Exploring the Effects of Multi-Level Protective and Risk Factors on Child and Parenting Outcomes in Families Participating in Healthy Start/Healthy Families Oregon (HS/HFO)

摘要

While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy Families Oregon (HS/HFO) home visitation program (treatment group) who completed a follow-up phone survey at the child’s 12 month birthday (n = 405). Families were offered HS/HFO services prenatally after meeting risk screening eligibility criteria on the New Baby Questionnaire (NBQ). Program mothers having received at least one home visit (n = 248) were included in the final analyses. Families had an average of 3.1 (SD = 1.2) NBQ risk factors at enrollment and 83% reported having trouble paying for basic needs. Families received an average of 16 home visits in the first 6 months of the program. Thirty-one percent of mothers were aged 19 or younger, 60% were White and Non-Hispanic, 31% were Hispanic, and 9% were another race/ethnicity. Hierarchical regression models with main effects (RFI, PFI, race) and an interaction term (RFI X PFI) were developed to predict eight outcomes. Interaction effects models were not significant. Five RFI main effects were significant: higher RFI scores were associated with greater likelihood of child welfare involvement, greater parenting stress, less favorable scores on child health and well-being, lower parent responsiveness and ii acceptance, and less supportive learning environments. One PFI main effect was significant: higher PFI scores predicted lower parenting stress. A trend level result showed higher PFI scores were associated with less child welfare involvement. Race was significant in two models: White/Non-Hispanic families were more likely to have a home visitor report child welfare involvement and had more frequent parent-child activities compared to other race/ethnicity families. Unpacking the results with separate single risk factor (12 items) and protective factor (10 items) regression models followed. Results showed parent’s prior family history of maltreatment and younger maternal age predicted child welfare involvement (home visitor report), while protection was seen for those with access to housing support. Social support and family functioning protectors were linked to lower parenting stress, while maternal depression showed the opposite finding. Better scores on a child health and well-being measure were seen with higher neighborhood cohesion and greater participation in HS/HFO; in contrast, neighborhood violence and frequent mobility were linked to worse scores. Developmentally supportive home environments were seen for families participating in additional parent support programs, in which the mother had greater knowledge of infant milestones and behavior, and if the family had access to housing supports. Unemployment proved to be associated with less enriched home environments. In summary, there was no support for the cumulative PFI in buffering risk for negative outcomes in this model. The RFI was also a more robust predictor of outcomes compared to the PFI in the main effects models. Overall, study findings provide some evidence for the utility of specific protective factors, as well as cumulative and specific single risk factors, for screening families for effectively targeting services and guiding the conceptual development of program and evaluation formats.