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In early 2002, the Center for Child and Family Policy, in partnership with the Center for Child and Family Health North Carolina, launched an ambitious initiative to promote healthy parent-child relationships and the health and well being of children in Durham, North Carolina. One of the core goals of this initiative is to reduce child-abuse rates in Durham through a comprehensive community and family-based approach. The initiative is supported by the Duke Endowment as part of its effort to enhance the welfare of North Carolina's children.
The premises of the Durham Family Initiative (DFI) are that child maltreatment occurs within the context of the parent-child relationship, which is strengthened or impaired by the ecological context in which it is embedded. Family supports, professional services, neighborhood social capital, and community leaders and policies all play a role in affecting what happens in the parent-child relationship. The work of the DFI is directed toward strengthening the people and institutions that support parents.
Outcome evaluations have revealed a very favorable impact of the DFI on countywide rates of substantiated child maltreatment. Since the start of the DFI, this rate has decreased in Durham by 37 percent, whereas the decrease in the five comparison counties has been only 14 percent and in the state of North Carolina as a whole, 21 percent. Among children aged 0-6, which has been the focus of the DFI, the impact has been even more favorable: the rate of substantiated maltreatment has decreased in Durham by 41 percent, in comparison with 14 percent for the five comparison counties and 19 percent for the state as a whole.
During the past year, 2006, the emphasis of the DFI has been on implementing several protocols, including home-visiting for high-risk mothers; professional therapy for families in which child maltreatment has already occurred; enhancement of social support for mothers of toddlers; neighborhood development; and systems capacity building. Brief summaries of these interventions follow:
• The Home-Visiting protocol, Healthy Families Durham, uses professional family support workers (as opposed to paraprofessionals) and has a manualized approach based largely on the Parents As Teachers curriculum. Family support workers strive to support parents using activities that promote child development, health and safety, and attachment. This intervention is targeted toward pregnant women at high risk for maltreatment due to inadequate social support, stress, or other risk factors.
• The Parent-Child Support Program is targeted toward families referred by the Division of Social Services due to an allegation or substantiation for past maltreatment. The goal is to prevent recurrence of maltreatment by strengthening the parent-child relationship in professional therapy. Depending on the age of the child, we are using one of the following approaches. Child Health and Safety is a 16-week home-based intervention appropriate for families with a child from birth through six years. The protocol utilizes John R. Lutzker's model, Reducing Child Maltreatment: A Guidebook for Parent Service. Promoting Early Relationships intervention, developed internally and based largely on the Circle of Security model, is a 16-session written treatment protocol for children birth -2 ½ years. The intervention targets two aspects of parenting: (1) learning how to read and respond to a child's cues and (2) recognizing and reducing parental stress while caring for the child. Parent-Child Interaction Therapy (PCIT) is a 16-session evidence-based model with specified step-by-step, live-coached sessions with parent/child dyads. PCIT is targeted to children 2 ½ to 6 years in this study.
• The Neighborhood Development intervention has been completed as planned at the end of 2006. The goal of this intervention was to improve the social capital of neighborhoods by placing a community partner in the neighborhood to strengthen institutions and recruit indigenous involvement. Anecdotal reports from the neighborhoods have been favorable, but analyses of official maltreatment rates as well as neighborhood surveys have not revealed favorable outcomes. Additional evaluation of the neighborhood development will be conducted in 2007 and the decision of whether to continue this endeavor in new neighborhoods and/or with a new format will be made before the end of 2007.
• The Social Support intervention was designed to reach out to mothers of one- to three-year-old children in high-risk neighborhoods, to assess their parenting needs in areas of health care, tangible support, parenting advice, planned and emergency respite, and to help them find ways to fill their needs. Although mothers responded positively to this intervention, a significant challenge was reaching our recruitment goal in locating families with children in the specified age range. The intervention has been suspended as a protocol but will become part of the new plan for 2007.
• The Prenatal Screening protocol attempts to systematically identify all women at two OB clinics serving the largest numbers of low-income pregnant women to screen them for risk factors for maltreatment, thereby provide information needed to match these women to appropriate services. This protocol has been a strong success in that screening has become standard practice with these women. We will expand this protocol to all pregnant women in the community of Durham, beginning in July 2007.
• Systems Capacity building continues to be a necessary component. Its focus is on the development of the collaborative management structures and processes to integrate local prevention and intervention services with a network of neighborhood supports and community resources. The goal of this integrated, comprehensive approach will give families what they need when they need it to support the healthy development of their children, thereby developing a “culture of care” for all children and families. Community agency leaders meet regularly and have implemented the System of Care. This program received a national award, the Excellence in Community Collaboration (2006) from the National Council for Community Behavioral Healthcare. This effort will continue in 2007 with a new focus on the first year of life.
• The goals for the policy component of the DFI are to improve and increase the number of guidelines at federal, state, local, and private levels that support families' access to services; increase funding for prevention and early intervention services; increase collaboration among child-serving agencies; and increase use of policies at federal, state, local and private levels that improve parenting. This past year, the policy interventions have focused at the state level, including involvement in child maltreatment prevention committees and supporting the drafting of certain legislation. These new pieces of law require the use of Child and Family Teams and the principles of System of Care in schools to address children at-risk for academic failure; and establishes the requirement that the System of Care principles, values, and practices are used in the public agencies which are serving children at-risk for out-of-home placement. In 2007, the major focus will be on bringing policy reform to allow financing of prevention activities, including home visiting for high-risk mothers.
• Social marketing was piloted in 2006 through a contract with MEE Productions. The social marketing campaign was designed to create a new cultural climate in Durham that: reduces the social stigma associated with participation in parent support programs and activities; supports immediate family members, friends and neighbors to be re-engaged in helping one another proactively; and encourages professional service providers (including medical professionals) to better anticipate and meet the needs of parents of young children. It revealed the depth of needs among Durham's low-income mothers and led to a pilot intervention called "Days of Pampering." Future efforts will emphasize the dual goal of "Help giving and help receiving" for mothers.
The DFI will build on the intervention activities of the past several years and the conceptual model that we have formulated to bring the intervention to community-wide scale in a systematic way for all new births beginning in July 2007. The goal of this exciting and challenging program will be to prevent official and real child maltreatment in each annual cohort of births.
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