2011 The Palm Beach County Family Study (Full Report)

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Use of Formal ServicesA central question of the longitudinal study is what formal services are available and used by familieswith young children in the TGAs. Data on service use come from both administrative data records and themothers’ self-reports. This chapter begins with a summary of analyses of information from the FOCiSdatabase about the use of maternal and child health services by mothers in the Palm Beach County 2004–2009 birth cohorts and mothers in the baseline study sample. 40,41 More details of these analyses and datatables can be found in previous study reports (Spielberger et al., 2007, 2009) and in Appendices B and C.We then present findings from the fifth-year interview, in which we asked the mothers to identify a rangeof service areas in which they received help during the previous year.The Maternal Child Health SystemThe Maternal Child Health Partnership (MCHP) is a growing network of integrated and coordinatedprevention and early intervention health and social services for pregnant women who are at risk of poorbirth outcomes and for children from birth to age 5 who are not on target for developmental or healthoutcomes, and who, without the support of the program, may have an increased risk of abuse or neglect ora diminished chance of being ready for school. 42 Focused on improving birth outcomes, reducing childmaltreatment, and promoting early childhood development and readiness to learn, the MCHP system40 Because the year 5 study sample is similar in most respects to the baseline sample (see Table 3), we expect that statistics onuse of maternal and child health services will be very similar for the two samples.41 The FOCiS database replaced the Right Track database as the source of information on mothers served by the maternal childhealth system in November 2007.42 This system has evolved over time. It began as the Healthy Start Coalition in 1992 and later became a larger, more formalsystem called the Maternal Child Family Health Alliance. In 2004, shortly after the start of the longitudinal study, the system wasreconstituted as the Maternal and Child Health Partnership (MCHP). Although the system was renamed Healthy Beginnings in2006, we refer to the system here as “MCHP” because it was in place at the time mothers were recruited for the study. We alsowant to distinguish this system from a new Healthy Beginnings system that formally began in July 2009 and includes some newpolicies and procedures for screening and engaging families in services. Over the period of the study, agencies providing servicesin the system have also changed; some changed their names, whereas others ceased operation or left the system. We did notinclude FOCiS data for these agencies after these dates in counts of services in the system.Chapin Hall at the University of Chicago 85
includes universal risk screening, targeted home visitation programs, and referrals and linkages to a rangeof services within and outside the system. Services also include assistance connecting with a payer sourceand/or medical home, health education/health literacy, identification of and treatment for perinataldepression, nutrition counseling, childbirth and breastfeeding education, and family support servicesranging from telephone counseling to intensive home visiting services. Qualified providers also deliverdevelopmentally appropriate early childhood therapeutic and family supportive services to eligiblefamilies and children birth to age 5 through home visits or consultations at childcare or other clientconvenientlocations. These services include parenting support/education and infant mental health/socialemotionalwellness, including parent/child bonding, family therapy, and early literacy.Early identification is a key preventive service for all pregnant and postnatal women and children birth toage 5. According to a recent description of the MCHP, in the future, the system will include two entryagencies based on assessment information. 43 There were three common entry points to the system duringthe period of this study, however: the Healthy Mothers/Healthy Babies Coalition of Palm Beach County;Healthy Start/Healthy Families; and the Women’s Health Initiative (WHIN). Mothers could enter thesystem prenatally or postnatally based on the Healthy Start Prenatal and Infant Risk Screen or a homeassessment, but a majority of mothers entered through the Healthy Mothers/Healthy Babies Coalition,whose staff of hospital liaisons administered the 10-item Healthy Start Risk Screen to as many newlydelivered mothers as possible. On this instrument, a score of 4 or higher is considered an indicator ofpossible risk, and mothers who scored 4 or higher were encouraged to accept a home visit from a HealthyStart nurse. Mothers who received lower scores were not offered a home visit but could request one. 44Subsequently, in a home visit, mothers were reassessed and identified as having service needs of E, 1, 2,or 3. Mothers assigned levels 2 and 3 were thought to need more frequent or more varied services andthus were loosely referred to as “high risk,” whereas mothers with service levels of E or 1 weredesignated as “not high risk.” Mothers who were screened or assessed at a level 3 were automaticallyassigned to intensive care coordination services. 45In the following sections, we summarize what we have learned about mothers’ use of the MCHP systemin Palm Beach County.43 Personal communication with Carol Scott and Regina Battle, CSC September 2008.44 At the time we began recruiting, the Healthy Start program included a universal home visiting component for all newly deliveredmothers. In spring 2005, the program changed to target mothers who were, based on a risk screen score, identified as most in needof and more likely to use services. Mothers in a “special low risk” group were also offered a home visit if they were younger than19, new to the county, had delivered their first child with no or only late-term prenatal care, had no identified pediatrician, haddifficulty bonding with their baby, or seemed to lack social support (personal communication with Tanya Palmer, Children’sServices Council, 2005; personal communication with Christine Walsh, Healthy Mothers/Healthy Babies Coalition, 2005).45 Risk screen and assessment scores also are likely to change over time with subsequent contacts with healthcare and otherservice providers.Chapin Hall at the University of Chicago 86
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FifthMarciaGouvêa2011
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AcknowledgmentsThis fifth report of
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Chapin Hall at the University of Ch
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List of TablesTable 1. Components o
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Table 58. Logistic Regression of Mo
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Table C- 24. Mothers’ Baseline an
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• In addition, we observed a pote
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kind of out-of-home educational exp
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IntroductionOver the last three dec
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eadiness and school success and in
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The study’s comprehensive, longit
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Table 2. Characteristics of Mothers
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The Year 5 Study SampleTable 4 show
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Household Structure, Employment, an
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Although mothers continued to repor
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Table 6. Family Income and Economic
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Specifically, mothers living outsid
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at the birth of the focal child tha
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Table 10. Reasons for Transportatio
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Health, Healthcare, and ChildDevelo
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two years of the study. In year 1 1
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Subsequent Pregnancies and Prenatal
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Children’s HealthcareMost (80%) o
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private plans or HMOs increased sig
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outside the TGAs to report that all
Page 54 and 55: Children’s Behavior and Developme
Page 56 and 57: cultural norms regarding what sorts
Page 58 and 59: Table 21. Emerging Pre-academic Ski
Page 60 and 61: the year 5 interview, over three-qu
Page 62: various activities, mothers reporte
Page 66 and 67: Negative Parenting PracticesThere i
Page 68 and 69: Table 28. Fathers’ Negative Paren
Page 70 and 71: Table 30. Parent Involvement Activi
Page 72 and 73: Table 32. Mothers’ Positive Paren
Page 74 and 75: Table 34. Mothers’ Parent Involve
Page 76 and 77: The most frequent parent involvemen
Page 78 and 79: Figure 3. Primary Childcare Arrange
Page 80 and 81: for 6 months, but when the subsidy
Page 82 and 83: ecause it is of particular interest
Page 84 and 85: types of care between mothers whose
Page 86 and 87: Table 40. Characteristics of Mother
Page 88 and 89: Table 41). Of the 204 children, 91
Page 90 and 91: commented on their children’s nee
Page 92 and 93: nonparental childcare arrangement f
Page 94 and 95: Informal and Community SupportAn un
Page 96 and 97: Table 46. Frequency of Husband/Part
Page 98 and 99: We also asked the mothers about the
Page 100 and 101: Table 49. Type of Family/Friends Su
Page 102 and 103: Access to Support by TGAFigure 5 sh
Page 106 and 107: Correlates of At-Risk StatusA large
Page 108 and 109: services after 6 months. Among the
Page 110 and 111: Enhanced ServicesEnhanced services
Page 112 and 113: Termination of MCHP ServicesAs prev
Page 114 and 115: services were fairly stable, althou
Page 116 and 117: languages. The fact that more mothe
Page 118 and 119: In interpreting these results, it s
Page 120 and 121: Overall, mothers reported seeking h
Page 122 and 123: We found that in years 2 and 3, aft
Page 124 and 125: We also found that mothers tended t
Page 126 and 127: variables that could potentially be
Page 128 and 129: significant levels of stress. Paren
Page 130 and 131: positive parenting items and 5 nega
Page 132 and 133: friend/neighbor/other), which were
Page 134 and 135: Table 60. Logistic Regression of Ch
Page 140 and 141: County in either fall 2009 or fall
Page 142 and 143: Figure 6. Percent of Focal Children
Page 144 and 145: Next, we conducted logistic regress
Page 146 and 147: Table 68. Selected Maternal and Chi
Page 148 and 149: R 2 .180*p < .05, **p < .01, or ***
Page 150 and 151: SummarySimilar to previous analyses
Page 152 and 153: less than a high school education,
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Parenting PracticesWhen surveyed in
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We also looked at the stability of
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Service Use, Maternal Functioning,
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Conclusions and ImplicationsMore th
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Meanwhile, our findings indicate th
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literacy skills, families who do no
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BibliographyAbidin, R. R. (1995). P
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Dinan, K. A. (2005a). Federal polic
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Leventhal, T., Brooks-Gunn, J., McC
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Weisner, T. S. (1984). A cross-cult
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What are pathways to service use? W
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Table A- 1. FOCiS Codes for MCHP Se
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Table A- 2. Interview Study Samplin
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Table A- 3. Household Survey Topics
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Table A- 5. Reasons for Sample Attr
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we sought to identify the ecologica
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Table B- 2. Characteritics of TGA M
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Figure B- 1. Characteristics of Mot
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Figure B- 5. Percentage of PBC Moth
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Table B- 5. Logistic Regression Pre
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Table B- 7. Characteristics of TGA
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Table B- 9. Logistic Regression Pre
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Type of Enhanced Service2009N% of M
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Table B- 12. Logistic Regression Pr
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Numberof BirthswithReferrals2009 TG
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Table B- 15. OLS Logistic Regressio
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Table C- 1. Selected Characteristic
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Table C- 4. Social and Emotional Be
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Table C- 7. Communication Skills of
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Table C- 11. Emerging Literacy and
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Table C- 14. Mothers’ Negative Pa
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Number of Different Arrangements ac
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Figure C- 1. Mean Days of MCHP Serv
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Table C- 19. Characteristics of Mot
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Table C- 22. Number of Service Area
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Table C- 23. Number of Services Use
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Table C- 25. Linear Regression Anal
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Table C- 27. Baseline Characteristi
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2011 The Palm Beach County Family Study (Full Report)

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