With All Families: Parents

With All Families: Parents brings together evidence-based and research-informed best practices to holistically create change in parenting skills and in the family’s overall functioning. Initial screenings first identify areas of concern related to self-sufficiency and family functioning. Parent coaching then provides 1:1 individualized support to help connect participants with needed resources, support the setting and achievement of goals related to social and economic self-sufficiency, and provide additional support and accountability for enhancing family protective factors.

These practices (screenings, coaching) are described below.

Screenings: Following a referral from the pediatrician’s office, the parent complete several screening tools to assess child welfare risk factors, such as adverse childhood events (ACEs), food/financial insecurity, harsh discipline, and parental stress. These screening tools are subsequently completed every three months to assess progress in needed areas.

Natural Strength ParentingTM Coaching: This Beech Acres coaching model is a collaborative, client-centered coaching process that helps parents navigate everyday challenges. The coaching process supports parents in reducing and/or preventing toxic stress within their family, as well as helping their children develop critical life skills and coping skills needed for them to thrive. The coaching approach and philosophy is rooted within the Natural Strength ParentingTM framework, which draws on ideas from social cognitive theory (e.g., goal-setting and monitoring and self-efficacy) and positive psychology (e.g., mindfulness and strengths) to develop a coaching model within which clients are active collaborators in their goal-setting and behavior change process.

Coaching uses the goal planning and setting, ongoing self-monitoring and goal review, benchmarking, and behavior change through development of strengths and skills. Coaching focuses on enhancing parenting skills and ensuring family economic self-sufficiency. The process is culturally sensitive to individuals who are non-majority as well as those who are economically disadvantaged. Coaches and participants collaboratively identify goals based on participants’ self-identified needs, helping participants build and expand on the competencies most relevant and significant for them. As part of coaching, staff support the family overcoming any barriers to obtaining any needed resources, benefits, treatment, or services.

The goal of With All Families: Parents is to support pediatric care visits and improve child welfare by using screening tools and individual parent coaching to identify and address social determinants of health. Specific program objectives are to improve family functioning generally while specifically focusing on improving protective factors and economic-self-sufficiency. As part of the program, staff also work with families to increase parent concrete support and connect parents to needed physical health, behavior health, and educational resources for their child.

Research supports the benefits of using the strategies employed by With All Families: Parents (i.e., screening, resource navigation, and parent coaching) to improve family welfare by addressing underlying risk factors related to poverty and access to resources. For example, programs designed to provide screening and resource navigation support are associated with reduced social needs, improved child health and decreased child hospitalization visits. In light of evidence suggesting that social factors may in fact play a larger role in determining one’s health than medical care, programs that target these social factors, such as With All Families: Parents, are becoming increasingly important.

References
Garg, A., Toy, S., Tripodis, Y., Silverstein, M., & Freeman, E. (2015). Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics, 135(2), e296-e304.

Gottlieb, L. M., Hessler, D., Long, D., Laves, E., Burns, A. R., Amaya, A., ... & Adler, N. E. (2016). Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA pediatrics, 170(11), e162521-e162521.

Pantell, M. S., Hessler, D., Long, D., Alqassari, M., Schudel, C., Laves, E., ... & Gottlieb, L. M. (2020). Effects of in-person navigation to address family social needs on child health care utilization: a randomized clinical trial. JAMA network open, 3(6), e206445-e206445.

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.

The With All Families: Parents program was evaluated using pre-test and post-test measures of family protective factors and social/economic self-sufficiency.

The Arizona Self-Sufficiency Matrix was used to assess family economic and social self-sufficiency. Paired t-tests were conducted comparing number of domains in crisis or vulnerable at intake versus follow-up for two groups: all participants for whom pre- and post-test scores were available (Group One), and individuals with one or more domains in crisis or vulnerable status at intake (Group Two). Comparison of the average number of at-risk domains (identified as “In Crisis” or “Vulnerable”) showed statistically significant reductions between intake and follow-up for both groups:

Group One (N = 58): Percent who improved: 43.1%. Mean number of at-risk domains at baseline (1.22) and follow-up (0.05), p<.0001.
Group Two (N = 25): Percent who improved: 100.0%. Mean number of at-risk domains at baseline (2.84) and follow-up (0.08), p<.0001.

Clients showed improvement on the Arizona Self-Sufficiency Matrix, regardless of at-risk status at intake or as a function of average score across domains. For both groups, over half of clients showed improvement from first administration to follow-up.

The Protective Factors Scale was used to assess the family protective factors that reduce negative outcomes for children. Paired t-tests were conducted comparing mean scores at intake and follow-up (N = 40). Results were as follows for the protective factors subscales:

Family functioning: Percent who improved: 82.5%. Mean score at baseline (3.98) and follow-up (5.30), p<.001.
Social Support: Percent who improved: 72.5%. Mean score at baseline (4.03) and follow-up (5.23), p<.001.
Concrete Support: Percent who improved: 70.0%. Mean score at baseline (4.98) and follow-up (6.33), p<.001.
Nurturing and Attachment: Percent who improved: 52.5%. Mean score at baseline (5.60) and follow-up (6.18), p<.001.

Clients showed statistically significant improvements in family functioning and nurturing and attachment, with approximately one-half to over three-quarters of participants showing improvement on each subscale.