Evaluation of Family Preservation and Reunification Programs: Final Report - Volume Two. 4.5.3 Family and Child Functioning - Caretaker Interviews

09/01/2002

Life Events. In both the initial and second interviews, caretakers were asked to respond to a 15 item "life events" inventory asking about the occurrence of both positive and negative

events (see Appendix K, Volume 3, Initial Caretaker Interview, p. 7, and Interim Caretaker Interview, p. 8). Three scales were formed from this inventory: positive life events, negative life events, and a scale of those life events that might reflect depression in the caretaker (we had a more formal depression measure as well, described below). In the post-treatment interview, the proportion of positive life events reported by caretakers in the experimental group was significantly higher than the proportion reported by caretakers in the control group (.19 vs. .15; p = .05). (78) The proportion of positive life events reported by caretakers in the experimental group remained higher in the followup interview (.23 vs. .20), however, the difference was not statistically significant. On the measures of negative life events and life events reflecting depression there were no statistically significant differences between the experimental and control groups at the time of the post-treatment or followup interviews. (79)

Problems. In the post-treatment and followup interviews, caretakers were again asked questions about problems in the family. These questions paralleled those asked in the first interview (see Section 4.2.1 Family Problems above, under Section 4.2 The Philadelphia Families), except this time caretakers were asked to respond to questions with regard to the time "since we last spoke to you." Tables 4-21 and 4-22 display these items and the proportion of affirmative responses at the time of the post-treatment and followup interviews. At the time of the post-treatment interview, there were no significant differences between the experimental and control groups responses to any of the nine items about problems in the family. (80) At the time of the followup interview, no significant differences were found on eight of the nine items in the primary analysis. However, on the question about the overall economic condition of the family,

Table 4-20
Philadelphia Family and Child Functioning Scales
    Post-Treatment Followup Multivariate Repeated Measures
N Ma pb N M p N Means Multivariate ps Univariate ps-Time Univariate ps-Grp-time interaction
Initial Post Follow Grpc Timed Time -Grpe Initial
v. laterf
Post
v. Followg
Initial v.
later
Post
v. Follow
Positive life events C 113 .15 .05 90 .20   70 .13 .15 .21   .001   .003 .001    
E 148 .19 135 .23 102 .17 .18 .23
Negative life events C 113 .06   90 .08   70 .13 .11 .14   .02     .03    
E 148 .05 135 .08 102 .10 .09 .12
Life events depression C 113 .38   89 .35   69 .43 .34 .33 .09 .001   .001      
E 148 .41 135 .41 102 .53 .40 .42
Paying bills C 113 .27   90 .21 .08 70 .33 .23 .20   .02   .005      
E 148 .31 134 .28 100 .32 .31 .30
Income support C 113 2.20   90 2.25   70 2.40 2.38 2.43              
E 148 2.22 135 2.14 102 2.24 2.23 2.15
Treatment programs C 113 .36   90 .37   70 .39 .41 .40              
E 148 .37 135 .32 102 .28 .39 .32
Punishment C 112 .16   89 .16   69 .20 .15 .15 .06 .002   .001      
E 148 .19 132 .17 98 .25 .20 .17
Child aggression C 113 1.32   90 1.13   70 1.34 1.30 1.14              
E 148 1.25 135 1.21 102 1.16 1.24 1.24
School problems C 93 .14   80 .16   56 .15 .14 .17         .07    
E 123 .13 116 .17 79 .18 .14 .19
Child withdrawn C 113 .52   90 .42   70 .51 .51 .43              
E 148 .61 135 .54 102 .48 .63 .56
Stolen things or arrested C 113 .20   90 .13 .02 70 .27 .19 .10   .03 .04 .01     .02
E 148 .16 135 .26 102 .26 .18 .27
Child substance abuse C 113 .03   90 .01   70 .03 .01 .01              
E 148 .01 135 .02 102 .00 .00 .03
Child problems C 113 1.59   90 1.68   70 1.61 1.56 1.67              
E 148 1.76 135 1.67 102 1.61 1.84 1.66
Negative child behaviors C 108 .25   88 .22   65 .26 .25 .23              
E 143 .25 131 .25 96 .25 .25 .25
Positive child behaviors C 109 .80   89 .79   66 .78 .79 .79              
E 145 .81 134 .80 97 .81 .81 .79
Household condition C 112 .09   90 .06 .05 69 .12 .08 .06              
E 147 .09 135 .10 101 .10 .10 .10
Depression (SCL-90) C 113 .96   89 .79   69 1.05 .89 .78   .006   .003      
E 148 1.00 135 .83 102 .98 .95 .88
Positive child care practices C 108 .90   87 .91   66 .90 .90 .91              
E 142 .88 129 .88 93 .90 .88 .88
Negative child care practices C 108 .13   86 .13   66 .15 .13 .13     .008     .002  
E 147 .15 130 .15 94 .19 .15 .14
a Means of control and experimental groups
b Test of hypothesis of equivalent group means
c Test of hypothesis that group means, averaged over time, are equal d Test of hypothesis that means at three points in time, averaged over the groups, are equal
e Test of hypothesis of no interaction between group and time, that is, that the pattern of means over time is the same for both groups
f Test of hypothesis that time one is equal to average of time two and time three
g Test of hypothesis that time two is equal to time three
Table 4-21
Philadelphia Caretaker Problems and Strengths, Caretaker Post-treatment Interview (% responding yes)
  Control Experimental p
N % N %
Problems
Felt blue or depressed 113 45 148 43  
Felt nervous or tense 113 43 147 46  
Just wanted to give up 113 22 148 29  
Overwhelmed with work or family responsibility 113 41 146 47  
Felt you had few or no friends 112 22 148 25  
Not enough money for food, rent, or clothing 113 48 148 59 .08
Gotten in trouble with the law 113 2 148 3  
Had too much to drink in a week 112 4 148 2  
Used drugs several times a week 113 8 148 6  
Economic Items
Had difficulty paying rent 113 19 148 20  
Had difficulty paying electric/heat 113 28 148 33  
Had difficulty buying enough food 113 26 148 31  
Had difficulty buying clothes 113 34 148 42  
Positive Items
Have you felt happy 112 83 148 86  
Gotten together with anyone to have fun/relax 113 51 148 53  
Doing a pretty good job raising kids 112 93 148 95  
Table 4-22
Philadelphia Caretaker Problems & Strengths, Caretaker Followup Interview (% responding yes)
  Control Experimental p
N % N %
Problems
Felt blue or depressed 90 46 135 49  
Felt nervous or tense 90 38 135 44  
Just wanted to give up 89 18 135 25  
Overwhelmed with work or family responsibility 89 38 135 46  
Felt you had few or no friends 90 31 135 27  
Not enough money for food, rent, or clothing 90 33 135 49 .02
Gotten in trouble with the law 90 0 135 1  
Had too much to drink in a week 90 3 135 2  
Used drugs several times a week 90 0 135 2  
Economic Items
Had difficulty paying rent 90 18 134 20  
Had difficulty paying electric/heat 90 29 134 29  
Had difficulty buying enough food 90 16 134 27 .05
Had difficulty buying clothes 90 21 134 37 .01
Positive Items
Have you felt happy 89 89 135 90  
Gotten together with anyone to have fun/relax 90 57 135 57  
Doing a pretty good job raising kids 88 97 134 96  

"have you felt you did not have enough money for food, rent, or clothing?" 49 percent of the experimental group and 33 percent of the control group responded affirmatively (p = .02). (81)

In addition to the items about problems, caretakers were asked three questions about positive aspects of their lives: "getting together with anyone to have fun or relax," "felt happy and "felt that considering everything you're doing a pretty good job raising your kids." For the experimental and control groups combined, at post-treatment, 85 percent responded affirmatively to the question of whether they "felt happy," 53 percent responded affirmatively to the question of "getting together with anyone to have fun or relax," and 94 percent responded affirmatively that they were "doing a pretty good job raising [their] kids." At followup, 90 percent of respondents (experimental and control groups combined) reported that they "felt happy," 57 percent responded affirmatively to the question of "getting together with anyone to have fun or relax," and 96 percent reported that they were "doing a pretty good job raising [their] kids." (82)

Economic Functioning. In addition to the general item on not having enough money for food or rent, caretakers were asked four specific questions about difficulties in paying for the essentials of living (rent, electricity and heating, food, and clothing). When these items were combined into a scale, all analyses (primary, secondary, and tertiary) revealed no significant differences in the average proportion of affirmative responses to the four items at the time of the post-treatment interview. At the time of the followup interview, the average proportion of affirmative responses to the four items was greater for the experimental group than the control group (.28 vs. .21) but the difference was not statistically significant in the primary analysis (p = .08). (83) Using repeated measures to look at changes in the scale responses over time, results indicate a decline in the average proportion of affirmative responses to this scale of economic functioning for both groups (p = .02). These changes over time did not differ significantly for the experimental and control groups.

Looking at the 4 individual items that comprised the scale of economic functioning, there were no significant differences between experimental and control groups at the time of the post-treatment interview. At the time of the followup interview, primary analyses revealed significant differences between experimental and control group respondents on 2 of the 4 items. A greater proportion of the experimental group respondents reported having difficulty buying enough food (27% vs. 16%; p = .05), and difficulty buying clothes (37% vs. 21%; p = .01). (84)

Household Condition. Caretakers were asked 10 questions about problematic conditions in the home (e.g., nonfunctioning heating, plumbing, or electrical systems; peeling paint; broken windows or doors). The experimental and control groups did not differ on the average proportions of the presence of such conditions at the time of the post-treatment interview. At the time of the followup interview, the average proportion of problematic conditions present was greater for the experimental group than for the control group (.21 vs. .06; p = .05). Repeated measures analysis revealed no significant changes over time and no significant differences between the two groups averaged over time.

On only one of the specific items regarding problematic conditions in the home were there any differences in the primary analysis of the post-treatment interview. Twenty-three percent of caretakers in the experimental group and 13 percent of the caretakers in the control group reported that "there were not enough basic necessities such as chairs, tables, beds, cribs, mattresses, or not enough basic necessities such as blankets, sheets, pots or dishes" (p = .03). (85)At the time of the followup interview, primary analysis revealed significant differences between the experimental and control group on one of the 10 specific household condition items. Four percent of the experimental group and none of the control group caretakers reported that the electricity did not work for more than a day at a time since the post-treatment interview (Fisher's exact p-value = .05). (86)

Child Care Practices. In both the post-treatment and followup interviews, caretakers were asked a series of yes-no questions about child care practices in the last three months (both positive and negative). The results from these questions are shown in Tables 4-23 and 4-24.

Table 4-23
Philadelphia Caretaker Reports of Child Care Practices, Post-treatment Interview
  Control Experimental p
N % N %
Lost temper when child got on nerves 112 53 148 52  
Found that hitting child was good 112 4 148 6  
Hitting child harder that meant to 112 5 148 11  
Out of control when punishing child 111 18 147 24  
Have you praised your children 112 95 147 98  
Listened to music together w/child 112 95 148 92  
Tied child with cord- string-belt 112 0 147 1  
Gone to amusement park, pool, picnic 111 85 147 77  
Uncomfortable hugging child 105 10 138 13  
Encouraged child to read book 108 98 142 99  
Have children handled household chores 105 76 140 71  
Not let children into the house 105 1 140 1  
Punished for not finishing food 107 6 140 3  
Blamed child w/ things not their fault 107 21 139 22  
Let child to play where not allowed 107 15 139 12  
Unable to find someone to watch children 111 42 144 46  
Table 4-24
Philadelphia Caretaker Reports of Child Care Practices, Followup Interview
  Control Experimental p
N % N %
Lost temper when child got on nerves 89 52 132 44  
Found that hitting child was good 89 6 132 9  
Hitting child harder that meant to 89 4 132 7  
Out of control when punishing child 89 17 132 26  
Have you praised your children 89 99 132 96  
Listened to music together w/child 89 93 132 92  
Tied child with cord- string-belt 89 0 130 0  
Gone to amusement park, pool, picnic 90 79 133 73  
Uncomfortable hugging child 87 10 131 11  
Encouraged child to read book 87 99 129 98  
Have children handled household chores 85 84 128 80  
Not let children into the house 84 1 126 2  
Punished for not finishing food 86 1 130 7 .05 (FE)
Blamed child w/ things not their fault 86 21 130 24  
Let child play where not allowed 86 19 129 16  
Unable to find someone to watch children 88 47 133 33 .04
NOTE: "FE" indicates significance determined by Fisher's exact test

Three scales were formed using items that appear in Tables 4-23 and 4-24: positive child care practices (5 items), negative child care practices (10 items), and punishment (5 items, all of which were also in the negative child care practices scale).

At the time of the post-treatment interview, primary analyses revealed no significant differences between experimental and control groups on any of the items. (87) At followup, a significantly greater proportion of experimental group respondents responded affirmatively that they "punished [child] for not finishing food" (7% vs. 1%; Fisher's exact p-value = .05). (88)

There were no significant differences between the experimental and control groups with regard to the positive and negative child care practice scales at the time of either the post-treatment or the followup interview. At each point in time, caretakers from both groups responded affirmatively to over 80 percent of the positive items and less than 15 percent of the negative items. Repeated measures analyses revealed no significant changes over time in the positive child care practices scale. There was a small but significant decrease in the proportion of negative child care practices and in the proportion of affirmative answers to the punishment items for both groups averaged over time (see Table 4-20 and Figure 4-3). For all scales, there were no significant interactions between group and time variables, indicating that the pattern of means over time was similar for both the experimental and control groups.

Caretaker Depression. In all three interviews, we administered the SCL-90 depression scale to measure the level of depression of the caretaker. (89) There were no differences between the groups in scores on this scale at the time of the post-treatment or followup interview. Results of the repeated measures analysis indicate significant decreases over time in the depression scores for both groups averaged together (see Table 4-20 and Figure 4-3). The pattern of declining depression scores was the same for both the experimental and control group. (90)

Child Behavior. We asked 35 questions about specific child behaviors, both positive and negative. Questions were phrased in terms of "any of the children" and some questions were age specific. Responses to these questions were used to form various scales: aggression (3 items), school problems (5 items), positive child behaviors (10 items), and negative child behaviors (21 items, including the aggression and school problems items). Neither the primary nor the secondary analyses revealed any significant differences between the groups in scores on any of these scales at the time of the post-treatment or followup interviews (see Table 4-20 and Figure 4-3). Furthermore, none of the hypotheses tested in the repeated measures analysis resulted in significant effects for any of the levels of analyses (primary, secondary, or tertiary).

Figure 4-3
Child and Family Functioning Over Time (Families)

Figure 4-3 Child and Family Functioning Over Time (Families)Figure 4-3 Child and Family Functioning Over Time (Families)

Figure 4-3 Child and Family Functioning Over Time (Families)Figure 4-3 Child and Family Functioning Over Time (Families)

Specific items on whether the child was withdrawn, or had engaged in substance abuse also did not reveal significant differences between groups at either point in time (post-treatment or followup) or in any of the analysis (primary, secondary, or tertiary). A scale measuring two items asking whether any of the children had stolen things or been arrested did result in significant differences in the primary analysis of the followup interview and of the effects over time. This scale was calculated by summing the "yes" responses to the two items, resulting in scale scores ranging from 0 to 2. At the time of the followup interview, the scale score was significantly higher for the experimental group than for the control group (.26 vs. .13; p = .02). Repeated measures analysis indicated that the pattern of scores over time was significantly different for the experimental and control groups, particularly in the time period between the post-treatment interview and the followup interview. In the control group, the average score for caretakers responding that their child had stolen things or been arrested consistently declined over time, but in the experimental group, the average score declined between the initial and post-treatment interviews and returned to the original level in the followup interview (see Table 4-20). For further interpretation of these results, scale scores of 1 and 2 were collapsed and Chi-square analyses were used to examine the proportion of caretakers from each group responding affirmatively to either item at each point in time.

At the time of the initial interview, 22 percent of caretakers from both the control and experimental groups reported that their child had stolen things and/or been arrested in the last three months. At the time of the post-treatment interview, 17 percent of caretakers from both the control and the experimental groups reported that their child had stolen things and/or been arrested since the time of the initial interview. At the time of the followup interview, a significantly greater proportion of caretakers from the experimental group reported that their child had stolen things and/or been arrested since the time of the post-treatment interview (24% vs. 13%; p = .04).

Overall Assessment of Improvement by Caretakers. In both the post-treatment and followup interviews, caretakers were asked about general changes in their family lives since entering the study (see Tables 4-25 and 4-26). At the time of the post-treatment interview, 27 percent of experimental group caretakers generally thought there was "great improvement" in

Table 4-25
Philadelphia Caretakers' Assessments of Overall Change
Since First Interview, Post-treatment Interview
  Control
%
Experimental
%
  p = .07
Great improvement 17 27
Some improvement 46 51
Same 27 17
Somewhat or a great deal worse 6 5
Not ascertained 4 1
Table 4-26
Philadelphia Caretakers' Assessments of Overall Change
Since Post-treatment Interview, Followup Interview
  Control
%
Experimental
%
  p = n.s.
Great improvement 38 36
Some improvement 38 40
Same 17 21
Somewhat or a great deal worse 7 4
Not ascertained 1 0

their lives, compared to 17 percent of control group caretakers ( p = .07). (91) When response categories were collapsed to reflect "some or great improvement," things are "just the same," or "somewhat or a great deal worse," a significantly greater proportion of experimental group caretakers reported "some or great improvement" (77% vs. 63%; p = .05). (92)

At the time of the followup interview, slightly more than a third of respondents reported "great improvement" and three quarters of respondents reported "some or great improvement," with no significant differences between the experimental and control groups in any of the levels of analysis (primary, secondary, or tertiary).

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