2011 The Palm Beach County Family Study (Full Report)

Table A- 2. Interview Study Sampling PlanTGA % High Risk % Not High Risk %TotalNon-Glades 40 40 80Glades 10 10 20Total 50 50 100Data for identifying families as “high risk” and “not high risk” were based on screens and assessmentsconducted at various points during pregnancy, at birth, and after birth and recorded in an administrativedata system for the Maternal Child Health Partnership. 78 At the time of the study, mothers who receivedprenatal services from the Department of Health were usually given an assessment of risk during thosecontacts. Many mothers also were given the Healthy Start Infant Risk Screen in the hospital shortly aftergiving birth. On a scale from 0 to 10, a score of 4 or higher was considered an indicator of possible risk.Mothers who scored 4 or higher were encouraged to accept a home visit from a Healthy Start nurse.Mothers who received lower scores were not offered a home visit, but could request one. 79 Subsequently,mothers who were visited at home were assessed again and designated as having services levels of E, 1, 2,or 3 on the basis of scored risk assessments, observations by nurses (and perhaps other medicalpersonnel), and clinical judgments of nurses. Mothers who were assigned levels 2 and 3 were thought toneed more frequent or more varied services and thus were loosely referred to as “high risk.” 80In addition to risk status and TGA, mothers were to have recently given birth and to have custody of thatchild to be included in the study. The baby did not have to be a first-born child, however, to qualify themother for study participation. Other selection criteria included a maternal age and language. Mothers hadto be 16 years and speak one of the three main languages spoken in Palm Beach County—English,Spanish, or Haitian Creole.Each year, mothers were interviewed in person for about an hour to an hour and a half in their homes oranother location. Six months after an in-person interview, they participated in a brief telephone interview78 Known as Right Track when we began the study, the data system is now called FOCiS.79 At the time we began recruiting, the Healthy Start program included a universal home visiting component for all newlydelivered mothers. In spring 2005, the program changed to target mothers most in need of and more likely to use services.Mothers in a “special low-risk” group are also offered a home visit if they are younger than 19, new to the county, have deliveredtheir first child with no or only late-term prenatal care, have no identified pediatrician, have difficulty bonding with their baby, orseem to lack social support (personal communication with Tanya Palmer and Christine Walsh, 2005).80 Clearly, none of these measures of risk is perfect in identifying children and families that may need services. The screenings,assessments, and level designations all involve judgments, which are of unknown reliability and validity. In addition, not allmothers receive prenatal services. Not all are given the in-hospital screen. Some mothers refuse the assessment. Hospital liaisonsare not present on weekends, and although other hospital personnel are supposed to visit mothers who give birth on weekends,those contacts do not always happen. Nor do all mothers agree to the postpartum visit by nurses. Those mothers who do agree arenot always visited for a variety of reasons. Thus, the selectivity at each of these stages is likely to be biased and cannot beassumed to be random.Chapin Hall at the University of Chicago 159