Family Connects, a program in which nurses conduct home visits for newborns and their families, is linked to substantial reductions in child maltreatment investigations in children’s earliest years, according to new research from Duke University.
Rachel Scheckter and James Soliah reading to baby Eleanor.
Program participants had 44 percent lower rates of child maltreatment investigations during children’s first 24 months of life, compared with parents who did not receive the program, researchers found.
“We now have evidence from a rigorous evaluation that the Family Connects program can reduce the community rate of early child abuse investigations,” said lead author Kenneth Dodge, Pritzker Professor of Early Learning Policy Studies at Duke’s Sanford School of Public Policy. “Supporting families with newborns is key to child and family well-being.”
The study also found improvements in maternal health among Family Connects participants. The rate of maternal mental health problems was lower among those visited by a nurse — 18.2 percent, versus 26 percent among those who did not participate.
The results appear in JAMA Network Open.
Key contributors to the positive results included high rates of program participation and careful implementation, Dodge said. The study examined 936 births in Durham, N.C., from Jan. 1 through June 30, 2014. Among the 456 families randomly assigned to receive a home visit, 76 percent agreed to participate and were successfully reached, and nurses followed protocols 90 percent of the time.
Family Connects provides home visits from a trained registered nurse shortly after the birth of a child. The nurse conducts infant and mother health checks and refers new parents to resources within their community that meet their individual needs and preferences. These may include substance abuse treatment, maternal depression counseling, general parenting support, housing assistance or childcare resources.
The research-based public health program aims to improve health at a population level, reaching as many families as possible in communities where it is available. The Family Connects program is unusual in emphasizing community-wide impact, short-term duration and relatively low cost of about $500 per family, the study’s authors note.
Managed by Duke University’s Family Connects International, the model originated as a partnership between the Center for Child and Family Policy at Duke and the nonprofit Center for Child & Family Health in Durham, N.C. Family Connects International has since grown, with 19 communities across the United States currently implementing the program and many more in various stages of planning. The model has been evaluated through two randomized controlled trials. As the program continues to expand, research and evaluation will continue.
Funding for this study was provided by The Duke Endowment, the Eunice Kennedy Shiver National Institute for Child Health and Human Development (grant R01HD069981), and the Laura and John Arnold Foundation.
CITATION: “Effect of a Community Agency–Administered Nurse Home Visitation Program on Program Use and Maternal and Infant Health Outcomes: A Randomized Clinical Trial,” K.A. Dodge, W.B. Goodman, Y. Bai, K. O’Donnell, R. A. Murphy. JAMA Network Open, November 1, 2019.
DOI:10.1001/jamanetworkopen.2019.14522
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Children of incarcerated parents are six times more likely than other children to develop a substance use disorder as adults and nearly twice as likely to have diagnosable anxiety, according to new research from the Center for Child and Family Policy at Duke University.
In addition, children whose parents were incarcerated are more likely to encounter significant hurdles transitioning into adulthood, including being charged with a felony (35% vs. 11.5%), dropping out of high school (25.5% vs. 5.0%), becoming a teenage parent (14.3% vs. 2.8%), experiencing financial strain (37.2% vs. 17.5%), and being socially isolated (24.5% vs. 9.4%), the study found.
“The increased risk for adverse adult outcomes remained after accounting for childhood psychiatric status and other adversities, suggesting that parental incarceration is associated with profound and long-lasting effects for children,” said co-author William E. Copeland of the University of Vermont, who conducted the research while at Duke. “This increased risk persisted whether the incarcerated parent was biologically related to the child or not. Risk for adverse adult outcomes increased further with each additional incarcerated parent figure.”
The United States has the highest incarceration rate in the world. The U.S. Department of Justice estimates that over half of those who are incarcerated are parents of children under age 18.
With more than 2.7 million children experiencing a parent being sent to jail or prison, understanding the long-term health and social implications of incarceration for children is critical, the researchers say.
The study was published Friday in JAMA Network Open. Lead author Beth Gifford of Duke University and Copeland, principal investigator for the Great Smoky Mountains Study, along with colleagues from Duke, the University of Vermont and the University of Zurich, analyzed study data gathered between 1993 and 2015 on the life experiences of children from the Appalachian Mountains in western North Carolina from age nine until age 30.
Researchers considered all adults who had significant responsibility for the child’s discipline or care to be “parental figures.” They also interviewed families as many as eight times during childhood. Using those methods, researchers identified a higher prevalence of incarceration by parental figures (23.9 percent) than the 8 to 11 percent previously documented in other population-based studies.
Incarceration rates for parental figures were higher among racial and ethnic minorities: 47.9 percent among American Indians and 42.7 percent among African-Americans, compared with 21.4 percent among whites. Parental incarceration cases overwhelmingly involved fathers (87.9 percent).
“Our findings point to the potentially high societal costs of incarcerating children’s caregivers — potentially for generations to come,” said Gifford. “From a public health perspective, preventing parental incarceration could improve the well-being of children and young adults, as could aiding children and families once a parent figure has been incarcerated.”
This research was supported by the National Institute of Mental Health (R01MH117559, R01MH104576), the National Institute on Drug Abuse (R01DA040726, R01DA11301, and P30DA23026), the National Institute of Child Health and Development (R01HD093651), and Robert Wood Johnson Evidence for Action.
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CITATION: “Association of Parental Incarceration with Psychiatric and Functional Outcomes of Young Adults,” Elizabeth J. Gifford, Lindsey Eldred Kozecke, Megan Golonka, Sherika N. Hill, E. Jane Costello, Lilly Shanahan, William E. Copeland. JAMA Network Open, Aug. 23, 2019. DOI:10.1001/jamanetworkopen.2019.10005
By Leslie Babinski
I always knew school principals had a big job, but my recent stint as “Principal for a Day” made it very clear how complex and multifaceted even just a few hours of a principal’s life can be. Thanks to the Greater Durham Chamber of Commerce and their efforts to bring business and community leaders in schools together, I had the pleasure of shadowing Dr. Shaneeka Moore-Lawrence, principal of Bethesda Elementary School in Durham Public Schools, on her morning rounds.
Within the first 15 minutes, Dr. Moore-Lawrence handed me the school’s intercom speaker and the hand-crank tornado siren. My task was to first introduce myself as “Principal for the Day,” then announce the state-wide tornado drill – all while cranking an incredibly loud siren, which immediately halted all school activities.
I was very impressed with Dr. Moore-Lawrence. She was extremely welcoming, and I could tell she had given some thought to what I could experience in my short time as principal. I quickly caught on to the breadth of her principal duties when we started our classroom visits during the tornado drill that morning.
Dr. Moore-Lawrence and I visited each wing of the school to make sure students were in their safe, tucked positions lining the interior halls. She briefed teachers on how to improve the safety of their students in a constructive, straightforward way. As principal, Dr. Moore-Lawrence has to be the expert on students’ physical safety – among innumerable other things – and teachers look to her for advice and feedback.
I noticed during each classroom visit that Dr. Moore-Lawrence was taking notes on her phone. She later explained that she’s writing one positive observation and one constructive piece of feedback that she can email the teacher about his or her classroom later that day. She explained that teachers have come to expect her feedback, and she is even careful about her body language when visiting a classroom.
She walks fast in between classroom visits and brings lots of energy. As we walk, she stops to greet students we pass in the hallway. She knows each one by name. She clearly enjoys her interactions with students, which she told me she considers among the best parts of her job.
Dr. Moore-Lawrence is well-versed in every aspect of Bethesda Elementary – from student safety to curriculum implementation. She explained that when she first came on board nine years ago, her strategy was to begin with addressing big picture things, such as school culture and structures and routines, in order to create a strong foundation.
Her current focus is on curriculum and ensuring effective implementation of two new packages that the school added this year. Each week, she meets with teachers to make sure the implementation process is going smoothly and that students are progressing and have the support they need.
As an education researcher, I often work with teachers, but I found this experience to be surprisingly eye-opening. Throughout the visit, while walking down the halls and visiting classrooms, I was reminded of how rich and dynamic the environment of a school setting is and how the job of the principal encompasses all aspects of school life from curriculum leadership, to school safely, to creating meaningful personal connections with students, families and teachers.
As researchers, we often have ideas of what we’d like to see in a classroom based on studies of best practices. However, it is important that we respect the tensions that arise in classrooms every day and the multiple demands on teachers. We have to remember that teachers – and school administrators – are always balancing long-term and short-term goals, as well as situations that require them to respond in the moment.
When I tell people that I do research in schools, they often share their strong opinions about what should be done to improve education. They went to school, after all, and feel like they know what would make things better. But the complex and dynamic everyday life of principals and classroom teachers demands a high level of skill and sophistication to create a warm, inviting, and positive place for students to grow and learn. I was humbled by my visit to Bethesda and reminded that even those of us studying schools and education need a reality check once in a while.
My sincere thanks to Dr. Moore-Lawrence for providing me with this valuable opportunity.
Leslie Babinski, Ph.D., is an associate research professor in the Sanford School of Public Policy and former director of the Center for Child and Family Policy.
DURHAM, N.C. -- Young people who self-harm are three times more likely to commit violent crime than those who do not, according to new research from the Center for Child and Family Policy at Duke University.
The study also found young people who harm themselves and commit violent crime -- "dual harmers" -- are more likely to have a history of childhood maltreatment and lower self-control than those who only self-harm. Thus, programs aimed at preventing childhood maltreatment or improving self-control among self-harmers could help prevent violent crime, the authors state.
Rates of self-harm -- deliberately harming oneself, often by cutting or burning -- have increased substantially among adolescents in recent years both in the United States and the United Kingdom. In the U.S., roughly one in four teenage girls try to harm themselves and one in 10 teenage boys. In the U.K., the yearly incidence of self-injury among teenage girls has risen by nearly 70 percent in three years.
"We know that some individuals who self-harm also inflict harm on others," said Leah Richmond-Rakerd, lead author of the study. "What has not been clear is whether there are early-life characteristics or experiences that increase the risk of violent offending among individuals who self-harm. Identifying these risk factors could guide interventions that prevent and reduce interpersonal violence."
In the study, published in The American Journal of Psychiatry, Richmond-Rakerd and researchers from Duke and King's College London compared young people who engage in "dual-harm" behavior with those who only self-harm.
Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative U.K. cohort of 2,232 twins born in 1994 and 1995 who have been followed across the first two decades of life. Self-harm in adolescence was assessed through interviews at age 18. Violent offenses were assessed using a computer questionnaire at age 18 and police records through age 22.
"By comparing twins who grew up in the same family, we were able to test whether self-harm and violent crime go together merely because they come from the same genetic or family risk factors," said Terrie E. Moffitt of Duke University, founder of the E-Risk Study. "They did not. This means that young people who self-harm may see violence as a way of solving problems and begin to use it against others as well as themselves."
Researchers also found that those who committed violence against both themselves and others were more likely to have experienced victimization in adolescence. They also had higher rates of psychotic symptoms and substance dependence.
"Our study suggests that dual-harming adolescents have experienced self-control difficulties and been victims of violence from a young age," said Richmond-Rakerd. "A treatment-oriented rather than punishment-oriented approach is indicated to meet these individuals' needs."
Additional recommendations include:
- After incidents of self-harm, clinicians should routinely evaluate a person's risk of suicide. Clinicians should also assess a person's risk of committing acts of violence against others.
- Improving self-control among self-harmers could help prevent violent crime. Self-harming adolescents should be provided with self-control training, which may reduce further harmful behaviors.
- Self-harm and violent crime have largely been studied separately within the fields of psychology, psychiatry and criminology. Interdisciplinary research should be pursued, since it could yield new insights.
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This research was supported by the National Institute of Child Health and Human Development (NICHD) (HD077482), the Jacobs Foundation and the Avielle Foundation. Leah S. Richmond-Rakerd was supported by a postdoctoral fellowship provided by the NICHD (T32-HD007376) through the Center for Developmental Science at the University of North Carolina at Chapel Hill. The E-Risk Longitudinal Twin Study is funded by the UK Medical Research Council (grant G1002190).
CITATION: "Adolescents Who Self-Harm and Commit Violent Crime: Testing early-life predictors of dual harm in a longitudinal cohort study," Leah S. Richmond-Rakerd, Avshalom Caspi, Louise Arseneault, Jessie R. Baldwin, Andrea Danese, Renate M. Houts, Timothy Matthews, Jasmin Wertz, and Terrie E. Moffitt. The American Journal of Psychiatry, Jan. 4, 2019. DOI: 10.1176/appi.ajp.2018.18060740