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APPENDIX C
BABY MAKES THREE
Seattle, Washington
May 18-20, 2002
OVERVIEW
Baby Makes Three is designed to meet the needs of couples who are expecting or have just had a new child. The program is intended to prevent the decline of marital satisfaction that often occurs after the birth. It involves a weekend workshop and, for one group of participants, a series of 12 support group meetings facilitated by childbirth instructors. The program, currently implemented as a demonstration program in a hospital in Seattle, is being experimentally evaluated. The workshop curriculum is based on the research of John Gottman, and the support group component is based on work by Philip and Carolyn Cowan. The participants are typically middle-income, married, white, and well-educated.
PROGRAM GOALS
The program’s primary goals are:
- To strengthen couple relationships in order to reduce both the marital
conflict that arises when couples become parents and the likelihood of
divorce
- To increase father involvement in parenting
- To increase both parents’ knowledge of infant and child development
TARGET POPULATION
The program’s target population is couples ages 18 to 50 who are expecting a baby, are planning to parent the child together, and are willing to both participate in the study and attend 10 to 12 support groups.
Participating couples are predominantly white and middle-income. Of the 112 couples in the study, 4 are African American and 4 are Asian. Only one couple is not married. Just under 50 percent have other children.
CORE PROGRAM SERVICES
The program, based on Gottman’s research on marriage and influenced by the research of Gottman and Silver (1999) and Cowan and Cowan (2000), has two main components: a weekend workshop and a series of 12 support groups. For the study, couples found eligible for the program were randomly assigned to a program group that attends the workshop and the support groups, a program group that attends only the workshop, and a control group who cannot attend either.
The weekend workshop is attended by both parents either while they are expecting their baby or within the first few months after the baby is born. Most of the curriculum is focused on preserving the marriage, but there are sections on child development and on interacting with the baby, covering such topics as the dangers of overstimulation. Also included are discussions about the importance of a strong marriage, father involvement, and co-parenting to child development.
The support groups provide an opportunity to express feelings about the transition to parenthood and to receive emotional support from other couples. While they do not offer therapy, per se, they are often “therapeutic.” The two-hour group sessions, held two times a month for six months, begin soon after the couple has completed the workshop.
SERVICE DELIVERY
The weekend workshop and support groups are held in the Swedish Medical Center in Seattle. In the workshop, there are three instructors and three to five volunteers. All three instructors are childbirth educators who also facilitate the support groups. The workshop is held for most of the day on both Saturday and Sunday. The support groups are held on a weekday evening or on Saturday. The couples bring their children to both the workshop and support groups. Infants remain with their parents; child care for older children is provided in an adjacent room.
RECRUITMENT
Recruiting participants for the study involved circulating flyers about the study in childbirth classes at the hospital, birth centers, prenatal yoga classes, local stores selling clothes and equipment for infants; placing notices in the hospital newsletter; and providing local newspapers with information about the study.
ASSESSMENT, SCREENING, AND REFERRALS
Baby Makes Three does not assess participants for the need for other services, nor has the program found that any participants have serious mental health or substance abuse issues. However, participants are given with a list of therapists and agencies that could help them with other issues.
PROGRAM SIZE AND INTENSITY
Because it is a demonstration program, Baby Makes Three is small. In total, 112 couples were recruited for the study, 46 couples receive the workshop and support group, and 33 couples receive the workshop only. The rest of the couples are in the control group.
BIENVENIDOS FAMILY SERVICES
East Los Angeles, California
May 14-15, 2002
OVERVIEW
Bienvenidos is a community-based organization in East Los Angeles that serves a predominately Latino population, providing comprehensive and culturally sensitive in-home and center-based services to families with minor children. The agency’s mission is to strengthen families so that they might provide a stable, safe, and nurturing environment for children. The organization provides an array of services, including parenting education, home visits, domestic violence treatment, anger management classes, fatherhood programs, substance abuse treatment, and free health care services. Bienvenidos has forged a partnership with the National Latino Fatherhood and Family Institute in a concerted effort to create a more father-friendly environment, establish programs to promote father involvement, and include fathers in family services. All of the center-based services are housed in one of three locations on the same block: the family support center, the health clinic, or the National Latino Fatherhood and Family Institute.
PROGRAM GOALS
Each Bienvenidos program has its own objectives, but the organization has four overarching goals: (1) to be proactive in preventing families from losing their children to the child protective system as a result of child abuse or neglect, (2) to strengthen families and help them to become self-sufficient, (3) to support families with the resources they need to develop and maintain a stable and nurturing home environment, and (4) to get parents involved with their children in order to improve child well-being.
TARGET POPULATION
Bienvenidos serves primarily low-income families in East Los Angeles. Approximately 97 percent of the service population is Latino, and most are of Mexican origin; about half speak Spanish, 40 percent of whom are monolingual. According to program staff, new Spanish-speaking immigrants are typically more likely to be married and to remain with their partners than are English-speaking non-immigrants. Overall, the clients reflect a variety of family structures, but many of the fathers live with the mother and child/children in the home.
Many Bienvenidos families are experiencing some form of crisis (such as child abuse or neglect, substance abuse, or poverty). One administrator estimates that approximately 60 percent of clients have experienced domestic violence. Physical and social isolation is also a problem for many, including new immigrants and those in abusive relationships. In addition, a significant number of clients have health problems, such as HIV/AIDS and sexually transmitted diseases. Among young fathers, there is also a high level of gang involvement.
Although Bienvenidos clients tend to share many characteristics, eligibility for some services is restricted to particular target populations because of funding stipulations. In addition, priority is typically given to families who have received court-ordered mandates to participate in specific program components (such as family preservation, anger management, or parenting education classes).
RECRUITMENT
Many clients come to Bienvenidos through word of mouth and “self-referrals,” while others are referred from outside institutions, such as the Department of Social Services, local high schools, and hospitals. In addition, the Children’s Dependency Court and the Los Angeles County Department of Children and Family Services allow at-risk families to participate in Bienvenidos programs as an alternative to placing their children in protective care.
ASSESSMENT, SCREENING, AND REFERRAL
All clients are informally screened at intake for risk factors, such as domestic violence and substance abuse. In addition to risk factors, the intake form includes a client history and a needs assessment. Clients are assessed on the basis of both this information and an informal discussion with the intake coordinator. A more intensive screening and assessment may take place once the client has been referred to a specific program component, but the level of intensity of the assessment varies across programs. Most services are provided in house, although clients are referred to outside agencies for some services such as job training and employment programs.
SERVICE DELIVERY
Bienvenidos’ comprehensive approach to strengthening families includes a multitude of programs and services:
- Parenting education classes are typically court-mandated for parents involved with the child welfare system. Classes in Spanish and English are offered on site during the day and evening.
- Home visits, provided weekly, are designed
to focus on child development, supportive services, and life skills, although
immediate needs and crises are addressed first.
- Father involvement initiatives include Con
Los Padres, a 20-week program comprising weekly group sessions from
5 to 7 p.m. that teaches young men ages 16 to 24 about their roles and
responsibilities as fathers.
- Domestic violence treatment is provided through Latinas en Progreso, a program for female victims of domestic violence comprising weekly group meetings, individual counseling, educational workshops and classes, and an after-care support group.
- Anger management sessions are provided through All My Relations, a 26-week class for men conducted by a trained mediator who teaches conflict resolution, mediation, and nonviolent communication.
- Substance abuse treatment is provided to women for 10 to 20 hours each week for six months to one year. Classes are offered Monday through Friday primarily in the morning at around 9 o’clock.
This approach to service delivery is both educational and therapeutic, although the ratio of one to the other varies by program component. Services involving parenting, health education, life skills, school preparedness, relationship skills, pregnancy prevention, and family violence prevention tend to be more educational, whereas services that address substance abuse or domestic violence are typically more therapeutic.
PROGRAM SIZE AND INTENSITY
Bienvenidos was in contact with approximately 300 potential clients in April 2002. Thirty-nine of them enrolled in the program. According to staff estimates, the National Latino Fatherhood and Family Institute makes approximately 30 contacts in a typical month, and about half of those who go through intake typically end up staying in the program.
The number of clients varies substantially by program component. Annually, there are approximately 426 mothers and fathers in the parenting education classes, 359 families who receive home-based services, 54 men in the Con Los Padres program for young fathers, 109 women in the Latinas en Progreso domestic violence program, and 45 men in the All My Relations anger management group. Many other programs at Bienvenidos also serve large numbers of clients, many of whom participate in more than one program at a time.
CENTER FOR FATHERS, FAMILIES AND WORKFORCE DEVELOPMENT
Baltimore, Maryland
May 17, 22, and 24, 2002
OVERVIEW
The Center for Fathers, Families and Workforce Development (CFWD) is a nonprofit organization in Baltimore that has two primary components: (1) Men’s Services, which focuses on father involvement, parenting education, relationship skills, anger management, and co-parenting, and (2) STRIVE, an intensive employment program for men and women. The organization also provides a number of services in house and through referrals to outside agencies, including case management, domestic violence treatment, adult education, substance abuse treatment, and child support assistance. Through the 50/50 Parenting pilot program, CFWD will begin providing co-parenting services in late 2002 to young parents who have had a child out of wedlock.
PROGRAM GOAL
The overall mission of CFWD is to help low-income men and women become self-sufficient and thus be able to contribute both emotionally and financially to their children. Each program component has its own objective that supports the overall mission. Men’s Services is intended to support fathers in becoming more involved in their children’s lives, STRIVE is intended to provide men and women with employment services, and 50/50 Parenting is intended to create a supportive family environment, help parents work together more cooperatively for their child/children’s benefit, and make advocacy and education services equally available to mothers and fathers. (See the section Core Program Services, below, for a fuller description of each program component.)
TARGET POPULATION
CFWD clients are predominately African Americans who live in Baltimore’s most poverty-stricken neighborhoods. The average client in Men’s Services is a 24-year-old noncustodial father who dropped out of school in the ninth grade. Approximately 80 percent of Men’s Services clients are unemployed, and many are underemployed. In general, clients tend to have low levels of education and skill, and most do not have a GED or high school diploma. CFWD staff estimate that approximately 75 to 80 percent of Men’s Services clients have criminal records. They also face such other issues such as substance abuse, domestic violence, multiple partner fertility, lack of affordable housing, mental health conditions, racial and class prejudice, and a lack of community resources.
CORE PROGRAM SERVICES
CFWD provides a comprehensive array of services in house and through referrals to outside agencies, as described below:
- Men’s services. As mentioned, the Men’s Services program focuses on father involvement, parenting education, relationship skills, anger management, and co-parenting. Services are provided through intensive case management, classes, peer support and discussion groups, individual and family counseling, and occasional home visits. The services, targeted to urban African American men, are based on a culturally competent approach. Instructional techniques include lecture, discussion, and the use of materials such as the curriculum handbook, videos, guest speakers, and handouts.
- Employment services. Employment services are
provided through the STRIVE program, an intensive job-readiness
workshop with two years follow-up that provides support in critical thinking,
self-examination, relationship building, affirmation, and practical skill
development. The program uses an adaptation of the curriculum used by
other STRIVE programs, supplemented with video, handouts, guest
speakers, and other teaching techniques. Workforce development services
are provided through case management, classes, peer support, and counseling.
Classes include role-playing, lecture, and discussion.
- Domestic violence. Clients identified as having
problems with domestic violence are typically referred to a local organization
that serves victims and perpetrators of domestic violence. In some cases,
a staff member from the local organization or from CFWD will work informally
with the client, especially when the client is not prepared to acknowledge
that he or she has a problem.
- Assistance with child support. CFWD collaborates
with the Maryland State Arrears Leveraging Program to assist noncustodial
fathers in reducing their child support debt, arranging a manageable payment
schedule, and avoiding possible criminal penalties.
- Referrals. Referrals are made for substance abuse treatment, housing assistance, and health care.
SERVICE DELIVERY
Men’s Services clients attend two sessions per week for 15 weeks. One session is educational and curriculum-based, and the other is a peer support group. STRIVE clients attend daily classes and are expected to be punctual, to come to the class every day, and to dress as they would for a professional job.
RECRUITMENT
Direct community outreach, found by the staff to be more effective than print advertising, is the core of CFWD’s recruiting strategy. Almost all the front-line staff recruit for Men’s Services and STRIVE by talking directly with potential clients, giving them materials on the program, and hanging “door knocker” leaflets. Staff conduct outreach at a variety of venues, including basketball courts, barbershops, health clinics, birthing clinics, and street corners that are centers for illicit drug transactions. In addition, a number of clients come to the program because of referrals from friends or family, health professionals, and other public and private agencies.
ASSESSMENT, SCREENING, AND REFERRAL
All CFWD clients receive an initial assessment and screening before they are directed to in-house programs or referred to outside agencies. Clients are assessed with regard to basic demographic characteristics, such as education, employment, and family composition in addition to problems with domestic violence and substance abuse. Clients identified as having substance abuse problems are referred to more specialized programs for further assessment and treatment. In general, the assessment process is viewed as an on-going event that may take place over several weeks, as CFWD finds that it is important to allow enough time for staff to get to know clients and build their trust. The staff has found that clients are more willing to open up once the organization has proven its ability to meet their needs, so assessment continues informally even after the initial screening is complete.
PROGRAM SIZE AND INTENSITY
Men’s Services. About 12 to 15 clients participate in Men’s Services classes at any given time, and about 180 to 200 participate each year. Clients typically stay involved in Men’s Services for about one year. The program has served about 900 men since its inception. About 15 to 20 percent of Men’s Services clients are also enrolled in STRIVE.
STRIVE. About 25 clients graduate from each three-week training cycle, and approximately 300 clients graduate in a year. On average, clients stay with the program for about two years.
CHILDREN FIRST
State of Oklahoma
March 13-14, 2002
OVERVIEW
Children First is a community-based voluntary family resource program that offers home visitation to families who have little financial or social support and are expecting to deliver and parent their first child. The program uses David Olds’ Nurse-Family Partnership Program model. Public health nurses conduct home visits during pregnancy and across the first two years of the child’s life, following well-developed protocols from the Olds model throughout this period. Through a schedule of weekly, biweekly, and, eventually, monthly visits, nurses focus on the health of the mother and child, the maternal role, personal sources of support, and accessing community resources. The program, administered through the state Department of Health, began in four counties as a pilot in 1997 and is now offered statewide in all 77 counties in Oklahoma.
PROGRAM GOAL
Children First is intended to promote the health and well being of pregnant women and their infants, and has three overarching objectives: (1) to promote healthy behaviors among mothers during pregnancy, (2) to enhance family caregiving for infants and toddlers in order to prevent child maltreatment and childhood injuries, and (3) to prevent subsequent unintended pregnancies, school dropout, welfare dependency, or unemployment.
TARGET POPULATION
The Children First target population is pregnant women under 28 weeks gestation, who are expecting to deliver and/or parent their first child, and who have little financial or social support.
CORE PROGRAM SERVICES
Children First provides families with parenting and nutrition education, health and safety information, and referrals to community agencies for services such as health care, child care, mental health care, and job training.
Nurses use the Partners in Parenting Education (PIPE) curriculum to help mothers develop healthy relationships. Though the primary focus of the program is the mother-baby relationship, there is an interest in expanding both resources and father involvement. Also, plans are currently under way to integrate the Prevention and Relationship Enhancement Program (PREP) into the services Children First already provides.
SERVICE DELIVERY
The relationship that develops between nurse home visitors and the mothers served is the foundation of the program, and caseloads are limited to 25 families in order to ensure that this is possible. Home visitation services are delivered on the following schedule: weekly during the first month of program participation, biweekly after that until delivery, weekly during the first six weeks after delivery, every other week until the child is 21 months old, and monthly until the child is two.
RECRUITMENT
Clients are referred through various sources, including agencies providing prenatal services.
ASSESSMENT, SCREENING, AND REFERRAL
Children First provides health assessments of mothers and children as well as child development assessments. In addition, mothers are assessed for postpartum depression during the six months following the birth of their children. Clients are referred to outside agencies when needs are identified that cannot be addressed by the home visitors.
PROGRAM SIZE AND INTENSITY
From October 2001 through May 2002, more than 13,500 families in Oklahoma enrolled in the program. During that time, nurses made more than 235,000 visits.
Now a stand-alone entity in the Department of Health, the program falls under the division of Family Health Services, which reports to the state Commissioner of Health. Program supervisors in the 77 counties throughout the state report to the local county-city health agency.
PREVENTION AND RELATIONSHIP ENHANCEMENT PROGRAM (PREP®)
OVERVIEW
The Prevention and Relationship Enhancement Program (PREP®), developed jointly by Scott M. Stanley, Howard J. Markman, and Susan L. Blumberg, has been offered for the past 12 years in many communities across the nation and around the world. PREP can be operated in a variety of settings by a diverse group of individuals, including educators, counselors, clergy, mental health professionals, or lay leaders. It can also be offered to couples through free-standing educational materials (such as videotape).
PROGRAM GOAL
The program’s primary goal is to prevent divorce by teaching the skills and competencies associated with successful marital adjustment—before problems develop. Focused on preventing marital dissatisfaction and distress, the program has five objectives: (1) to develop and guide the practice of constructive communication and conflict resolution skills, (2) to clarify and modify unrealistic beliefs about and expectations of relationships, (3) to maintain and enhance fun, friendship, and spiritual connection in intimate relationships, (4) to develop an agreed-upon set of ground rules for handling disagreements and conflict, and (5) to develop skills to enhance and maintain commitment.
TARGET POPULATION
The program is designed for middle-income, nondistressed couples who are engaged or married.
CORE PROGRAM SERVICES
The curriculum includes the following lecture series: Foundation and Danger Signs; Safety, Structure, and Communication; Filters; Issues and Events; Expectations; Negative Communication, Anger, and Constructive Griping; Fun; Problem Solving; Friendship; Ground Rules; Core Belief Systems (Religious, Spiritual and Otherwise); and Sensuality and Sexuality. Skills in each of these areas are taught, demonstrated, and then practiced as couples role-play a situation while being coached by an instructor.
SERVICE DELIVERY
Services are delivered in one of three forms: (1) six weekly two-hour sessions, (2) a weekend workshop, or (3) a one-day workshop. The weekly sessions is the dominant form. The program staff comprises a “leader” and one or more coaches. Children do not attend or participate in the sessions.
RECRUITMENT
The recruitment strategies programs utilize vary across sites.
ASSESSMENT, SCREENING, AND REFERRAL
In general, PREP programs do not assess or screen clients for needs; nor are clients referred to services.
PROGRAM SIZE AND INTENSITY
Groups are typically medium to large, with up to 40 couples in one group.
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