visiting and running groups, which I would categorize as direct service. There’s a fair amount of that that was happening as well.
CAP Month is child abuse prevention month and child abuse prevention month is April for those of you who don’t know. So there’s a lot of activities that sort of revolve around that. And while there could be, these numbers represent the number of strategies. They don’t necessarily represent the number of states, but, you know, it’s probably likely that a child abuse prevention month, there are 24 chapters that are actually doing this. There may have been more that just didn’t report on it, because I think a lot of our chapters obviously take advantage of April as, you know, to promote the work that they’re doing. And then you can see, you know, the rest of the roles. There are some school-based work, community presentations, working with hospitals and clinics to do outreach. And concrete support tended to come in the form of, there was actually a state that reported on providing WIC services. And, you know, they have this opportunity to reach this women that, you know, may be isolated or may have, you know, additional needs, and so they could provide some information about child development when they’re seeing the mothers when they’re in the WIC clinics.
Fund raising and awareness events, I think a lot, all of our chapters are probably doing some just, you know, would be like a specific, a rock or a radio found around child abuse prevention. So that sort of, they sort of separated it out, when they were sharing the information with us. So between this whole list is that, does it seem like it covers the gammit to you? Does it seem like there’s something that’s missing that you would have expected to see on this list? Yeah.
UNKNOWN: So does that mean like an intensive guaranteed program fall under what? Education or--
LORI FRIEDMAN: If it were, it would probably, if they indicated that it was like in a group setting, it would fall under groups. Or if they indicated that it was home visiting or is one-on-one, it would be, you know, probably home visiting. But those types of things tended to fall under groups. The other thing was, sometimes it was hard to tell if it was like a one shot deal where it might be a community presentation versus something that’s more ongoing. You know, because there are lots of chapters, I think that go out into their community or into a school and talk about, you know, what are the risk factors of child abuse versus, you know, you’re coming back together for, you know, weekly over 10 weeks and you’re talking about what you can actually do in school’s development. So that was thing that we learned was that, we probably needed to define our question a little bit more clearly so that people could give us better feedback. Yeah.
UNKNOWN: So Lori, when you counted these, did you single count them or did, if they, were they only counted once or where they did two things, you only put them in one (inaudible)?
LORI FRIEDMAN: No. Thank you for asking that question. If they fell into more than one area, they were counted with multi purpose because my thinking was and one of the things that was sort of orienting me as I was trying to figure out how to put this information together was, how are chapter asks us for information about what their colleagues are doing. And I thought, lets put as much information out there as we can so that when you have sort of a search feature in the database, that they’re going to pull everything that this person might be looking for. So, if somebody was doing, let’s just say, let’s say somebody was doing an activity around shaken baby. They may have, in California; for example, they have this multi prong approach where they’re doing provider education in the hospital. They’re doing a public awareness campaign. They’re doing training for home visitors that are working with new families. So, and that was just, they would just call that one strategy. So I didn’t want to just try and lump them in one place because then we’d lose all that information elsewhere. So that was what made this, that’s what makes this project so interesting and yet so challenging is to try and figure out how to sort through it all.
UNKNOWN: How can you tell if the strategies are making a part, are doing anything? Are they effective? I mean, have they, have you gone on back to look at, okay, you just gave California as an example. Are you saying at a difference and then there are difference who are presenting it in (inaudible) or anything.
LORI FRIEDMAN: Yeah.
UNKNOWN: You’re seeing in the thing is the consequence. I mean, if we can give them money, these people often do all kinds of education.
LORI FRIEDMAN: Right.
UNKNOWN: And just (inaudible).
LORI FRIEDMAN: Right.
UNKNOWN: But what’s in it given in?
LORI FRIEDMAN: Right. Well, and we did ask about evaluation, which I’ll get to that in a couple of slides.
UNKNOWN: Oh, I didn’t (inaudible).
LORI FRIEDMAN: No, no, that’s okay. But I mean, I don’t, you know, and I think that there’s another level of examination that needs to take place to get to that level because it’s sort of a lot more complex then just an easy yes or no answer, I think. You know, is this strategy working. Is this strategy working with what particular populations? So I think that we are trying to collect a lot of information that will put us in a position to go back and of those who are doing evaluation, to get more specific around those answers.
UNKNOWN: You mean it would help us a little bit if we get to that point in terms of explaining how you have targeted the work because was it totally population based educational efforts. In other words, all covers get--
LORI FRIEDMAN: Uh huh.
UNKNOWN: And you focus in on high risk areas, high risk communities, where there’s high incidents--
LORI FRIEDMAN: Uh huh.
UNKNOWN: --of child abuse and neglect. It’s really hard, I’m sitting back here and I don’t what in the heck you’re talking about. I mean, forgive me, but I am just real confused. I may be the only one, but I don’t get it.
LORI FRIEDMAN: Well, and this is, this is helpful for us, too, because--
UNKNOWN: Oh okay.
LORI FRIEDMAN: Well, I think, you know, as we mentioned, we’re still very much in the mix of this, so your questions and your feedback is really helpful for us to think about it. And we did, we did ask about target population, which I think is getting to what you’re asking about. That particular set of data is something that still needs to be synthesized a little bit more because that was an open ended question, so there’s a lot of, it’s very broad based who we’re, you know, who we’re actually reaching because it went from very broad and vague, to very specific as I mentioned earlier, so.
UNKNOWN: I work with people that weren’t going to have those kinds of parenting difficulties. In the first place you can’t measure because they weren’t going to be (inaudible).
LORI FRIEDMAN: Right. Right.
UNKNOWN: I mean.
LORI FRIEDMAN: Yeah.
UNKNOWN: I just want to add that, since we’re using the example of shaken baby syndrome, you can certainly target your education towards high-risk areas. But shaken baby syndrome happens at all ends of the spectrum regardless of education and regardless of income.
LORI FRIEDMAN: Right. Well, and I think the reality is, is that as our chapters have the opportunities to select different strategies to implement, you know, it’s taking into account what the need is within their community, where the funding is, you know, the funding certainly does filter into that as well. So I think that those are things that they need to take into consideration that were not requiring or anything like that. So, it’s kind of, understanding the needs of your community. Yeah, I think the gentleman.
UNKNOWN: If you mentioned it, I missed it but did any of your respondents did they ever mention those (inaudible)?
LORI FRIEDMAN: You know, I don’t, I actually don’t think any of our, I don’t believe so. No, I mean, obviously we’re familiar with that program, but I’m not aware. I think some of our chapters are working with nurse family partnership programs in their state, but I don’t think any of them are actually implementing them, that I’m aware of.
UNKNOWN: So I guess that’s an issue, too. I mean, the thought (inaudible), that personalizes (inaudible). Your respondents are not telling you about things they are aware of. They’re only telling you about things they themselves have been involved in.
LORI FRIEDMAN: Yeah, and that was actually a big discussion that we had when we set out to begin this. And CDC was very clear with us that while that would be phenomenal to collect that information, we just wanted to get a sense of what was happening with our own network first. And I think a lot of our chapters were sort of struggling with that because a lot of times they’re at the table. They might not be taking a lead role, but they were saying well, did we tell you about this? And we sort of were using a guideline if you’re spending money or time on it, we want to hear about it. But, you know, people process that differently, too. So, you know, again, this was very much a first time out for us to collect this information. And I think we’d love to get that scope of work, but to me to do that you have to go beyond your own network and I would need to say, well, who are the key players in the state, and you need to ask all of them. You can’t just ask our chapter because you’re just going to get that perspective. So, yeah.
UNKNOWN: I think where the confusion might be coming at is the title of the workshop says attractive strategies for preventing child abuse. And so in my mind, the first thing I was thinking of, oh good. Here I’m going to find out--
LORI FRIEDMAN: I know the answer.
UNKNOWN: You know, I knew I’d be getting to that but so far we’re sort of seeing this inventory to kind of finding out generally what’s going on but not what (inaudible).
LORI FRIEDMAN: What the answer is?
UNKNOWN: And I think maybe just for your own benefit, maybe--
LORI FRIEDMAN: That’s helpful.
UNKNOWN: --changing the title around a little bit or--
UNKNOWN: Or presenting the strategies.
UNKNOWN: Yeah, or presenting the strategies, or if you wanted, you know, sort of (inaudible).
LORI FRIEDMAN: Okay.
UNKNOWN: I think that’s where her question is coming from and that was in my mind, too. Well, this is great but does it work, does any of it work?
LORI FRIEDMAN: That’s very, yes, that’s very helpful and I wish, you know, I wish we had this total slam dunk answer, but I can tell you that we, that we don’t, you know what I mean? There are a lot of things out there that appear to, you know, to be very promising to be working but, you know, so that’s helpful feedback, but that’s a challenge.
Okay. So okay for me go on? Any more questions? Okay. As far as topical area, because, of course, I think a lot of what we know is happening within our network. It’s a lot of sort of positive parenting, general parenting education, but then we want to know more, you know, is there anything specific that’s happening within our network? So, these are the things that sort of shook out. There’s a lot of, you know, a fair amount of work that’s being done around child sexual abuse as well with shaken baby syndrome. There are programs that are happening in schools that have to do with sort of building up resilience and life skills and bullying prevention. There was some work being done around people serving on child fatality review boards and training around (inaudible) into reporters and recognizing risk factors. We wanted to also know about engaging fathers not just as a target population because that’s important, but sort of the important role of fathers in parenting, in child development in the role of parenting.
We also were asking about early childcare and youth advocacy and then we called the (inaudible) violence, mental health and substance abuse big three because those are such challenges with child abuse prevention. So, there are four strategies that we’re doing some collaborational work in these areas.
We also asked about intended duration of strategies because, you know, from where I stand it tends to be those programs that work intensively over the longer term with families that seem to be the ones that, you know, the longest results. I think the challenge can often be with funding, to get funding for those programs for the long term and that we’re seeing here, you know, that a lot of our strategies tended to be of the shorter-term nature of less than six months. Although, there were a fair amount also that were occurring between six months and a year, I was personally surprised to see that, you know, that period between one year and two years, there was only nine strategies that, you know, tended to last for that long. And then were some that we know sort of were occurring year around. I think those were along the lines of community education and legislator education. And then there were some things that happened particularly during child abuse prevention month or during legislative sessions.
We also asked about funding. And public dollars tend to be the source that’s funding our strategies the most. They were coming from the child abuse prevention treatment act, community based child abuse CB cap funding, from our new safe and stable families. Some funding that the CDC was giving out in (inaudible). At the state level it tended to be general revenue, dollars coming through the Departments of Health, Human Service, Children and Family Services. No surprise there. Foundations were a huge supporter of this type of work. And then there are, you know, a lot of fund raisers and fee for service and selling publications and selling materials and T-shirts and things that were also contributing to the financing of these strategies.
For the 350 to three, uh huh?
UNKNOWN: On the funding, are there any areas where the states are doing some creative funding and captive where the early intervention programs and child abuse programs are working together with things that are happening or--
LORI FRIEDMAN: That is a great question. I unfortunately don’t know, that wasn’t something that seemed to jump out at all from the data. It was like sort of very straight forward, what I would expect to find. Are you aware of any?
UNKNOWN: No, I just know we have the early intervention program and we have some money and are willing to, you know, put some money into something but it definitely is like what (inaudible).
LORI FRIEDMAN: And you’re trying to figure out how to do it.
UNKNOWN: (Inaudible) going to be funding to try to bring everybody together.
LORI FRIEDMAN: And where are you? Where are you located?
UNKNOWN: Nebraska.
LORI FRIEDMAN: Okay.
UNKNOWN: And I sent, the interesting thing is I’ve sent a lot of my cash information to our Trust Fund in Nebraska and, you know, power point presentations and all thinking, gee, this is something that everybody would jump right on because it’s the infants and toddlers--
LORI FRIEDMAN: Right.
UNKNOWN: And, but we’re not--