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"1‘ 1. 5 m1: ‘1'1‘.3'31,l‘- “MNWJM ; who LIBRARY ' Michigan State University _ This is to certify that the thesis entitled IMPACT OF PARENT AIDES 0N CHILD NEGLECT: AN ECOLOGICALLY-ORIENTED INTERVENTION APPROACH presented by Jane Fremouw Swanson has been accepted towards fulfillment of the requirements for Ph . D degree in .Fami Ly Ecology ail/1‘ 49% Major professor Datved 0-7639 w lIILlIIIIll/IIZIIIQIILlUIll/lyfl[Elly/[MMIII/l OVERDUE FINES: \ 25‘ P" dew per item RETUMING L p] 1 IBRARY MATERIALS: ace n book return to ' -.. charge from circulation :23 “now in Q _'_0289 IMPACT OF PARENT AIDES ON CHILD NEGLECT: AN ECOLOGICALLY-ORIENTED INTERVENTION APPROACH By Jane Fremouw Swanson A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Family and Child Ecology T980 e/wo 77" ABSTRACT IMPACT OF PARENT AIDES ON CHILD NEGLECT: AN ECOLOGICALLY-ORIENTED INTERVENTION APPROACH By Jane Fremouw Swanson This study was conducted to describe the effect of a parent aide model of intervention upon child neglectful families over a twelve month period of time. The preliminary objectives were to determine if changes occurred in parenting behavior, relationships with other systems and social isolation. An intensive, time—series methodology was utilized involving three indepth home interviews and observations. The sample consisted of 24 families determined to be neglectful by the Michigan Department of Social Services' Protective Services workers and who were assigned a parent aide as the major intervention system. Data were analyzed utilizing non-parametric analysis of variance as well as descriptive information. Significant overall positive change occurred in parenting be— havior particularly within the first six months of the study with the second half demonstrating fewer changes. No significant differences occurred in the areas of families' physical environment and household maintenance. Jane Fremouw Swanson Relationships with other systems also improved. More relationships became stronger, fewer were described as stressful and relationships became more reciprocal in terms of the energy utilized. The social isolation of families was also significantly re- duced. Informal and formal resource systems became significantly stronger. The importance of relationships did not significantly change. Demographic factors, in general, were not associated with change. The number of children of the participants and the amount of education did not relate significantly to changes in parenting or social isolation. The age of the mother did not influence social isolation, however, her age did influence change in parenting behavior and attitudes. Mothers thirty years of age and over improved signifi- cantly more than younger mothers. The results of this study should not be broadly generalized. The sample was small, although it was generally characteristic of Michigan Protective Services families. Replication would be desirable over a longer time frame to determine if the decrease in change over the last phase of the study was a trend or a temporary plateau. Addi- tional work should also be done to determine the validity and reliability of the modified instrumentation and the applicability of the findings to more rural areas. A more extensive case study would be a highly desirable supplement to this type of research. @Copyright by JANE FREMOUW SWANSON 1980 ii Dedication: To Bill with Love ACKNOWLEDGMENTS I wish to thank each person who has provided me the support and encouragement over the many years of challenge, strength, and achievement in the completion of this dissertation. My committee members have offered substantial help and guidance. I would first like to express my appreciation to Dr. Jean Schlater, the chairman of my committee. Her skill, patient direction, interest, and time investment for the last three years have been invaluable to me and a significant contribution. Dr. Mary Andrews has been a constant source of understanding and encouragement as well as providing a wealth of knowledge and an example of the best of professional colleagues. I cannot even begin to mention the numerous other ways that she has been helpful. Dr. Robert Boger has provided me with a multitude of examples of research at its finest. His expertise in research coupled with his concern for people and his proactive approach provide a model of true quality and one to emulate. Dr. Linda Nelson has given important assistance both as a teacher and a committee member. Her thoroughness and knowledge of ethnographic methodology have been very useful. Dr. Donald Melcer has contributed greatly to my knowledge of the field of family relationships which has assisted in my dissertation and professional life. I would also like to thank Charlita Walker, Wanda Downer and Elaine Glasser. Their cooperation with the project, their enthusiasm, and willingness to allow me to do research within their program was iv outstanding. Nayne Anderson, my professional colleague and employer, has offered me continual encouragement and support in the pursuit of my education over the last eight years. Marleen Root's energy, patience, and hard work in typing and re-typing are greatly appreciated. Finally, and most importantly, my family. My gratitude extends especially to my mother who has sacrificed and never lost her enthusiasm in encouraging her children's continued education. My father must also be appreciated for his example of achievement. I wish to thank my children, Kristi and Billy, for their tolerance, patience, flexibility and understanding that, although their mother was not always available, she still loved them. My husband, Bill, made everything possible. He was enthusiastic when I was discouraged; he offered patience when I be- came frustrated; he gave strength when I was tired; he assured me of his love whether I succeeded or failed and his joy exceeded mine when the task was complete. Thank you. TABLE OF CONTENTS Page LIST OF TABLES ............................................... ix LIST OF FIGURES .............................................. xii Chapter I. INTRODUCTION ......................................... l Statement of the Societal Problem .................. l Statement of the Research Problem .................. 4 Significance of the Study .......................... 5 Conceptual Framework ............................... 7 Goal of the Study .................................. ll Objectives of the Study ............................ ll Definition of Terms ................................ l2 Operational Definition of Terms .................... l4 Hypotheses ......................................... l7 Assumptions ........................................ 20 Limitations of the Study ........................... 20 II. REVIEW OF LITERATURE ................................. 22 Child Neglect ...................................... 22 Child Maltreatment ................................. 25 Intervention and Treatment of Child Neglect by Parent Aides ....................................... 34 III. METHODOLOGY .......................................... 38 Overview ........................................... 38 Population ......................................... 39 Sample ............................................. 40 Research Design .................................... 42 Data Collection Procedures ......................... 43 Pretest .......................................... 43 Interviewers ..................................... 44 Interview ........................................ 45 vi Chapter Page III. Instrumentation .................................... 46 Childhood Level of Living ........................ 46 Eco-Map .......................................... 49 Michigan Screening Profile of Parenting .......... 5l Family Support Index ............................. 53 Data Analyses ...................................... 55 IV. RESULTS: PHASE I ANALYSIS ........................... 58 Demographic Characteristics ........................ 58 Michigan Screening Profile of Parenting ............ 67 Childhood Level of Living .......................... 7T Eco-Map ............................................ 74 Family Support Index ............................... 78 Parent Aide Role ................................... 78 V. RESULTS: PHASES I, II AND III ....................... 81 Hypothesis l ....................................... 81 Hypothesis l.l ..................................... 86 Hypothesis l.2 ..................................... 88 Hypothesis l.3 ..................................... 9O Hypothesis l.4 ..................................... 9l Hypothesis l.5 ..................................... 93 Hypothesis 2 ....................................... 94 Hypothesis 2.l ..................................... 95 Hypothesis 2.2 ..................................... 96 Hypothesis 2.3 ..................................... 98 Hypothesis 2.4 ..................................... 99 Hypothesis 3 ....................................... lOO Hypothesis 3.l ..................................... l02 Hypothesis 3.2 ..................................... lO4 Hypothesis 4 ....................................... l05 Hypothesis 4.l ..................................... 106 Hypothesis 4.2 ..................................... lO9 Hypothesis 4.3 ..................................... lO9 Hypothesis 4.4 ..................................... llO Hypothesis 5 ....................................... llO Hypothesis 5.l ..................................... ll3 Hypothesis 5.2 ..................................... ll4 Hypothesis 5.3 ..................................... ll4 Summary of the Results ............................. ll4 VI. DISCUSSION AND CONCLUSIONS ........................... 117 Change in Parenting Attitudes and Behavior ......... ll7 Change in Family Relationships with other Systems.. l20 Change in the Family's Social Isolation ............ l23 Michigan Screening Profile of Parenting as Related to Change .......................................... l24 Demographic Factors as Related to Change ........... l25 vii Chapter Page VI. Parent Aides as an Intervention Model .............. 126 Evaluative Commentary .............................. 128 Conclusions and Suggestions for Future Research.... 130 APPENDICES Appendix A Instruments .......................................... 132 Appendix B Childhood Level of Living - Pearson Correlation ...... 150 BIBLIOGRAPHY ................................................. 157 viii Table LIST OF TABLES Comparison of Research Group with Random Group By Site and Characteristic ............................ Comparison of Total Research Group with Statewide Protective Services Population By Characteristic ...... Michigan Screening Profile of Parenting Frequency By Category ........................................... Emotional Needs Met and Relationship with Parents Compared with Age, Education and Number of Children... Expectation of Children and Coping Compared with Age, Education and Number of Children ...................... Initial Scores on Childhood Level of Living By Means and Characteristic .................................... Initial Eco-Map Descriptions By Importance of Relationships ......................................... Initial Eco—Map Descriptions By Type of Relationship.. Initial Scores on Energy: Means By Direction of Flow. Initial Scores on Family Support Index: Frequency By Degree of Isolation ................................... Parent Aide Role as Perceived By Mothers & Parent Aides: Response By Activity Change in Observation Score By Phase: Friedman Test.. Change in Observation Score By Phase: T Test ......... Change in Interview Score By Phase: Friedman Test.... Page 60 64 68 69 7O 72 75 76 77 77 83 83 84 Table 20 2T 22 23 24 25 26 27 28 29 3O 3l Change in Interview Score By Phase: T Test ........... Change in Total Score By Phase: Friedman Test ........ Change in Total Score By Phase: T Test ............... Comparison of Total CLL Change Scores By Phase: Friedman Test ......................................... Change in Supervision, Control, and Discipline By Phase: Friedman Test ................................. Change in Supervision, Control and Discipline By Phase: T Test ........................................ Change in Family Interaction By Phase: Friedman Test. Change in Family Interaction By Phase: T Test ........ Change in Child Development Activities By Phase: Friedman Test ......................................... Change in Child Development Activities By Phase: T Test ................................................ Change in Nutrition and Health By Phase: Friedman Test .................................................. Change in Nutrition and Health By Phase: T Test ...... Change in Physical Environment and Household Mainte- nance By Phase: Friedman Test ........................ Change in Physical Environment and Household Mainte- nance By Phase: T Test ............................... Change in Frequency of Important Relationships By Phase ................................................. Change in Value of Important Relationships By Phase... Change in Frequency of Strong Relationships By Phase.. Page 84 85 85 86 87 87 88 89 90 9l 92 92 93 94 95 96 97 Table 32 33 34 35 36 37 38 39 40 41 42 43 44 45 Page Change in Value of Strong Relationships By Phase ...... 98 Change in Frequency of Stressful Relationships By Phase ................................................. 99 Change in Frequency of Energy Utilization By Type of Energy ................................................ 100 Frequency of Change from Phases I to Phase III By the Family Support Index Score ............................ 101 Family Support Index Change ........................... 102 Change in Frequency of Important Formal Resource Systems By Phase ...................................... 103 Change in Frequency of Strong Formal Resource Systems By Phase ...................................... 103 Change in Frequency of Important Informal Resource Systems By Phase ...................................... 104 Change in Frequency of Strong Informal Resource Systems By Phase ...................................... 105 Change in Total CLL Scores By Michigan Screening Profile of Parenting .................................. 107 Michigan Screening Profile of Parenting By CLL, Eco- Map and Family Support, Phase I to II Change Scores... 108 Change in Total CLL Score by Demographic Character- istics ................................................ 111 Change in CLL, Eco-Map and Family Support Index By Demographic Characteristics: Kruskal-Nallis - Phase I to Phase II ........................................... 112 CLL Pearson Correlation Scores: Variable By Variable. 152 xi LIST OF FIGURES Figure Page 1 Ecological view of the study's approach to the Impact of the Parent Aide Intervention Model ....... 10 2 World of Abnormal Rearing Cycle .................... 26 3 Gelles Social - Psychological Model of Causes of Child Abuse ........................................ 3O 4 Stress Curve and Family Performance ................ 33 CHAPTER I INTRODUCTION Statement of the Societal Problem Child neglect is becoming an increasingly recognized social 1 ii problem with families today. The lack of appropriate physical care ha! of children has been the problem predominantly identified within the ‘FTE socio-legal system and is prevalent particularly in families with few financial resources. Emotional neglect, the failure to provide necessary affection and warmth, and an enviornment to encourage healthy relationships, can be found within all socio—economic groups. Families considered neglectful due to physical neglect are usually emotionally negligent as well. Many families who have deprived their children emotionally are not identified as readily by the system, but are reason for concern nevertheless. The ramifications of child ne— glect affect all levels of society by creating members who are unable to participate fully and usually require special societal supports such as health care, education and public assistance programs. In Michigan, there are currently 6,208 families who are active Protective Services cases due to child neglect. An additional 2,391 families are identified as abusive; two to three times as many families are actually referred to the program. Most experts, notably Polansky, Helfer, Visser and Kempe, emphasize that these families are only a small 1 part of the actual population of neglectful families. A consensus estimates that 14 per 1,000 families neglect their children. In Michigan alone, this would constitute 21,234 neglectful families. Utilizing a mean number of 2.51 children per neglectful family, this would indicate that there are approximately 54,000 neglected children within the State of Michigan. A dearth of research exists today on the etiology of neglect and no single theory has been de- veloped. Polansky, Billingsley and Giovanni are almost the exclusive : yi pioneers in this area. Conversely, the areas of child abuse, and 4 child maltreatment, the combination of abusive and neglectful families, I. have received considerable recent attention (Helfer, Kempe, Garbarino). Although, identified cases of child neglect constitute twice as many families as abusive ones, insufficient information about the families, their problems, and methods of intervention is available to create change. It is known, however, that child neglect may have serious consequences. One of the results of child neglect has been termed the “failure to thrive syndrome” (Klein). This debilitating syndrome impacts primarily on infants who do not grow nor develop normally and, for some, may result in death. Malnutrition, a phenome- non, closely associated with neglect, can cause severe mental retardation (Vore, 1973). Other physical problems also result. Psychological damage as a result of neglect is cited in the literature related to maternal deprivation (Spitz, 1945; Bowby, 1954; Harlow, 1971). Strong evidence correlates this behavior with physical and/or emotional neglect. Recent research has discovered that this type of child depriva— tion is pervasive and frequently the patterns are inter-generational; in effect the behavior becomes an accepted way of life by the participants (Young, 1964; Minuchin, 1967; Polansky, 1972; Geismer, 1973). Particu- lar types of emotional problems have also been associated with child neglect: the apathy/futility syndrome, (Polansky), which has been described as a sense of emptiness, coupled with an inability to form relationships; the neurotic, characterized by anxiety; and the charac- ter disorder, where the moral code and conduct are predominantly self- centered. Additionally, a study by Steele (1977) has demonstrated a strong relationship between neglect, abuse and delinquency rates. Fontana (1973) described the lives of notorious ‘killers' who had been maltreated as children. Some information does exist regarding the nature of child neglect (Young, 1964; Kaduschin, 1974; Nagi, 1979). Early work has demonstrated that economic deprivation is a significant contributing factor. Stress, social disorganization, and cultural values are also seen as contributing factors. Social isolation has also been discovered to be a crucial ingredient (Giovannoni, 1970; Polansky, 1976). Complex social problems such as child neglect are not easily understood nor changed. Bronfenbrenner (1977) was once told ”If you want to understand something, try to change it.“ Thus, research into a specific intervention technique should help us to understand better the dynamics of child neglect. According to Weber and Polansky (1979) no thorough qualitative study of the treatment of neglect exists. Nevertheless, a variety of treatment approaches are being utilized. Among them are: social casework, family therapy, group techniques, child placement, parent-child community programs, mental health clinics, day care, and the use of volunteers. It is the last of these which is the focus of this research. During a time of accentuated awareness of the increased incidence and implications of child neglect, coupled with a reduction of social services and intervention monies, the utilization of volunteers is increasing. Termed ”Parent Aides", these individuals are recruited, trained and matched to families, and supervised by sponsoring agencies. Their function is to be a friend to the parents and to provide an appropriate role model. It is the expectation that the impact of this one new relationship within the family will be sufficient to create enough change in the family, considered neglectful, to warrant the closure of the Protective Services case within a six to twelve month time period. No current research exists which studies the effect on family functioning, over time, of a parent aide as the primary treatment modality. Information relating to whether or not parent aides can create change, and if so, with what types of people, and in what areas, is vital data needed by policy makers attempting to maximize their scarce financial resources and develop an effective method of helping families. Statement of the Research Problem This study focuses on providing more knowledge in the utilization of a particular technique, parent aide impact, on neglectful families. A small sample study was implemented to observe changes in neglectful families assigned a parent aide over a twelve month period of time. Five aspects of neglectful families over time are investigated: (1) change in parenting behavior, (2) change in family relationships with other ‘IT‘ 1‘2“. systems, (3) change in social isolation, (4) the relationship of a mother‘s score on a predictive maltreatment instrument, the Michigan Screening Profile of Parenting, and (5) the relationship of demographic characteristics and change. The phenomenon of neglect has been chosen to study as distinct from abuse. Neglect can be characterized as acts of “omission” in which physical and/or emotional care are not given children. Abuse is one of “commission" in which overt acts are directed toward children physically and/or emotionally. Although some families may be both 34 neglectful and abusive, so little prior research has been directed toward solely neglectful families that this population was chosen to emphasize the need for more understanding of this behavior. Both a qualitative and quantitative methodology were utilized for the study. Families' behaviors, attitudes and relationships were described from the perspective of the mothers of the families and also from the view of trained interviewers. A combination of statistical analysis and descriptive information was developed to provide an intensive under— standing of the families' lives and the influence of the parent aide. This approach potentially can offer a contribution to the field by sug- gesting a more comprehensive view of neglectful families. Significance of the Study The current utilization of parent aides as a treatment technique is a very small part of the actual overall approach. Approximately one percent of Protective Services‘ families in Michigan have a parent aide. If it can be documented that parent aides do, indeed, create change in the functioning of neglectful families, the implication for a changed emphasis in treatment modalities would exist. Such documen- tation would also assist case workers in determining what types of families would be most amenable to the support of a parent aide and most appropriate for referral. Further amplification on the types of families served could also lend itself to a consideration of the use of this intervention technique in a preventative function as well. The utilization of the Michigan Screening Profile of Parenting with exclusively neglecting families, as compared to both abusing and neglecting, will assist in a determination of its validity as a pre— dictive instrument with this population. A meaningful predictive instrument for both groups could be extremely important. Other adapted instruments, to measure change in families, may also be potentially useful for case workers in their planning of appropriate treatment. Additionally, the fiscal significance of the study is an impor- tant consideration. Currently, the Michigan Department of Social Services, Protective Services Division, spends approximately $280,000 for the ad— ministration of statewide parent aide programs. This money is utilized to purchase agency supports to parent aides including: recruitment, training, supervision, and reimbursement for expenses. The parent aide portion is approximately 1.5 percent of its total budget. A substantial monetary savings could be accrued if it can be proven that parent aides' services were maximized and increased with a concurrent reduction in other less effective functions. The utilization of more parent aides, in a more preventative service, could also potentially decrease the number of families actually referred to Protective Services, resulting in a cost savings. Norman Polansky (1978) stated that what neglectful families need is a ”parental prosthesis“, i.e. someone who can form a relation— ship with the parent and teach by example. There has been no study to test this assertion. The parent aide concept could be considered one concrete example and the results might help to confirm their use as a viable, effective treatment. Conceptual Framework It is strongly felt that only an ecological approach has the ability to view the problematic parent-child malfunctioning in a manner sufficient to integrate adequately the many diverse components. The phenomenon of child neglect is a highly complex one. In fact, standards by which parents are determined to be neglectful are highly qualitative in nature and are existent along a continuum of societal tolerance as epitomized by cross-culture studies (Korbin, 1979). An ecological approach views child neglect as a result of the parent and child in interaction with each other and their environment, both affecting and being affected. It has the perspective of viewing the delicate balance of human beings in their environment and their inter- dependence. Garbarino (1977) is a strong advocate of the ecological approach as a method of studying child maltreatment. He cites the following rationale: 1. An ecological approach focuses on the progressive, mutual adaptation of organism and environment. 2. It conceives of the environment topically as an inter- active set of systems ”nested” within each other, and sees the interdependent interaction of systems as the prime dynamic shaping the context in which the organism directly experiences social reality. 3. It focuses on the issue of ”social habitability” - the question of environment ”quality” and the means for achieving it. 4. It asserts the need to consider political, economic and demographic factors in shaping the quality of life for children and families. It is the study of the dynamic multiplicity of factors, not one single influence, which alleviates the tendency for reductionistic solutions. Bubolz, Eicher and Sontag (1977) and Hook and Paolucci (1970) further elaborate on the family eco-system approach to understanding human behavior. This perspective includes human beings existing in interaction with the total environment including the natural, human constructed, and human behavioral. It is organized around three major concepts: the human environed unit, the environment, and their inter— actions and transactions between and within each other. A useful part of the model is that of energy flow which enables one to view families as both consumers and converters of energy. The establishment of familiy boundaries in distinguishing itself from other systems is a critical aspect in an intervention model. Watzlawick (1978) has described the resistance of family eco—systems to change. He has developed a theoretical model utilizing a system's framework to assess and understand change. He suggests that the most effective approach to change is one termed ”second order“. This type allows one to move temporarily outside the family system to achieve a different frame of reference. The utili- zation of a parent aide as a facilitator of second order change in parents who neglect their children would be theoretically plausible. Other researchers have also endorsed an eco-systems approach. Hartman (1978) warns of the danger of not having an understanding of eco-systems: We have learned that all living things are dependent for survival or nurturing and sustaining environments and are interdependent upon each other. We have learned that the unforseen consequences of ”progress" have too often been the disruption of these important relationships and we now know that even the most well— intentional intervention may lead to further destruction. The science of ecology studies the sensitive balance which exists between living things and their environments and the ways in which this mutuality can be enhanced and maintained. (p. l) Bronfenbrenner (1977) has stated: Research on the ecology of human development should in- clude experiments involving the innovative restructuring of prevailing ecological systems in ways that depart from existing institutional ideologies and structures by redefining goals, roles, and activities, and providing interconnections between systems previously isolated from one another. (p. 528) It would thus appear that research which occurs on the change of a family eco—system via the addition of a new component, i.e., the parent aide, would be ecologically sound. Figure 1 represents the ecological model utilized for this study. The family's relationship and interactions with the parent aide and formal and informal resource systems are described FORMAL INFORMAL RESOURCE RESOURCE SYSTEM SYSTEM Ecological view of the study's approach to the Impact of the Parent Aide Intervention Model. Figure 1 and analyzed. This approach takes into account the complexity of interactions which may occur with the addition of one new system, the parent aide. ; Goal of the Study 5 The overall purpose of this study is to determine the effect of parent aides on neglectful families. vi, v.4...” Objectives of the Study The primary objectives of this study are: ’ 1. To determine if neglectful families, with whom a parent aide is working, change and improve in their parenting behavior among Phases I, II, and III of this study. 2. To determine if neglectful families, with whom a parent aide is working, have a different, more positive, type of relationship with other people in their family eco—system than they had prior to their involvement with a parent aide. 3. To determine if neglectful families, with whom a parent aide is working, change and improve in their degree of social isolation. 4. To determine if there is a relationship between the pre— dictive scores of the Michigan Screening Profile for neglectful families and their change in parenting behavior and attitudes between Phases I and II, I and III, and II and III of this study. 12 5. To determine if there is a relationship between demo- graphic characteristics and improvements in social and parental functioning during the course of the study. Definition of Terms Concepts which assume an important role in the study and general discussion are defined below. It is recognized that some of the terms may be found in the literature with other definitions. It is not the intent to offer an exhaustive meaning for the term, but rather to clarify the utilization within this study's general context. Child Abuse: ”Harm or threatened harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through non-accidental physical or mental injury, sexual abuse or maltreatment“ to such a degree that the family is active in a Protective Services Division caseload (Michigan Department of Social Services Manual 8210, 1977). Child Neglect: ”Harm to a child's health or welfare by a person, respon- sible for the child's health or welfare which occurs through negligent treatment, including the failure to provide adequate food, clothing, shelter or medical care” to such a degree that the family is active in a Protective Services Division caseload (Michigan Department of Social Services Manual, B210, 1977). 13 Child Maltreatment: The culturally defined labeling of behavior which does not meet societal expectations, be it excessive use of force or inadequate provision of essential nurturance. Ecological Approach: The examination of the interdependent nature of human beings with other organisms, and their environment, including support systems, energy flows and communica- tion. Intervention Approach: Actions taken with the intention of bringing about a change in the calibre of child care and a reduction in behavior and attitudes considered to be "neglectful”, by utilizing parent aides as the primary treatment modality. Parent Aide: An individual who has volunteered to become a supportive friend to a parent, who is neglecting his/her children. Services provided include emotional support, parent modeling, communication skills and occasional concrete help such as transportation to doctors, recreational activities or other services. Protective Services: ”Social Services designed to protect children from conditions which threaten their health and safety due to the actions or inactions of those responsible for their care. These services include investigation of a report; determination of the facts of danger to the child and immediate steps to remove the danger; providing or arranging for needed services for the family and child; and when appropriate, initiation of legal action to protect the child” (Michigan Department of Social Services Manual, 8210, 1977). Resource: ”Any commodity, material or symbolic, which is trans- mitted through interpersonal behavior” (Foa and Foa, 1974, p. 26). system: A set of units (or human beings) together with the relation- ships between the units and the properties of the units. The units are interdependent and have interrelationships with other systems. Operational Definition of Terms The following operational terms were utilized with the hypotheses being analyzed: vVllllllulllh], uulIIIIHIZI v, IJIUc Eco-Map: The diagram of a family's ecological system at a point in time describing relationships among systems. Variables include: Energy Flow: A measurement of the degree of effort and time required to maintain a relationship which can be characterized by: receiving more than giving, giving more than receiving, or by giving and receiving approximately the same as measured by the direction of arrows . Importance of Relationships: .A measurement of the significance of a systematic relationship as measured by the size of the system in the Eco-Map. Type Of Relationship: A measurement of the nature of interaction with others described as strong, tenuous, or stressful and measured by the line differentiations on the Eco—Map. Formal Resource System: Structured helping services Offered by the community to assist individuals or families including public assistance programs, court, protective services, and mental health programs as measured by the Family Support Index and the Eco-Map. These are designated as: welfare, work, housing, Protective Services worker, court and related others. 16 Informal Resource System: A helping source which is particularistic and voluntary in nature without formal organization or funding: in- cluding friends, extended family, and parent aide as measured by the Family Support Index and Eco-Map. These are designated as: friends, extended family, parent aide, recreation and neighbors. Parenting Behavior: Those acts needed to be performed or those conditions pro- vided by the parents for their children to assist them in the growth toward adulthood including: supervision, con- trol and discipline of children; emotional and physical interaction; child development activities; nutrition and health, promotion and maintenance of the physical and house- hold environment as measured by the Childhood Level of Living. Participants: Mothers who have been identified as neglectful by the Michigan Department of Social Services and have been given a parent aide to facilitate change. Social Isolation: That behavior which results in an individual's or family's lack of contact with people outside of their own immediate family, except for the Formal Resource System as measured by the Family Support Index and the Eco-Map. 17 Time Phases: Includes Phase I during the first month of the study; Phase II which is four to five months from the initiation of the study; and Phase III which is eleven months from the beginning Of the study. Hypotheses The following five hypotheses were formulated for this study. Several sub-hypotheses specific to the individual variables were also developed. Hypothesis 1. There is no difference in the participants' total parenting behavior over the three phases of the study. 1.1. The participants will not change in the area of supervision, control, or disci- pline of their children. 1.2. The participants will not change in the area of family interaction. 1.3. The participants will not change in the area of child development activities. 1.4. The participants will not Change in the area of nutrition and health. 1.5. The participants will not change in the areas of physical environment and house- hold maintenance. Hypothesis 2. There is no difference in the mean and frequency of the type and importance of the participants' relationship with other systems over the three phases of the study on the direction of energy flow utilized. 2.1. The participants will not change in the frequency and mean of relationships des- A cribed as important. 2.2. The participants will not change in the frequency and mean of strong relationships. 2.3. The participants will not change in the frequency of stressful relationships. 2.4. The participants will not change in the direction of energy flow involved with their relationships. Hypothesis 4. There is no relationship between the partici- pants' High or Low Risk Score on the Michigan Screening Profile of Parenting and their change in parenting abilities and social isolation characteristics. Hypothesis 5. 4.1. 4.2. 4.3. 4.4. 19 There is no relationship between the participants' High or Low Risk Score on the Emotional Needs Met (ENM) and their change in parenting and social isolation. There is no relationship between the par- ticipants' High or Low Risk Score on the Relationship with Parents (RWP) and their change in parenting and social isolation. There is no relationship between the parti- cipants' High or Low Risk Score on the Expectations of Children (EOC) and their change in parenting and social isolation. There is no relationship between the parti- cipants' High or Low Risk Score on Coping (COP) and their change in parenting and social isolation. There is no relationship between the demographic characteristics of the participants' age, educa- tion and number of children and the improvement in parenting behavior and social isolation. 5.1. There is no relationship between age of the participant and improvement in parenting be- havior and decrease in social isolation. Assumptions 20 5.2. There is no relationship between the number of children in the family and improvement in parenting behavior and decrease in social isolation. 5.3. There is no relationship between the number of years of education of the par- ticipant and improvement in parenting behavior and decrease in social isolation. The following assumptions were made with respect to this study: 1. Limitations The observation and interviewing of families within their own home provide data for an accurate assessment of parenting behavior. Family relationships, both within the family, and with others outside the family system, are measurable and quantifiable. Mothers' responses are reflective of actual parental and social attitudes and behaviors. of the Study This study had the following limitations: 1. Generalization: A study with a small nonrandom sample and which is intensive in nature, cannot be generalized to other individuals. In order to assure the representa- tive nature of the group, a random sample whould have to 21 be studied or a series Of replications of this study be made to validate the conclusions drawn. Non-Representative Sites: Three large counties in Michigan; Kent, Oakland and Genesee were selected as the research sites. The counties contained both urban and rural populations as well as having varied ethnic and social compositions. These areas would not be characteristic of some all-rural or urban communities which may have distinctive types of values and unique child neglect problems. Instrumentation: Two of the major instruments, the Family Eco-Map and the Childhood Level of Living, were revised and adapted for the study. Therefore, no re- liability nor validity measures are available. CHAPTER II REVIEW OF LITERATURE The literature related to this study is divided into three areas. The first section reviews work exclusively on the nature of child neglect; the second deals with studies which do not differen- tiate between child abuse and neglect, but rather generic child maltreatment; and the third pertains to intervention and treatment of child maltreatment by parent aides. Child Neglect The first researcher to look specifically at child neglect was Leontine Young (1964). In a classic and seminal study, she drew a profile of 180 neglecting families. She found that over 95 percent of the families failed to feed or clothe their children adequately or keep them Clean; they also did not provide needed medical care. Sixty—five percent frequently left their children unsupervised. The parents were more likely to cooperate and secure help if it were devoted toward them rather than focused on their children. She found that “unless help Offered by someone Outside the family...and maintained by outside responsibility, these parents tended to remain indifferent to the behavior and problems of their children” (p. 29). The families were also characterized by their lack 22 23 of routine, a pervasive sense of loneliness, and the failure to seek out other people; they did not have even informal social relationships. Norman Polansky, subsequent to Young's work, has done extensive research on the nature of child neglect. He began his work in the mountains of North Carolina and Georgia where he did a series of studies regarding the phenomenon of child neglect and the personality types of neglectful mothers. From this research he determined that although poverty is almost a universal characteristic of neglect, all families living below the poverty line do not neglect their children, in fact, there are striking differences in child rearing. There is not an intrinsic ”culture of poverty” which causes child neglect, but rather contributes to it. He developed a psychodiagnostic tool, the Maternal Characteristics Scale, which enabled him to discover prevalent per- sonality types. The most pervasive was the apathetic—futile mother. She can be described as: having an aura that nothing is worth doing, an emotional numbness, an absence of intense personal relationships, a passive aggressive anger particularly toward authority, a low com- petence in most areas coupled with an unwillingness to invest energy to acquire skills, a noncommitment to positive stands and low self—confi- dence, an almost ”uncanny” ability to infect those trying to help her with the same feeling of futility and a verbal inaccessibility. Other, less frequent, but related types are: the Impulse-Ridden mother, the Mentally Retarded mother, the mother in a Reactive Depression, and the Psychotic mother. Isolation and the feeling of powerlessness were universal themes throughout the subjects. 24 In order to ascertain whether his findings were generalizable, Polansky replicated his study in an urban area, Philadelphia. He studied 125 families which included control families in similar cir- cumstances, but not known to be neglectful, and achieved similar re- sults. He also looked more extensively at the variable of isolation. Significant differences were discovered in comparing the two groups. Neglectful families had much stronger feelings of alienation and futility, had much less accessibility to a supportive helping network; participated less in formal organizations, and socialized less in- formally. The researcher found this true of the fathers, if present, as well as the mothers, although in a slightly less severe degree. A study by Billingsley and Giovanni (1970) sought to determine if they could differentiate Characteristics of low income neglectful families and potentially neglectful families from non-neglectful, low income families. Ethnicity was held constant: white, black, and Spanish speaking families were studied. One hundred and thirty-six mothers were assessed on the following factors: family and social background, current situational features including age, family struc— ture and stability, income, material resources, social functioning, informal and formal social systems and child rearing practices. No differences were discovered in the mothers' childhood history; however, significant differences occurred in the current situations. Neglectful mothers were found to have a higher number of children, more frequently single-parent households, fewer material resources, a higher degree of poverty, fewer positive relationships within the kinship system and less ability to accept their children’s dependency needs as well as provide them with general emotional nurturing activities. 25 Camille Jeffers (1967) conducted a participant—Observation study in a low income housing project. Child neglect was a fairly frequent occurrence and her description of the mothers' lives is consistent with other research findings. Faced with chronic lack of money, many of the children were improperly fed and clothed. Marital relationships were highly unstable and there were few friends or re- latives to offer support. Children were left unsupervised and health problems were frequent. The women did not perceive the world as a positive place and fear of the outside was evidenced in their reluctance to allow their children to play in an adjacent park. Their reluctance to form relationships was also apparent in that it took Jeffers con- siderable time to secure their trust. However, once this was achieved, some became very dependent on her. Child Maltreatment The term ”battered child syndrome” was coined in 1962 by Kempe highlighting of a national problem. Much research has been conducted since that time specific to child abuse; some work has examined both neglect and abuse since they are both deviant child rearing phenomena. Several conceptual models have also been developed which would appear relevant to child neglect. Helfer has done considerable research in the area of child abuse and neglect. He has developed a model termed W.A.R. “World of Abnormal Rearing Cycle” to epitomize the cyclical nature of child maltreatment as being transmitted from one generation to another (See Figure 2). His approach is primarily one Of individual psychopathy based on early 26 use a Newsau ago .ouagmaz use .0 .ngmx ..m .mepmz mmzn< crwsu — mmmzho mm: o» >HH4HmHHJ~mHQ «zomhmm MJOm monHu wzfim a zoocafiofl> Haoflmofioeoxma: .m mufismmm< woumomom .m pfismmm< Hmoflmxnm ofiwcfim .H omsn< wfiflcu .mucoesme< .mo>w:oomwz wfiwcu mcoflpmsuflm wcflwmufiafloohm opmmonEH oucoaofi> mo oezuasonsm a mesuflm t pooflmoz owsaocw ou :ofluwumww< mouwoflmcHlsl meoceomfla Hmowmofiopzoz Homecoo goo; mwflaee youoeewgu :cflficu Eofinopm: .m vaflcu moucmzca .H mmoeum wouswonmucflfinu .Eooummnmfiom .mosfim> .xuflpoguz< Hmpcoeam ou mumopze .v :oflumfiomH Hmwuom .m ecosonmEocs .m connaflzu mmooxm .H mmoeam Magnuozeum mousmmflm kuwewz .N omwweemeeoch .H mpcoew; somzuom m:0flumaom mmmmbm 4 mo Hone: ofiom omsn< oozofleomxm :ofluwmwawfloom _ » mEHoz can mozfim> xuflczesoo can mmmfiu wmzn< vaco mo mmmzmu to Pete: quwmo—ocuzmm u meuom mmFch mum xom ow< paused we mcofleflmo; Hawuom 31 Characteristics were the same as described in other studies: predomi- nantly single parent; living at poverty level, and experiencing stress, isolated with health and relationship problems. They discovered that the most significant variables, related to discontinuation of abusive or neglectful behavior were the mother's age and the length of the period of services. Nagi, in a national study (1979) attempted to differentiate parental characteristics of those who abuse their children as compared to those who neglect. The neglecting parents were much more likely to be of lower educational attainment and economic levels; the abusive parents were higher in the areas of unhappy childhood and under more emotional pressure. Both groups had a high frequency Of parents who were emotionally disturbed. Several authors have discussed Child maltreatment as a result of stress. Ten Have (1965) and Elmer (1977) have described abuse as a culmination of a long period of tension. Elmer's comparative study of abused and non-abused children, who had received accidental injuries, found that abusive mothers perceived a great amount of stress as con- trasted to other parents. Nagi has modified Reuben Hill's crisis model to reflect its relevance to child maltreatment (See Figure 4). Letters a, b, c and d represent occurrences which may contribute to abuse: - (a) and (b) are fluctuations in family relations which remain within the limits of acceptable behavior. - (b) represents a critical incident; a crisis or an incidence of abuse (Gelles' term precipitating situation). 32 - (c) actual crisis - a report of abuse, investigation and level of disorganization. - d1, d2, d3 - a redirection and adjustment to a higher level of performance. The angle of recovery indicates the amount of time to increase their level of functioning. The narrower the angle, the shorter the time in which the family can achieve higher functioning. (a)...(e) represents the situation in neglect or insidious, non- manifest abuse, which has a slow, steady, progressive decline in per- formance. (a)...(e) reflects the type of neglect stemming from poverty, in which the family never achieves an adequate level of performance. Garbarino (1978) has also described a multi-causal ecological model for viewing child maltreatment. He considers four factors as necessary to create a pattern conducive to abuse: isolation, social and/or economic stress, parenting ”style", and the child as a stimulus. He is particularly concerned with the element Of isolation. He hypothe- sizes that: as the value and opportunity for privacy increases, the danger of isolation increases correspondingly, and with it the possibility of child abuse due to some combination Of personal and social stress, depression and inconsistent parental behavior (p. 569). He endorses a “kinship intrusive” system as a more desirable value to be used to supplant the one for privacy, which, in its extreme form, leads to isolation. He suggests a surrogate support network to be developed and Offered to families in order to create change. 33 STRESS CURVE AND FAMILY PERFORMANCE (a) (b) (d1) Level of Performance Nagi, S. Child Maltreatment in the United States, New York, Columbia University Press, 1977. Figure 4 34 Intervention and Treatment of Child Neglect by Parent Aides There is a dearth of information regarding evaluation and effectiveness of treatment techniques to Change child neglect. Nagi's national survey sought to describe the status of the current interven— tion system in child maltreatment. One of the issues that he identified was that related to the state of knowledge and technology in the field. Medicine appears to be considerably advanced, with great sophistication in the diagnosis and physical treatment of children. The legal profession has also added substantially to legislations permitting the public to intrude in family relationships when abuse or neglect occurs. However, the state of technology in the remediation of emotional damage and Change in the behavior of families was considered seriously underdeveloped. Practitioners demonstrated a wide variance in their assessments of effective treatment - more than a third of the respondents agreed that ”treatment for parents who mistreat their children is largely ineffectual", and ”we just don't know enough to deal effectively with problems of child mistreatment”. The concept Of parent aides was first introduced in 1969 by Kempe at the National Center for the Treatment of Child Abuse and Neglect in Denver. He conceived of them as paraprofessionals whose primary task was to be a non-judgmental friend. At the Center, and many other places, parent aides have been utilized primarily for abusive families. Vincent Francis also developed the concept of social service assistants who would serve as surrogate mothers or as ”life-lines” to abusive mothers under stress. 35 Young suggests that the casework/psychological change approach is not the most feasible one to create change in these families. She advocates focus on external change, with clearly identifiable standards of behavior, for example, the establishment of routines such as meal preparation. This has the function of building the external life structure and the consequential stabilization and integration of fami- lies. For abusive families, she suggests the utilization of foster homes for child placement. Van Stalk (1978) also supports this approach for abuse, and cites cases of child mortality as a result of leaving the abused child within the home. She is encouraging of the the concept of parent aides as a means to ”drain off the hostility, loneliness, anger, and rejection that the parents might very well take out on the child” (p. 87). A study conducted by Sherman, Phillips et a1, (1973) on the topic of services to children in their own homes, did not address the use of parent aides as a service modality. It did indicate that ”support" and “practical help” constituted 44 percent of all agencies' predominant casework techniques. No comparison was given to the effectiveness of the seven approaches utilized. Minimal changes were noted in the mother's specific behavior at the end of one year - although a total overall score of parental functioning did improve for 42 percent of the subjects. Within a handbook for protective services workers (Breezby, 1978), a brief chapter is devoted to intervention techniques. No research or evaluation of the approaches is made, simply a description Offered. Parent aides are described under the category “Lay Therapy“. Their primary role is to provide ”long-term nurturing”. This method is considered useful, 36 because it provides ”a supportive relationship that the parents have never before experienced” as well as having the advantages of being economical and saving time for professional staff. Ray Helfer (1978) advocates the use of parent aides as an intervention technique to change the W.A.R. cycle of lack of trust, isolation and "I'm No Damn Good”. He feels that parent aides not only break down isolation, but also provide a good model of parenting be- havior. Parent aides also facilitate the family's development of positive relationships with others. Helfer notes, ”Parent aides are, of course, adjuncts to other forms of therapy”. Research at the National Center for the Treatment of Child Abuse and Neglect has indi— cated, via subjective assessments, that positive growth is experienced by parents with parent aides and that no serious re—injuries to the abused child occur. Perhaps the strongest research available to demonstrate the effectiveness of parent aides was not done with humans, but with gorillas by Rock (1978). The 200 to which the gorillas had been brought at a very early age encountered enormous problems once the female gorillas had grown, been mated, and had babies. The mother gorillas ignored their children, refused to nurse them, or supervise them, and were fre— quently abusive. This behavior was abnormal compared to gorilla maternal behavior in the wild. The scientists then captured mother gorillas and their young who had experienced a normal, natural, developmental period and placed them with the abusive and neglectful mother gorillas. In a very short time, the appropriate mothering behavior demonstrated by the gorilla “parent aides" was adopted by the deviant gorillas. Along with 37 an improvement in parenting behavior, a distinct social support group was established which, in general, provided additional modeling ex- periences. Carrol and Reich (1978) have conducted a descriptive study of ten abusive parents who had parent aides as the primary treatment approach. They studied the families for two years to determine the behavioral impact of the program and attitudinal changes. Eighty-five percent of the parents did not abuse their child after contact with their parent aide began. The researchers also found a trend toward more posi- ii tive interaction and relationships. No significant change in social 34 isolation was discovered. A description was also offered of the parent : aides themselves; the selection, training, maturing and program structure of such an approach was described. Wanda Downer (1977) has also presented two case studies in which a neglecting mother and an abusing mother who had parent aides reported the significance of the relationship to them. For both mothers, their parent aides represented a friend who could be counted on, a parent that they had never had and the one resource on whom they could depend. Downer also conducted an evaluation of the program via an attitude sur- vey. Ten parents responded (approximately one-third of the agency's population). They indicated at 80 percent or above, that they strongly agreed that ”the parent aide understands me and my situation”; ”the parent aide is able to provide what I need“; ”I am gaining benefits from knowing the parent aide that I did not expect”; and the ”service I am receiving makes a difference in my life”. CHAPTER III METHODOLOGY Overview The data for this study are part of the data collected for a larger study which was a descriptive comparative parent aide study of three Michigan agencies: the Genesee County Department of Social Ser- vices, the Grand Rapids Child Guidance Clinic and the Oakland County Cooperative Extension. The primary focus of the parent project was to compare and describe the activities of the parent aides, the supervising agencies and their effect on the families with whom they worked (Andrews and Swanson, 1979). This study utilized data collected on families which had not been previously analyzed and therefore supplements the master project. This researcher was the larger study's project co-ordinator and was responsible for: assisting with the project design, hiring, training and supervising interviewers, evaluating participating agencies' programs, data analysis, the final report and recommendations. Information from the three sites was combined to provide a statewide perspective and different focus for this research. A time series, small sample descriptive study methodology was used. Families were interviewed and observed within their own homes over 12 months. A variety of instrumentation was utilized including: non-directive and directed interviews, open-ended questions and 38 39 self-administered questionnaires. The approach combined a qualitative and quantitative analysis to facilitate a better understanding of the lives and changes in the lives of neglectful families. Population The population from which the participants were selected was that of families who were 1978 clientele of the Michigan Department of Social Services, Protective Services Division, due to child neglect, and had been assigned a parent aide as a method of intervention. A11 families had been investigated by Protective Services case managers and had been found to be unable to provide minimal parental care for their children. The Protective Services case managers accordingly made a determination of services needs. Families within the population were those for whom a case manager had decided that a parent aide would be an appropriate service provider. Regular re—determination of family functions was made as to the advisability of continued action: maintain the case open with the same or different intervention; close the case due to improved family/parenting functioning; or remove the children and con- sider subsequent termination of parental rights. The auspices of the provision of parent aide services varies throughout the State. The Michigan Department of Social Services may contract with local, private or public agencies who agree to recruit, train, supervise and support parent aides. Within their service domain, some parent aides may also work with abusive parents, or those whose parenting problems are not severe enough to constitute sufficient cause to be open Protective Services cases. 40 mm: A meeting was held with the Central Office, Department of Social Services Administration to consider potential research sites among parent aide sponsoring agencies. Subsequent meetings were held with the identi- fied agencies to explain the primary purpose of the research and to secure their participation. An advisory task force was established consisting of the participating agencies to review procedures and findings. Its approval was secured prior to initiating the study. Clearance was also received from the University Committee on Research Involving Human Subjects. A total sample of 24 family/parent aide combinations was chosen from the three sponsoring agencies from similar large urban counties, eight from each site. Due to the limited number of new family/parent aide matches made within each sponsoring agency, and in order to acquire an adequate number of subjects, three sites were chosen. Preliminary study indicated the time of year in which most families and parent aides were first matched. This time period was consequently chosen to initiate the study. August 1978 through August 1979 constituted the study period. Th (D following criteria were utilized for inclusion of a family: 1. The family must be an open Protective Services case primarily due to neglect. Families who were exclusively abusive would not be included. 2. Only families who were receiving a parent aide for the first time would be involved. Replacements of a parent aide were not considered appropriate. 3. The family and parent aide must consent to participation in the study. 41 Once sponsoring agencies agreed to participate in the study, and an initial date determined, every referral to the parent aide program was considered a possible study participant if they met the criteria. The sampling process consisted of the following: 1. The family was identified by the Department of Social Services case managers as a neglectful family. 2. The family was a new referral to the parent aide program. 3. Following the initial match of the first family/parent aide combination, every subsequent match was included in the study until the sample size of eight families at each site was achieved. Two additional families were included to allow for potential attrition. A representative from the sponsoring agency explained the pro- ject to the selected families and consent was received. The consent form was also signed by the parent during the first interview. The researcher met with all the parent aides within each sponsoring agency to explain the study and secure written consent. Individual letters of consent were also received during the first interview. The sample consisted of a cross section of families and parent aides at each site although this was not intentionally sought in the sampling technique. Wide variation in the types of families and condi- tions were evidenced within the group. In order to judge how typical or atypical these families and aides were, a random sample of the Protective Services families and parent aides was identified and basic demographic characteristics compared. 42 Research Design In this time series analysis, an intensive, longitudinal design was chosen. Specific behavior and attitudinal variables were studied within the families' eco—systems over three phases of obser- vation. Treatment effects were contrasted over the independent variable Of time (Phases I, II, and III): Phase I - When the parent aide was first assigned to the Protective Services family, an initial interview and series of measures were administered to document baseline or entry level behavior of families and initial characteristics of parent aides. Phase II - After four to six months of program contact, measures were again administered. Phase III - After ten to twelve months of program contact, the final administration of instruments was conducted. The following variables were studied: 1. Participants'perceived amount of social isolation. 2. Participants' relationships with the following systems: fp:mal_- Court; School; Work; Protective Services case manager; Social Agencies (public assistance, mental health, other related agencies); and Housing. 43 Informal - Friends; Neighbors; Family; Extended Family, and Parent Aide. 3. Participants' parenting skills and attitudes. Descriptive information, not utilizing a time series approach, also examined the following variables: 1. The participants' early childhood experience contrasted to their level of isolation and improvement in parenting. 2. The participants' age, education, and number of children ' I ‘l. v ‘ - .‘ h 4. .‘ ‘ ' tn! _.1. as related to improvement in parenting and isolation. 3. The participants' change in interaction with formal and informal systems constrasted with age, education and number of children. Data Collection Procedures Pretest A pretest at a site not included in the research was employed with a family which had had a parent aide for three months. The in- depth family interview lasted approximately four hours which was equi- valent to two interviews during the actual research project. The physical environmental conditions of the home, interactions of mother and children, and the involvement of the mother with the researcher were helpful in the final development of the instrumentation. The methodology of the inter- view, its length, ordering of instruments, and reception by the participant were all useful in the determination of the final procedures. Information 44 learned from the pretest was particularly useful in assisting in the subsequent interviewer training sessions. Interviewers One interviewer was hired in each of the three sites to conduct the in—home, family and parent aide interviews. Adjacent universities at each site were contacted in order to solicit referrals of individuals who had appropriate education and training, as well as experience, in conducting family interviews. Great care was taken in the selection process to hire those individuals who would be sensitive to the needs . ,' '1 ..-' I“. ' ‘vvi, ‘1' e, ’ J I L and problems of the families whom they would be interviewing. All of the interviewers employed had a minimum of a Bachelor's degree in a human services related field and two of the interviewers had Master's degrees. Some of the data to be collected involved an ethnographic or case-study approach. This necessitated great attention to the training of the interviewers in an effort to achieve a degree of standardization of their observations. The researcher planned and conducted an all-day training session which included utilization of the interview schedules and the questionnaires, role playing, and an item—by-item discussion of observable behavior. Each of the interviewers also pretested the ques— tionnaires with their own family to become more accustomed to it. There was an attrition rate of two interviewers, at one site, during the study. Each of the new interviewers was individually trained. Although one site did have interviewer change, the other two sites maintained a stable staff which allowed for a more personal, positive relationship to develop, thus 45 encouraging the continuation of families within the study and their willingness to share very intimate details of their lives. Interviewers also were in constant contact with the investigator who offered uniform clarification of uncertain ratings. Of the five interviewers employed, four were female, four were white, one black; the mean age was 35, and the mean education was 17 years. The interviewers were instructed to make every effort to make the interview situation comfortable for the participants, and that in no case, should they pres— sure the participants to respond to particular question items if they showed some resistance. This was required since many of the families did evidence emotional problems, the subject matter was potentially painful, and possible harm might occur if some topics were actively pur- sued. Interviewers were not informed of any history of the participants and were not aware that they were Protective Services families. They were told that the families were to be considered as team members and consultants regarding the parent aide program in which they were parti- cipating. Interview Families were paid a ten dollar ($10) consulting fee for each interview phase and were paid at the conclusion of each session. Inter- views were conducted at the convenience of the participant, a majority of the interviews were held in the afternoon or evening. The interviews lasted approximately two hours each, for a total data collection time of six hours per participant. The home interview, besides offering an opportunity to make observations Of the family's interactions in a 46 naturalistic setting, as opposed to more artificial experimental settings, is ”ecologically sound”; the family is more comfortable on familiar ground (Eubank, 1976, Kerlinger, 1967). In all interviews, the mother was the primary participant. The parent aide-mother relationship was the major element in the attempt to create change in the overall family system. Few families actually had a husband/stable boyfriend present consistently over the time Of the study. The unit of analysis, however, was the family, and the mother was asked to describe the total family interactions and relationships. Although the children were not interviewed, their appearance and be- havior, as individuals, and with their mother were observed and included in the study. Instrumentation A variety of instruments and data collection techniques were utilized for this study. These may be found in Appendix A. The primary method was an interview conducted within the participants' homes in order to facilitate observation. Interviews consisted of questionnaires and observations. Case files were also read by the researcher in order to collect demographic data. The following instruments were utilized: Childhood Level of Living - One of the primary instruments utilized was a modification Of Norman Polansky's Childhood Level of Living Scale (C.L.L.) the intent of which is to indicate the conditions of care under which children are reared (Polansky, 1976). Based upon the Sears, et al, approach to evaluating parenting patterns (Sears, 1957), it utilizes the families' Protective Services workers to rank basic areas of 47 physical, emotional and cognitive care. The instrument response format was modified for use by interviewers, separating those questions into topics which could be observed and scored immediately following the interviews and those items which could be elicited in open, non- directive interviews. It was felt to be crucial that some topics, such as discipline, which are highly “loaded“ questions to ask a family already in jeopardy of losing their parental rights, must be dealt with sensitively. Consequently, a majority Of the information was elicited in an unstructured manner. Lead questions were also formulated by this researcher to assist the interviewers in soliciting the information in a non-threatening manner. The original response format required "yes-no” answers. The response format was modified to read “yes”; ”no” and "unable to elicit” response. The scale was scored so that a low score indicated problematic/low level of living. The original C.L.L. has construct validity, high internal consistency and ”robustness” (Polansky, Chalmers, Butterwieser and Williams, 1979). However, due to the modifications in response format the reliability and validity of the modified instrument is unknown. It is felt that the modifications are an improvement and would, therefore, strengthen the instrument. Scores were clustered around specific areas of care: 1. Family Interaction and Characteristics 2. Supervision, Control and Discipline 3. Child Development Activities 4. Nutrition and Health 5. Physical Environment/Household Maintenance. 48 The Family Interaction and Characteristics grouping included areas such as recreational activities, use Of television, relationships with spouse and other family members, activities outside the home, and the mother's style of communication with others. Supervision, Control and Discipline contained questions relating to daily routines, methods of supervision and discipline and tolerance and understanding of children's behavior. Child Development Activities' items were such things as involve- ment of parents and opportunities for play, school activities, and nurturing experiences. Nutrition and Health included knowledge and use of basic medical facilities, provision of adequate meals and knowledge of medical emer- gency resources. Physical Environment and Household Maintenance dealt with the condition of the house relative to safety and cleanliness. Three scores were developed at the end of each phase: Interview Items, Observational Items, and Total Score. Scores were reported as percentages: Number of Positive Responses over Total Possible Positive Scores. Items on the C.L.L. reflected minimal expectations for an adequate standard of family living. Scores ranging from ninety (90) to one hundred (100) would indicate a high degree of meeting minimal level; scores from eighty (80) to ninety (90) demonstrated a moderate compliance; scores below eighty (80) generally represented some areas of serious lack of meeting minimal levels of child care. 49 Eco—Map - Another instrument utilized was a modification of the eco-map, Hartman (1978). Based on the concept of viewing the family ecologically, i.e., in interaction with its environment, it has been primarily utilized as a diagnostic and therapeutic tool with multi-problem families. Although no statistical analysis has been done relating to its validity and reliability, the eco—map has been utilized extensively by personnel in the Michigan Department of Social Services temporary foster care projects and by a crisis walk-in center. Both attest to its accuracy in evaluating outcome and measuring change, albeit in a qualitative manner. The eco-map consists of diagramming the family and its relationship, both internally and externally, with other systems. The interviewer acts as a facilitator enabling the family to map their perceived relationship with others. The original instrument has pre-established circles, already labeled with the system of interest. To prevent this bias, and maximize the descriptive oppor- tunities, interviewers named the system and the parent determined its size and location as well as the nature of its relationship to the family. The original map was drawn during Phase I, distinctive colors were utilized to denote family members. Data in respect to individual family members were not fully analyzed within this study. During Phase II and Phase III, transparencies were placed on top of the base- line eco-map to describe changes that had occurred. The following systems were described within the eco-map: 1. Family - Interactions Between Members 2. Friends 50 3. Extended Family 4. Work 5. Parent Aide 6. Court 7. Welfare 8. Housing 9. Recreation 10. Protective Services Worker 11. Other Informal and Formal Systems Each of the above variables were described by the following dimensions: 1. Type of Relationship: §EQI§_B§§iflflm§fl£ Stressful I I ‘ 1 Tenuous ___________ 2 Strong 3 2. Energy Flow: More Out Than In \ \ 9 More In Than Out é F F e—e—a— —Aé~Aé——4é—- (measured by direction of arrows) Reciprocal 51 3. Importance of Relationship: Score Assignment Of Little Importance (:> 1 Quite Important <::> 2 Very Important ‘ 3 (measured by size of circles) A three point score was utilized for type and importance of relationships with three being the most positive - ”strong relationship“ and one being the least positive — ”stressful relationship”. These were scored for every Phase to determine change. The number and types of energy flow were collected during Phase I and Phase III. A total ‘Df score was derived for each family based on the frequency and value for each variable. Three groupings were also developed which included: Intra-Family: Parent-Child and Parent-Parent/Significant Other to include boyfriends living in the home as well as husbands. Formal Resource System: including Protective Services, Court, Housing, Welfare, Health, and Work. Informal Resource System: including Friends, Extended Families, Recreation, and Parent Aides. Michigan Screening Profile of Parenting - The Michigan Screening Profile of Parenting (M S P.P.) questionnaire was utilized in Phase II to establish a developmental risk score (See Appendix A). This standardized 52 scale was developed by Helfer, Schneider and Hoffmeister (1978) to predict potential child neglect or abuse. A 50 item open—ended and forced choice questionnaire measured the following categories: Emotional Needs Met (ENM) Relationship with Parents (RWP) Expectations of Children (EOC) Coping (COP) The Emotional Needs Met cluster defines a type of relationship between self and others. Negative perceptions resulting in a high score would include feelings of being unloved and frequently criticized, ,Tl having to meet high expectations from parents and a general climate in which the person's own needs and wants were ignored by the parents. The person feels unloved and misunderstood in present relationships as well as childhood. Relationship with Parents cluster defines feelings about love and affection between the respondent and his/her parents, particularly, the mother. Negative perceptions indicate certain problems in getting along with, loving, and being close to parents. Expectations of Children deals with the feelings that very young children should be well behaved and sensitive to what their parents want from them., Negative perceptions are that children should know the parents' wishes and needs and meet them at a very young age. Coping reflects a feeling of being able or unable to cope with crises by handling the situations in appropriate ways. Feelings of wanting to run away, helplessness and frustrations occur. The high scorer has feelings of being unable to cope in crisis situations. 53 Based upon prior research indicating the importance of past childhood experience (Helfer, 1976), the M.S.P.P.'s main focus is on describing past parent-child relationships. Helfer, et al, have indicated in their utilization of this instrument, including cross- cultural comparisons, that it has high (85 percent) sensitivity (the ability to identify accurately mothers with known problems in inter- acting with their children), and high (79.8 percent) specificity (ability to identify accurately parents with no apparent problems in interacting with their children), particularly in the Emotional Needs 1 '.. 4'1... Met cluster. The other three clusters are not as discriminating (Helfer, Schneider, Hoffmeister, 1978). Reliability measures for the Emotional Needs Met were also high (85 percent), with the other clusters more marginal (62 percent). The scores on each of the variables were compared to other dependent variables to determine the predictive value of each variable for exclusively neglectful families. Family Support Index - Another measurement utilized dealt with social isolation. Inasmuch as this variable is of primary concern within prior child neglect research, it is addressed in several items within the total instrumentation through the formulation of questions relating to the types and amount of relationships of the participants. In addition, Polansky's instrument, Family Support Index (1978) was replicated in part. Mothers were asked to respond to two open-ended questions: 1. Within the last year, have you needed any help? 2. If yes, from whom have you requested help? 54 Responses to the questions were categorized into six types: A Six-Point Ordinal Scale was utilized. The Family Support Index (FSI) points and types follow: Points Types 1 Completely Isolated: No one helps, or mother stated that the only person to be counted on was a social worker or similar professional helper. 2 Family Dyad: One parent or one sibling can be counted on to help. 3 Friend Dependent: No family member can be counted on; only one friend can be called on. 4 Family Bound: Two or more immediate family members; parent(s) or sibling(s). 5 Family and Friend Related: At least one member of the immediate family and one friend or more distant relative can be called upon for help. 6 Supported: At least one immediate family member and at least two friends or more distant relatives can be called upon for help. Normative data from Polansky's research are available for comparison. The instrument was utilized twice during Phases I and III. Two groupings were also developed from the initial Family Support Index Score: Mothers with a score of one (1) — Formal Support System Reliant; mothers with 55 scores of two (2) to six (6) - Informal Support System reliant. This clustering enabled a comparison of families with this grouping to be correlated with their score on the eco-map groupings of informal and formal system change. Data Analyses The five major hypotheses, testing whether or not there were differences in the variables over time, were analyzed using primarily non-parametric procedures. Non-parametric techniques have been judged preferable due to their qualitative nature. Instruments which measure psychological properties may actually be valid only at an ordinal level, and numerical values should be viewed as relative magnitudes of the underlying property (Hays, 1973). Descriptive statistics and observations were also used to provide more information about the participants than would normally be available if statistical tests were exclusively applied. The chi-square test was utilized to determine whether there was a relationship between the variables of age, race, educational attainment, number of children and types of identifiable problems leading to neglect. The Friedman Repeated Measures One-Way Analysis of Variance Test was employed to determine if there were changes in variables over time. This test provides a method of deciding whether dependent samples repre— sent genuine change or whether they represent merely chance variations which would be expected from the same population. It determines whether there is any consistent relational pattern among the variables. The variables measured by the Childhood Level of Living, Family Eco—Map, and the Family Support Index over Phases I, II and III were deemed appropriate 56 for this type of analysis. The Friedman Test was the primary statistical test utilized. However, for the Childhood Level of Living, a supplemental test was also employed. The C.L.L. was analyzed with a dependent T test data. This served to provide an additional dimension to the data. The Pearson Correlation Coefficient was also used to analyze the relationship among the variables of the C.L.L. The Phi Coefficient Test for concordance was utilized to deter- mine if there was a relationship between the developmental risk scores ii on the Michigan Screening Profile of Parenting and the scores and .i change scores on the variables of the Childhood Level of Living. It ‘ was also utilized to determine if there were relationships among basic demographic data, age, number of children and education with change scores in the Childhood Level of Living. This test is useful for small samples, ten or more, since the sampling distribution is approxi- mated relatively well by the normal distribution. The Kruskal-Wallis One-Way Anova corrected for ties was employed with new independent variables, created based on change scores in the Childhood Level of Living, to determine if there were relationships among demographic factors, the Michigan Screening Profile scores and change. This test examines the difference in medians to determine whether the groups vary significantly in rank deviation from normality. Scoring and analysis for the Michigan Screening Profile for Parenting was done by its original source in Denver, Colorado. An alpha level of .05 was used in determining the probability of a type one error. The null hypothesis was rejected if the significant 57 level was .05 or lower. If the alpha level was between .05 and .10, this was considered as approaching significance and the entire cluster of tests and observations were assessed in determining whether to reject the null hypothesis. ‘ra. J _ CHAPTER IV RESULTS: PHASE I ANALYSIS Demographic Characteristics During Phase I, demographic data were collected for each parti- cipant. The Protective Services workers completed the National Standard Form of the National Clearinghouse on Child Neglect and Abuse for each family. A random sample was also chosen from each site from the entire Protective Services county population in order to compare how repre- sentative the research group was at each location. The results are summarized in Table 1. On a site by site basis, several significant distinctions can be noted: In two sites, the research group is lower in the area of married participants. In one site the percentage of white participants is higher than the random sample. This same site also had a significantly higher percent of broken families in the research group. Family discord was higher in site two for the random group. Insufficient income was true of a significantly greater number of re- search families than random ones. Significant differences also occurred in continuous child care responsibility and physical abuse of spouse and fighting. Inadequate housing was significantly more of a problem for the research group in two sites, and less in one site. Social isolation was a significant factor in all sites for the research groups. Loss of 58 59 control during discipline, lack of tolerance due to the child's disobedience and normal authoritarian method of discipline were higher for the random group than the research one. One site had a significantly higher research group with alcohol dependence. Two of the three sites' research groups were significantly higher in the area of lack of parenting skills. Although this analysis demonstrates that the research group cannot be generalized to the entire county population, in almost every significantly different characteristic, the research group demonstrates more problematic behavior with the exceptions of those characteristics most typical of abuse - loss of control during discipline, lack of tolerance for disobedience and authoritarian methods. Further analysis was done to compare the research group with similar statistics from the statewide population of Protective Services cases (See Table 2). Within the 29 characteristics compared, only three emerge as significantly different between the research group and the total population. The study contained more participants with parental history of abuse as a child (26.9% to 13.5%) and with physical abuse of spouse and fighting (23% to 12.3%) and fewer black families (12.5% to 23.9%). 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PLEASE NOTE: Pages 1h6—149 are lacking in number only. No text is missing. Filmed as received. UNIVERSITY MICROFILMS. APPENDIX B Chi1dhood Level of Living Pearson Corre1ation 150 lSl CODE SHEET CLL PEARSON CORRELATIONS ABBREVIATION VARIABLE SUP l, SUP 2, SUP 3 Supervision, Control, and Discipline, Phases I, II, III. FAM l, FAM 2, FAM 3 Family Interaction, Phases I, II, III CD l, CD 2, CD 3 Child Development Activities, Phases I, II, III NUT l, NUT 2, NUT 3 Nutritional Health, Phases I, II, III PE 1, PE 2, PE 3 Physical Environment and Household Maintenance, Phases I, II, III IN I, IN 2, IN 3 Interview Score, Phases I, II, III OB l, 08 2, DB 3 Observation Score, Phases I, II, III TOT 1, TOT 2, TOT 3 Total Scores, Phases I, II, III TABLE 45 CLL Pearson Correlation Scores Variable by Variable TOT2 TFTI TCTI 1N3 TCTE TCTIS TOT]. CAH 3:010 FWD \0 0 II “C. [\AH PWQ'CJ G’CJC.) Q: 0 H “(3. (35¢ U‘d’c—fi Q‘OIQ ‘1“ O u “C... 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QA\W -‘c :st 'T . “2“4— \‘4 C .4 o o I g "Q I H u - F) p— : C "" #- O‘AP) \aAo—t *OHO GDFOC‘ €050 ~70}: LI) 0 I“ 0 O 0 II M “C. “Q. rf‘v-Q hAo—l FIND [“703 TVJC‘ HO;:) f“ O \D 0 O 0 1| ll '0‘9 Naif? P’T'JTU‘ Q'Pfl') CFJH 3(3)"i o-4 o N o C O H II “CL “CL Qnfi Ina—a .VPH') ,3ch (INC £5qu 5) o q.) o O C H II HQ upQ' N F) L I; '( 1 LL u. i v I : '.. ... ‘ v". v n c.’ rs J: 1.) 3': 1:- -A‘ .1 1‘ \ »\ TOTE wAN whom \L (“[01 F1 0 ll VG. (‘JAQ‘ Q’U'NJO (LCJL) N 0 ll “CL (SA—'4 \Bu): P’TOJCJ KC 0 ll “CL “AN 0 F}: NN—s N o U ”Q. j,t02 tiohit o‘( O a, l l \ A l .25? TOT". DAG“ O'HO U‘K‘J‘: d’ o n “G. U‘ ~04 (‘1 the no (‘Jc L.) o o H “G. DAM ‘Dulo 0‘01?) L") 0 II “C. 10"" u-IF)C.3 01040 U “Q. ‘uAf‘- ‘ '1‘ -’ U; I‘_. H vLl. C03 3‘ "a A¢ Lbi-la Hi. 55‘ hUTl I") AN SHE] Q‘ (Mr; H vr --0 A C3 \- LL‘ ‘L‘ N‘VJf.) H v4. oiAo.’ "'UH": wrvfi) I. 0 ll “11 'LAC‘ (“‘03: ‘1. ‘JCJ 3' o U ‘Q. NUT? l \L‘AU’T CF)‘D NCO»: m o u “u. U7“? o—H'H“ r-H‘JD N) 0 ll “0. fine-o N")?! r‘x\.\—'.‘ n “L‘— PFIAv-a Mmu Goblfi) w 0 H “Li. '2 v NUT WAH 3.30) _'. Q'C‘AI‘ h- o H vs. (\Ah JON): ‘.:(J;:r U‘ o O H “CL H U Q NAN) we‘d HRH... \D 0 II P V‘- who-d Etc—h: ”’C‘ls') H “G. r')Av-< 3‘“: 304'?) II “D. ~To~o mom rap-4c: H ”CL LnAu—o U‘C‘JIJ? \L'CJC: 3“ o 0 ll “1 :rnv-q mm: ”(HT-J II “C. NA” 3'“. :7 CAN U‘CJQ HAL"! war/1° #2046 ll “Q. [Can 3"ch "’NC.) 'I) O 33AM) '4‘”: owe K‘- o H "C). TABLE 45 (cont'd.) NUTl CBS SUP3 FAHI FAVE PAP! C01 SUP2 SUPI (V’U‘ \Omv-a HNO 4: O H ~0- WAC»: Own: CL (\J') O o M “Q Who-I G'an' LUNG P) 0 New HIW‘C F.‘°j“; ll “Q wen» FIRM 1.110401 M “Q Haw 10"”.(‘1 \UNN H o iti‘ttu'. ( P: SUPl sud-cu amen: FWD N 0 II “a. HAP. "PUG-3 .‘nsc n O H “0. CAN NUT»? “MAID IO 0 II “G. 435% mu!“ 0‘04: ’34 o "A!“ C". P1 (.04? n 0 v0 NAM) ("Jb‘IN‘I Y‘ND f“) 0 “Q f‘Ji-(‘J CUT-1!" ONO u") 0 M “Q (.3 ) [Dz-titti- ( IODUU L U Eco—”4 '3U.q- LUNA-‘54 F) 0 “Q SUPZ woo-u,” carom ON¢ O O M “Q WAN MMJ' INN—1 0; o u “0. FAQ “I O U‘AU‘ CF H“ (DCJH (‘J 0 NAN (turn-I C 01:: Fl 0 II “C. “Ag“. VIN)(\4 \J‘N‘V r4 ' O H “0. SUP3 “an”, 'WU‘FO PINC’ 0 0 I5 “Q man... HF?” scww M “Q O‘RG' U‘LD—c nwc c o It V0. CLAN) C.u' :2: .;;uar) 3 a I! “0. TA.) ¢r0r~ run: a r it) ( .p: 1.1.3:.0 goo... ( p NA!!!) (‘JLN‘I NCUJ h) o H “k. OJAu) R "IN ILNN H “LL FAMl HAP) gnu {sub ’27th N o M “0.. \DAN IDU‘MO HG; C.‘ F) o M “Q (DAN) C If?) than: A a ll “Q FOAM ail-)4 COAL) .076.) \J NCJN '- 0 II “C. VVAC‘ C-afiln NN.” o o n “Q HAH- 4'4”“ cmo r": o H “d. (‘JAW mulw FICON '4 O M “Q FAHZ NINE H00 MN? 0 0 II “D. [Oh—4 VF)” U‘OJO If) 0 II “a. 1050‘ «HON Owe ¢ 0 II “Q gno-q -.‘.‘r’)