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Early childhood intervention in the
communityfindings from ourthree year collaborative study
Fleur Macqueen Smith, MA
Knowledge Transfer Manager, Healthy Children Research Team
Saskatchewan Population Health and Evaluation Research Unit
(University of Saskatchewan office)
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Background KidsFirst:provincial government early
childhood intervention programestablished in 2002
nine program sites in Saskatchewan uses intensive home visiting model
promotes healthy development connects families to existing
services, advocates for services
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Meadow
LakeNipawin
North
BattlefordMoose Jaw
Yorkton
Selectedneighbourhoods in:
Saskatoon
Regina
Prince Albert
All of Northern
Saskatchewan
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www.kidskan.ca/kidsfirst
clients enter the program duringpregnancy or after birth of a child
factors determining eligibility include lowmaternal education levels, mental health
issues, financial instability, substance
issues
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www.kidskan.ca/kidsfirst
Lay home visitors support families by:
informally teaching parenting and life skills
(using Growing Great Kids curriculum)
helping them interact with their children
connecting them with otherKidsFirstfamilies
advocating for them with service agencies
connecting families with existing services,
and helping establish needed services
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www.kidskan.ca/kidsfirst
Examples of typical families
Complex-needs: Sarah is an unemployed mother of two. She hasFASD, a history of drug addiction, and her children have been
apprehended once. Her boyfriend is occasionally abusive. Her
children have FASD and developmental disorders.
Intermediate needs: Patricia is a single mother of three who hasfinished high school and works part-time. She joined KidsFirsttohelp with her postpartum depression
Low-needs: Cecilia has a one-year old. She is unemployed butupgrading her high school as she wants to go to nursing school. She
lives with her boyfriend Kurt. Sometimes they struggle with money,
but they always pay bills and can buy groceries. They also have a
car so transportation isnt a problem.
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www.kidskan.ca/kidsfirst
Immigrant families: Thiri is originally from Burma and came toSaskatchewan when first pregnant. Her home visitor took her to the
hospital and stayed with her when her son was born and helped her
register for English classes. She also connected her to a settlement
agency, where Thiri has made friends.
Northern families: June has lived in northern Saskatchewan all herlife. Her parents were in a residential school, and she had her first
child at 16. She has had three more children since then. Her homevisitor helped her leave an abusive relationship. She would like to go
back to school but is staying at home with her kids for now. She is
learning parenting skills, and notices herKidsFirstbabies seem
more contented.
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KidsFirstevaluation focuses on child development in
vulnerable families
integrates findings from multiple methods
is driven by clear framework developed
with program staff
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Evaluation development initially government unit responsible for
KidsFirstapproached SPHERU with someevaluation funds
SPHERU researchers secured additional
peer-reviewed funding from the Canadian
Population Health Initiative (2007-2010)
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www.kidskan.ca/kidsfirst
Integrated knowledgetranslation
decision makers involved from the outset research team included researchers from
various disciplines, government decisionmakers
program managers were collaborators with
whom researchers interacted frequently
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www.kidskan.ca/kidsfirst
KFResearch
Questions
WhateffecthasKidsFirsthadonparticipatingparentsand
children?
1.Arethereimprovementsinperinatal andearlychildhood
healthoutcomesforchildrenparticipatinginKidsFirst?
2.Do
children
involved
in
KidsFirstfare
better
in
terms
of
early
developmentaloutcomes?
3.DoesKidsFirst increaseparentsconfidenceandknowledge
andenhance
the
quality
of
parent
child
interactions?
4.HowhasKidsFirst producedtheseimprovements?Whatsite
specificprocesses,practices,andpoliciesappearto
contribute mostto
positive
short
term
outcomes?
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www.kidskan.ca/kidsfirst
Phase 1 Foundational work Evaluation framework,
including programlogic model,
developed withprogram managers
linked program
operation, objectives
to theory in a
background paper
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Program Component Home VisitingProgram Goals
ProgramComponent
s
Component
Objective
KeyActivities
Short-term
OutcomesFamily
Engage families in home visitingprogramEstablish a trusting & nurturingrelationship with familyWork with families to identify
strengths, resources, and neededsupportsAssist families to set goals andidentify steps to achieve goalsDevelop personalized plans foreligible familiesProvide learning opportunitiesOffer Growing Great KidscurriculumDeliver group programmingProvide emotional and socialsupportAsses family vulnerability on anongoing basisEnsure pregnant women have
access to prenatal nutritionsupplementsModel advocacy skills andadvocate for families
FamilyFamilies accept home visitsand are retained in programFamilies are able to identifytheir own strengths and needsParents have a better
understanding of childrensgrowth and developmentParenting skills/knowledgeare strengthenedFamilies utilize neededresources and supportsSelf-reliance of families isincreasedSocial networks aredeveloped/strengthenedPregnant women identify riskconditions having a potentialhealth impactPrenatal nutritional status isimproved
SystemAdvocate with appropriategovernment agencies
SystemVulnerable families are bettersupportedProvincial policy is informed
KidsFirstfamilies areprovided withintensive supportand mentoring
Casefinding
In-depth FamilyAssessment
Home Visiting
MentalHealth &Addictions Services
EarlyLearning &Child Care
ProgramP
rinciples
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Community profiles
developed with inputfrom program managers
comprehensive homevisiting (HV) literature
review
systematic review of HV
effectiveness
Phase 1 Foundational work
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Mixed Methods quantitative study
analyzed program data,used control group to
analyze vital statisticsand health services data
qualitative study
conducted 84 interviews,
27 focus groups (242
program clients, staff,government officials)
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Methods: Quantitative studies Child health:
Saskatchewan administrative health data
Comparison group In-Hospital Birth
Questionnaire data (with score 9) Family functioning:
Family assessment tool
In-depth Assessment and Ongoing Assessments
Child development:
Ages and Stages Questionnaires
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N=3779 families Primary caregivers mostly female (98%)
Age of caregiver at enrolment Mostly in teens (28%) and twenties (55%)
Education of caregiver 55% had not completed high school
Methods: Quantitative studiesProgram management data
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Methods: Qualitative study
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www.kidskan.ca/kidsfirst
What the Evaluation FoundImprovements in risk conditions within the first
six months for families withoutcomplex needsin all eight areas measured:
availability of social supports
food security
expectations of child
parent motivation
family identity and interactions
living conditions
housing suitability
housing stability
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www.kidskan.ca/kidsfirst
Families with complex needs* haddecreased risk scores in only two
categories:
availability of social supports
food security
* challenges with domestic violence, mental illness,substance abuse, extreme parenting stress
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www.kidskan.ca/kidsfirst
The percentage of woman who enrolled in the
program during their prenatal period grewfrom 15% in the first years of the program (2002,
2003) to 35-40% in more recent years
demonstrated community acceptance of
program, improved outreach to vulnerablefamilies during a critical time in their lives
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www.kidskan.ca/kidsfirst
84% of children had at least onedevelopmental screen (Ages and Stages
Questionnaire, ASQ-SE) within the firstyear of life.
According to the ASQ, most of the
children appear to be developing
normally. However, there was norelationship found between families length
of enrolment in KidsFirstand their ASQscores.
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No differences in adverse outcomes at
birth between KidsFirstchildren and
comparison children
Children in the program had fewer well-child physician visits (regular checkups)
than children from a comparison grouphad during their first 13 months of life.
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KidsFirstchildren had relatively fewerphysician visits for perinatal conditions
such as jaundice
but more hospital visits for respiratory
conditions and more physician visits forinfectious diseases than comparison
children had
also, many KidsFirstfamilies do not havea regular family physician
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www.kidskan.ca/kidsfirst
From Qualitative Findings Improved prenatal/parenting knowledge
and practices
Better parent-child interaction
Greater assertiveness and self-confidence
More reaching out, accessing services
Reduced smoking, quit drinking or
addressed addictions issues Made gains in personal development, life
skills, and other areas
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Before KidsFirst, if I had a problem, Idrather run away from it than deal with it.But now I just feel like, okay. Now Ithink, How am I going to deal with it?
Ill kind of cool myself down, and thenIll deal with it, or talk to this personabout it, or talk to my kids about it.
parent
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www.kidskan.ca/kidsfirst
Some KidsFirst families that haveparticipated in different programs that I am
involved in have developed such goodskills that they are networking away from
here with each other. They providetransportation for each other; they helpwith child care for each other; they invite
other families to their [kids] birthdayparties.
program staff member
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Parents have more realistic expectationsabout what their children can do for theirage, probably more awareness of healthand safety, and more knowledge of child
development home visitor
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Challenges
families with the most complex needswere the ones least likely to stay in
program
home visitors found they were helping
families in moments of crisis, not providing
regular program support
home visitors felt they did not have
enough time with some families
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www.kidskan.ca/kidsfirst
low pay, safety concerns at some homes makehome visiting challenging
turnover of home visitors undermines families
trust in the program
challenges with programs computerized data
management system confusion about roles, overlap with Social
Services
cultural challenges, especially with residentialschool legacy
challenges with service acccess, family andcommunity poverty
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www.kidskan.ca/kidsfirst
14 recommendations developed, refinedin day-long stakeholder consultation
intake should focus more on increasing prenatal
recruitment, particularly in sites with relatively low
prenatal recruitment
parents should be encouraged to take their children for
well-child visits within the first vear, possibly through new
partnerships with medical clinics or public health
services
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www.kidskan.ca/kidsfirst
families with complex needs should be offered a
modified (specialized) program involving specialized
home visitors
working with appropriate agencies, increased effortshould be made to help families find suitable, affordable
and safe housing
a thorough review of all existing data and collection
procedures should be undertaken in order to enhance
data quality, reliability, completeness, and relevance
the database used to collect data should be reviewed
and adjusted to reflect the needs of all user groups, and
more training on its use provided
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www.kidskan.ca/kidsfirst
the Growing Great Kids curriculum should be evaluatedto see whether it was presented, received, learned, and
implemented
children screened and referred for additional psycho-educational assessment and/or interventions should be
followed and their outcomes recorded
the intensity of services provided in the first year should
increase
targeted area restrictions should be reviewed andupdated or eliminated
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www.kidskan.ca/kidsfirst
guidelines on the roles of various agencies and staffmembers who are involved in KidsFirstprogrammingshould be better defined
community agencies should be encouraged to share
information in an effort to streamline case management
families should be encouraged to progress through the
participation levels within the program, taking into
consideration their particular situation
efforts to retain home visitors should be increased
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KT Activities used integrated knowledge translation
knowledge from evaluation shared inpresentations throughout project
produced 7 public reports, and site-specific reports for each site (16 in all)
presented findings to 90+ stakeholders at
provincial meeting
www.kidskan.ca(select KidsFirst from projects menu)
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www.kidskan.ca/kidsfirst
produced seven fact sheets on the
evaluation: overall findings, process,literature review on home visiting
effectiveness, challenges such as staff
training, housing produced short video to introduce
evaluation and share KT products wrote several KT cases for publications
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Challenges geographic distances separating partners
partners differing views of the research
concerted effort needed to maintain contact,
diligence to avoid misunderstanding
good faith needed to work through issues
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Impact despite high level of decision maker-
researcher interactions, difficult to know if
results will produce large-scale policy
change more likely to encourage changes in
community practices, small-scale policychange
researchers situated between local
program staff, provincial officials
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www.kidskan.ca/kidsfirst
Implications
community-based intervention research
can be a unifying process
ideal partners are those who are
committed to participating fully early instudy, committed to acting on evidence
research needs to be both highly valid,highly policy relevant to maximize impact
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Finallywhile working this way is much harder
than conducting researcher-driven studies,it can be more energizing, and more likely
to make a difference
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AcknowledgementsResearch TeamNazeem Muhajarine Community Health and Epidemiology, U of S
Gail Russell Early Childhood Development Unit, Ministry of Education
David Rosenbluth Research & Evaluation Branch, Ministry of Social Services
Angela Bowen Nursing, U of SJody Glacken Community Health and Epidemiology, U of S
Kathryn Green Community Health and Epidemiology, U of S
Bonnie Jeffery Social Work, U of R
Fleur Macqueen Smith Saskatchewan Population Health & Evaluation Research UnitThomas McIntosh Political Science, U of R
Darren Nickel Saskatchewan Population Health & Evaluation Research Unit
Nazmi Sari Economics, U of S
Early Childhood Development Unit staff
KidsFirstProgram Managers and staff, and parents
Government of Saskatchewan, Inter-Ministerial Committee
Funders
Canadian Institute for Health Information-Canadian Population Health InitiativeGovernment of Saskatchewan
MITACS; College of Medicine
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For more information:
download KidsFirst reports from
www.kidskan.ca/kidsfirst