Phase II Final Report: Parent Education for Parents who have Cognitive Limitations, Page 2
| Parent has child aged 3 ? 6 Parent has no regular high school diploma (GED and modified diploma are ok) Parent has history of difficulty in school (originates before age 18). At least one of the following examples must be present:
|
At Time 1 (T1), PMs completed a baseline assessment consisting of a demographic information, a brief test of their knowledge, skills and confidence related to working with parents with cognitive limitations, information about the quantity and quality of support offered to the participating parent, ratings of their relationship with the parent, and ratings of the parent's skills in three of the six content areas (see attached instruments). Program materials were then mailed to professionals. PMs were asked to use three of the six modules with parents over a period of 12 weeks, allowing time between each module for the PM to work with the parent on the skills presented. Before and after each module was used, the PM collected information about the parents' knowledge and skills in the topic area. At Time 2 (T2), approximately 12 weeks after program materials were delivered, outcome assessments were conducted with professionals. The outcome assessment included the same instruments administered at T1 in addition to a consumer acceptance/satisfaction questionnaire that we developed to gain information about the PMs' perceptions of program usefulness and quality. Throughout the study, we also monitored PM's use of the online training assets by tracking the number of times participants in both groups visited the training website.
Study Instruments
Table 1 shows measures used in the evaluation study. As noted above, the project evaluation focused on four major outcomes: 1) increasing professionals' knowledge, skills and confidence related to working with parents with cognitive limitations, 2) increasing the quantity of support offered by professionals to the targeted parents, 3) improving the quality of the relationship between professionals and targeted parents, and 4) improving parents' skills in the targeted content areas. We also assessed parent and PM demographic information, and we collected consumer satisfaction/acceptance information from the PM and information about the PMs amount and length of exposure to the web assets.
Professional and Parent Demographics. This section consisted of the demographic questions developed for parents and professionals in Phase I. Items gathered relevant background information about the professional such as gender, ethnicity, race, age, educational background, years of experience in the field, size of caseload and how long they have known the participating parent(s). Items for parent demographics included gender, ethnicity, race, age, educational background, employment status, number of children, ages and genders of children, and family makeup (e.g., single parent mother, single parent father, two-parent family).
| Measure | Description | Citation | Use(Pre, Post) | Informant |
|---|---|---|---|---|
| Eligibility screen | See screen | In house | Screening | Mentor |
| Demographics | Age, Gender, Race/Ethnicity, SES, Education Level, Age of Child | In house | Pre | Mentor |
| Knowledge | Mentor's perceived knowledge about working with, identifying parents who have ID | Pre, Post | Mentor | |
| Self-Efficacy | Scales on menntor's sens of efficacy in working with the parent | In house | Pre, Post | |
| System Usability Self-report Scale | 8-item adaptation of System Usability Scale (SUS) | Brooke (1996) | Post | Mentor |
| Behavioral intention to use skills learned in program | Follows efficacy scales | In house | Post | Mentor |
| Consumer Satisfaction | Scales include: Usage, Interest, Comprehensibility, Acceptability, Persuasiveness and Comprehensiveness | In house | Post | Mentor |
| Frequency of contact with parent | Professionals will report on a) their average frequency of contact with the parent, b) how frequently they've visited and called the parent in the preceding month and c) approximately how long each contact lasted. | In house | Pre, Post | Mentor |
| Perceptions of relationship with parent | All items will be Likert-type ratings scales | Modified Penn Therapist Facilitating Behaviors scale (Luborsky, et al. 1985) | Pre, Post | Mentor |
| Parent Skills Assessment | 5-item Likert scale for each module. Pre, Post, and retrospective pre report on mentor preception of change in parent's skills within the topic domain relevant to the themes contained within each module | In house | Pre, Post | Mentor |
| Program Usage | Questions ask about the SSP's use of program components | In house | Post | Mentor |
Professional's knowledge, skills and confidence related to working with parents with ID
For a previous, related project (Working with Parents who have Cognitive Limitations) we developed instruments to measure knowledge and skills related to working with parents with ID for social workers. Test-retest reliability for the teacher instrument was .89. We used items from those previously developed instruments to construct a brief test of knowledge and skills for the professionals in this project. Professional's confidence was measured with Likert-type items asking them to rate their levels of comfort and confidence when working, in general, with parents who have ID and specifically with the targeted parent. Sample items might be: "How confident are you in your ability to: communicate with this parent, to understand the needs of parents with cognitive limitations, to establish rapport with this parent, etc."
Quantity of support offered to participating parent
Items in this section of the questionnaire asked professionals to report on a) their average frequency of contact with the parent, b) how frequently they've visited and called the parent in the preceding month and c) approximately how long each contact lasted.
Quality of relationship between professional and parent
This section was developed by modifying questions from the Penn Therapist Facilitating Behaviors scale (Luborsky, L., McLellan, T., Woody, G., O'Brien, C., & Auerbach, A., 1985) and creating new items derived from comments made by PMs in Phase I. All items were Likert-type ratings scales. Sample items include: I believe I am helping this parent, I feel that I am working together with the parent in a joint effort, I believe the parent and I have similar ideas about his/her strengths and challenges in parenting skills, I feel this parent trusts me, I believe this parent is honest with me.
Ratings of parent's skills in the five content areas
As noted earlier, we developed an assessment for PMs to use in evaluating parent competencies in the five topic areas, including: Setting up a bedtime routine (Ready for Bed), morning routine (Ready for School), courtesy, affection and manners (Ready to Get Along), emergent literacy (Ready to Read), and parent-child play (Ready to Play). This assessment was also used as a pre-post instrument. PM's completed the assessment before and approximately one week after reviewing the module with the parent.
User acceptance/satisfaction
Consisted of approximately 15-20 items, both open-ended and Likert-type questions to obtain both quantitative and qualitative evaluations of the program and of each module.
Hypotheses
We had five primary research hypotheses:- Parents would have a significant increase in one or more of the targeted parenting skills between T1 and T2.
- Professionals would significantly increase their knowledge, skills and confidence related to working with parents with ID between T1 and T2.
- Professionals would significantly increase the amount of contact with the targeted parents between T1 and T2.
- Professionals in the Intervention Group would significantly improve their relationship with the targeted parents between T1 and T2.
- Professionals and parents would report high levels of user satisfaction with the materials, e.g. at least 80% will rate the materials at the highest ends of Likert-type scales.
Participants
Of the 221 PMs who accessed the eligibility screening, 59 met the eligibility requirements. The primary reasons for ineligibility were that the parent did not have ID or did not have a child in the specified age range. Thirty-nine PMs consented to be in the project. 31 mentors completed the Time 1 evaluation and 23 of those viewed and completed at least three of the program modules. Given the high rates of attrition that are common in studies with this population, we made special efforts to reach out to and support the participating PMs. We consulted with PMs whenever they had questions about the program or needed assistance. Nineteen mentors completed the Time 2 evaluation. There were a variety of reasons why mentors could no longer continue to participate in the program ? parents had no time, parents were no longer interested, mentor was no longer working with the parent, and the mentor's workplace would not allow the mentor to be part of the program.
PM Demographics. Participating PMs were all female. Sixty-nine percent were Caucasian, 20% were African American, 3% Native Hawaiian, and 3% identified as more than one race. 6% did not report. 10% were Hispanic, 74% non-Hispanic, and 16% did not report. The average number of years that PMs had worked in this area was 10 years and the average caseload was 17 clients. The average amount of time that mentors worked with their clients in their homes was 41%, 23% in their offices, and 21% in and around the community. Fifteen percent worked with their clients on the phone.
The PMs spent 41% of their time teaching clients one-on-one, 8% in classes or groups, 35% in conversations, 8% in support groups, and 14% in other ways. Mentors averaged 31% of their time talking with clients on the phone and 58% talking face-to-face. With respect to their relationship with parents, PMs reported knowing the participating parent for an average of one year and having worked with them for an average of seven months. 41% of mentors had contact with the parent participating in the study at least once per week and 29% of mentors had contact with the parent more than once a week. The average amount of time spent in the parent's home was 51%, 11% in the mentor's office, 11% in and around the community, 14% on the phone, 6% in classes or groups and 5% of the time in other places.
Parent Demographics. Ninety-five percent of participating parents were female. Parents ranged in age from 19 to 50 years, with 26% married and 52% never married. 88% were non-Hispanic, 62% were Caucasian, 28% African American, and 7 % were identified as more than one race. 36% had a modified diploma while 48% reported "other." Seventy-nine percent of parents were not working, while 17% were working part-time. 50% were in a single-mother household, 21% in a two-parent household, and 19% lived with extended family. All parents had help from other adults outside of their home ? parents, partners, other relatives, friends and professionals. Three and four-year-olds olds made up 76% of the "target child" population. 52% of the children were female and 48% male, 83% of parents had one to three other children in the household.
Results
Program efficacy. To test the efficacy of the training program, pre-post paired t-tests were conducted on the three outcome measures: knowledge, self-efficacy, and quality of relationship. Table 3 presents the pretest and posttest means and standard deviations as well as the paired t -test results and effect sizes for the outcome measures. As can be seen, significant effects were obtained on seven of the eight outcome measures; large effect sizes were obtained for each the five skill level ratings (partial point-biserial rs > .77), knowledge (partial point-biserial r = .51), and relationship quality (r = .56). Although not significant, self-efficacy scores changed in the predicted direction (r = .30; medium effect size). Hence, as a result of the on-line training program, PMs improved their knowledge about working with parents who have ID, self-confidence in their ability to work with this population, and perceived quality regarding their relationship with the parent.
Before using each module with parents, PMs also completed online pre and post ratings of their perceptions of parents' skills in the five targeted domains. As seen below, parents significantly improved in each topic area. This was corroborated by the PMs overall: 96% reported that the program had a positive effect parenting in the family. As one PM noted, "The parent was able to recall what we worked on the visit before and retain what was discussed."
| Outcome measure | Pretest | Posttest | t | df | p-value | Effect size | ||
|---|---|---|---|---|---|---|---|---|
| M | SD | M | SD | |||||
| Knowledge | 3.62 | 0.8 | 4.04 | 0.62 | 3.08 | 27 | 0.005 | 0.51 |
| Self-efficacy | 5.44 | 1.26 | 5.78 | 0.87 | 1.63 | 27 | 0.116 | 0.30 |
| Relationship quality | 3.94 | 0.53 | 4.26 | 0.32 | 3.56 | 27 | 0.001 | 0.56 |
| Parent Skill Level: | ||||||||
| Bedtime Routine: Ready for Bed |
3.15 | 1.23 | 5.16 | 0.99 | 7.77 | 20 | <0.001 | 0.87 |
|
Parent-Child Play |
2.78 | 0.87 | 4.37 | 1.51 | 5.39 | 11 | <0.001 | 0.85 |
| Morning Routine Ready for School |
3.49 | 1.24 | 5.12 | 1.17 | 5.94 | 16 | <0.001 | 0.83 |
| Manners, Affection Ready to Get Along |
3.10 | 1.29 | 4.44 | 1.33 | 4.70 | 15 | <0.001 | 0.77 |
| Literacy Activities Ready to Read |
2.75 | 1.09 | 4.82 | 1.22 | 6.28 | 12 | <0.001 | 0.88 |
| Note. Effect size is the partial point-biserial correlation (Rosnow & Rosenthal, 2008, p.391). | ||||||||
Consumer Acceptance/Satisfaction
Overall, Parent Mentors were enthusiastic about the program. PM comments about the program overall are summarized in Table 4. Ninety-six percent of PMs indicated that the program had made their work with the family easier and 100% indicated that the program had improved their relationship with the parent. When asked to describe how the program influenced their relationship with the parent in the family, one PM said, "Although we had a good relationship when starting the program, we enjoyed working on a common goal and appreciated the positive effect it had on the parent-child relationship." Similarly, another PM commented, "I already had a very good relationship with this parent. It made it easier to talk about some of the issues that the parent needed help with. It was a positive way to address the family's needs without sounding judgmental."
| I loved the concepts and presentation. It was simple, clear and fun. |
| I was very impressed with the program overall. I especially liked the way the program broke down individual parenting skills into small steps. I found that the parent could use the program easily because of simple way in which the concepts were shown in the video and the simplicity of the cards and charts. |
| I thought the program was well organized, easy to teach and very attractive and effective for our clients. |
| In my work with the parent, it is difficult to find the time to put into parenting, because there are many other crises occurring on a regular basis. This program forced us to sit down and pay attention to issues that are very important but can be ignored. The parent also really wanted to please me by showing what she had done with her son or what her son had done. |
| It [the program] gave us a common vehicle to express our love for her child in specific ways (ie: trying to find a way to make a bedtime schedule, giving the child positive feedback, saying "I love you). It helped me to see how many positive things she was already doing. It made me think back on my parenting practices and see how I could have been more positive. In giving her examples of where I wish I had been more positive I think it empowered mom more than simply telling her what to do. |
| I thought the program with the DVDs, CDs, Cards and the Fridge Chart were great teaching tools. The Fridge chart served as a reminder to the parent and a great tracking tool for the instructors. The DVD is a good visual aid for role-modeling how to apply the information. Overall, I think this is a great program in which parents with intellectual disabilities can benefit from. |
| Well put together, very carefully explained, to meet the parent's level of understanding. Content was real to life and entertaining for the child and informational for the parent. |
| This is the kind of curriculum that makes learning enjoyable and that also provides good instruction. It is engaging and easy to use. |
| I found the program to be refreshing in the way it is presented. It does not make the parent feel as if they are not adequate, it allows you to take an idea and apply to your situation. Can be used by anyone. |
PMs noted that the program gave an opportunity to talk about parenting. One said, "It opened up more dialogue about parenting issues that come up," and another noted, "This program helped us to work together to build on the parenting skills she already had as well as introduce new ones in a positive way rather than just telling her how to do things better."
The program materials were well-liked by PMs, parents and their children. A PM commented, "The children all loved the DVD and asked to watch it again and again. I think they learned as much from it as the mom did." Another said, "We loved the songs, cards and activities. The father was willing to sing with his daughter." One PM noted that she especially liked the cards, "...the flash cards are an absolute hit!!! What a difference in the learning curve this has made. Thank you." Another PM said that the songs were a good complement to the cards, "The songs are significant as well and for the process of learning, it underscored the lessons learned via the flash cards."
PMs indicated that the program also affected the parents' motivation to work on parenting, "I think that the parent felt more collaborative in that she chose the modules herself and viewed the DVD and other material with me. I think that this improved her motivation to learn because she felt more like an equal part of the skill training," and another said, "The parent appeared more eager for me to come to her home. She was also eager to tell me about the progress she was making on the modules. PMs appreciated the sole focus on parenting issues, "It allowed us to take the focus away from stressful topics like budgeting, and work on something fun." Another said, "The appointment times with the client had an element of "entertainment" that created a pleasant learning environment and generated enthusiasm for the Mother and her children." One-hundred percent of PMs said that the program gave them new ideas about how to work with parents who have ID. One PM commented on how the program helped her see the parent in a new light, "Sunny Side of the Street helped to point out some of the strengths the mother had that I did not notice before."
Finally, ninety percent of PMs agreed that the family situations in the video were realistic. A PM commented, "This is one of the aspects of your program that I particularly liked. The situations were realistic and the appearance of the parents in the videos was realistic. This was critical to parents that sometimes feel ?different.' "Another PM said, "The parent I worked with commented on how much alike the video was to her situation?"
In conclusion, the purpose of this project was to create a parenting program that would flexibly meet the unique needs of this population of parents and professionals. There is a great need for this type of program. Without appropriate support, positive parent and child outcomes in families headed by parents who have ID are limited. To compound the problem, families headed by parents who have ID are involved with many service sectors. These support services are ill-equipped to meet the needs of families. Service providers often lack an understanding of the parent who have ID's needs, have difficulty identifying parents who have ID, lack knowledge about how to best support parents who have ID, and lack curriculum that is appropriate and engaging for this population. Those who support families headed by parents who have ID need a flexible program that they can individualize to meet each family's needs. They also need training in how to identify parents who have ID, in understanding their needs, and in knowing how to best support them. Another important finding was that parents' skills improved in each topic area after working with the PM. The parenting skill topics to be addressed in the project are those considered to be the most needed and effective forms of discipline to teach parents who have ID. We created a flexible parenting program for service providers to use with parents who have ID. Results of the formal evaluation show that Sunny Side of the Street was enthusiastically received by Parent Mentors, parents and their children. The program had important effects on PM attitudes and knowledge, and on parent behavior. Engagement in the program led to PMs increased knowledge and self-efficacy in working with parents who have ID, and significantly improved their relationship with the parent.
Literature Cited
Bandura, A. (1977). Social learning theory. Engelwood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
Berk, L. (2004). Awakening Children's Minds. Oxford University Press.
Coleman, P. K., & Karraker, K. H. (2000). Parenting self-efficacy among mothers of school-age children: Conceptualization, measurement, and correlates. Family Relations, 49, 5-11.
Dumka, L. E., Stoerzinger, H. D., Jackson, K. M., & Roosa, M. W. (1996). Examination of the cross-cultural and cross-language equivalence of the parenting self-agency measure. Family Relations, 45(2), 216-222.
Dowrick, P. W., et al. (1991). Practical guide to using video in the behavioral sciences. New York: Wiley. Dreikurs, R. (1964). Children: The challenge. New York: Plume.
Gordon, D. A. (2000). Parent training via CD-ROM: Using technology to disseminate effective prevention practices. Journal of Primary Prevention, 21(2), 227-251.
Haine, R. A., Sandler, I. N., Wolchik, S. A., Tein, J.-Y., & Dawson-McClure, S. R. (2003). Changing the legacy of divorce: Evidence from prevention programs and future directions. Family Relations, 52, 397-405.
Harwood, R. L., & Weissberg, R. P. (1987). The potential of video in the promotion of social competence in older children and adolescence. Journal of Early Adolescence, 3, 345-363.
Luborsky, L., McLellan, T., Woody, G., O'Brien, C., & Auerbach, A. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602-611.
Olson, D. R., & Bruner, J. S. (1974). Learning through experience and learning through media. In D.R. Olson (Eds.). Media and symbols: The forms of expression, communication, and education. (pp. 125-150). The 73rd Yearbook of the National Society for the Study of Education.: University of Chicago Press.
Rosnow, R. L., & Rosenthal, R. (2008). Assessing the effect size of outcome research. In A. M. Nezu & C. M. Nezu (Eds.), Evidence-based outcome research: A practical guide to conducting randomized controlled trials for psychosocial interventions (pp. 379-401). New York: Oxford University Press.
Vygotsky, L. (1978). Interaction between Learning and Development (pp. 79-91). In Mind in Society. (Trans. M. Cole). Cambridge, MA: Harvard University.
Webster-Stratton, C., & Herbert, M. (1994). Working with parents who have children with conduct disorders: A collaborative process. In Troubled families-Problem children: Working with parents: A collaborative process. (pp. 105-167). Chichester, West Sussex, UK: John Wiley and Sons.
Webster-Stratton, C., Hollingsworth, T., & Kolpacoff, M. (1989). The long-term effectiveness and clinical significance of three cost-effective training programs for families with conduct-problem children. Journal of Consulting and Clinical Psychology, 57, 550-553.
Wisconsin Council on Developmental Disabilities (2004). Cultivating Competence: 2nd Edition: Directory and Resource Guide on Supported Parenting. Retrieved from http://wcdd.org/Publications/ cultivating_competence.pdf
