Policy and Practice

School Research Partnership: Connections Matter

SONY DSC“Ask yourself: what are the absolute best outcomes for our children?” David Reese, president and CEO of the East Durham Children’s Initiative, implored attendees of the recent School Research Partnership dinner.

SRP, housed in the Center, offers undergraduate students the opportunity to work with faculty and community leaders to conduct hands-on research that benefits local education. At this year’s dinner, students presented work from partnerships with El Centro Hispano, The Hill Center and EDCI.

Ben Goodman, a research scientist at CCFP, also shared findings on Durham Connects, a program that provides a bridge between new parent needs and community resources, while undergraduates Hope Arcuri and Setonji Agosa presented work they did with El Centro Hispano to dispel the myth that Latino parents are not engaged in their children’s education.

“If you reduce parent engagement to only mean school involvement, of course it will seem like they are not involved or engaged in their child’s life,”  Arcuri said. “The moms care, but there are clear institutional barriers that impede them.” Mothers cited the limited number of translators at schools and difficulty finding child care as obstacles to school involvement.

“When talking to the parents,” she said, “we realized that there is such a clear solution to this problem, and making that connection between the parents and the school is the next step.”

A connection also needs to be made, according to Goodman, between the community and new parents. Durham Connects offers free home nurse visits to new parents and connects them to social workers and medical practitioners as needed. “The goal of Durham Connects is to meet families where they are,” Goodman said. After implementing the program, researchers noticed participating parents displayed more positive parenting behaviors and the number of child emergency room visits decreased.

EDCI similarly thrives on community connection. Reese described EDCI as an ecosystem of 40 partners and 45 different interventions that help children in East Durham. For example, EDCI worked with the Center for Child and Family Health to create an intervention that helped teachers understand the dynamics of food insecurity.

“A child cannot concentrate when he’s hungry, but teachers are not trained to teach kids who exhibit signs of poverty.” Reese said. CCFH came up with the Parent Advocate, a link between parent, teacher and child that Reese explained is “someone who comes into your home, spends time with you, finds out what is going on with your child and then helps be that link to the school.”

Ask yourself: what are the absolute best outcomes for our children? Arcuri, Agosa, Goodman and Reese all agree that better outcomes begin with better connections.

Dodge Lecture Honors Research, Election into NAM

Center for Child and Family Policy Director Kenneth A. Dodge speaks during a lecture honoring his election to the National Academy of Medicine. Former Center Director Kenneth Dodge provided a retrospective of his work in a special lecture that honored his induction into the National Academy of Medicine in March 2016.

Dodge shared his decades of research on defensive processing in children and how hostile attribution bias can be mitigated by teaching children self-control and problem solving. He discussed the Fast Track study, which looked at how long-term intervention can positively change defensive processing through home visits, peer coaching and social-emotional classroom lessons. The school curriculum has been used in more than 5,000 schools.

Dodge also discussed how, using those research insights, he and others were able to develop Durham Connects. The program, which has expanded to become Family Connects, links the families of newborns with a registered nurse who assesses the family’s need for community resources. Research shows the program reduces emergency room visits in the first 12 months of life and investigations into child maltreatment through age 2.

“I think we’re preventing child abuse in these families,” Dodge said.

He concluded the talk with the implications his research has on public policy. Practices that place aggressive children together or that confirm a hostile world view – such as zero tolerance – strengthen aggressive behavior. “But that is the major public policy that we have for aggressive children in this country,” he said

Dodge recommends that children – and adults – receive consequences for misbehavior, but not be allowed to perpetuate an aggressive world view.

Missed the lecture? Watch the video or review the slides.

_MG_1784D.C. Conference Features Durham Connects Evaluation

The White House is lending its support to the “evidence-based policy” movement, but hopes to encourage scientists to find ways to be thrifty even as they pursue rigor.

The White House Office of Science and Technology Policy co-sponsored a July 28, 2014, conference spotlighting effective, low-cost randomized controlled trials, such as Duke University’s Durham Connects evaluation. The Center’s Ben Goodman spoke at the conference about his work using cost-effective approaches to monitor the impact of the Durham Connects program.

The Durham Connects evaluation is also one of three winners in a recent national competition funding new, high-quality, low-cost randomized controlled trial evaluations. The award was given by the nonpartisan Coalition for Evidence-Based Policy, which co-sponsored the July conference. It will allow Goodman and Kenneth Dodge to continue monitoring the effects of the Durham Connects nurse home visiting program.

Durham Connects provides free nurse home visits to all infants born in Durham County. The nurses conduct health checks and connect families with community resources, in an effort to improve children’s outcomes. Participation in Durham Connects results in dramatically lower emergency care utilization in an infant’s first year of life, according to previous studies in Pediatrics and the American Journal of Public Health. The brainchild of Dodge, Durham Connects was born at Duke and is now operated by the independent Center for Child and Family Health.

With the new award in hand, Goodman and Dodge will consider Durham Connects’ effects on mothers’ and children’s emergency care usage from a child’s birth through 24 months of age.

 Connecting Education and Child Welfare Systems

A JenniSmileProfileCCSgrad_mg_1068group of researchers, practitioners and policymakers from three universities has embarked on a new project to forge stronger links between schools and child welfare systems in Illinois, Michigan and North Carolina. The Child Welfare and Education Learning Community, an outgrowth of the University-Based Child and Family Policy Consortium, aims to improve cross-state collaboration on issues of child welfare and education. The group also hopes to improve data sharing between professionals to help support children in the child welfare system, and to increase the number of programs serving those students that are grounded in solid scientific evidence.

The collaboration is a joint project of the Center, Chapin Hall at the University of Chicago and the University of Minnesota’s Children, Youth & Family Consortium. Jenni Owen represents the Center on the task force, which is funded by the WT Grant Foundation. The group’s 2015 report is available here.

 Policy and Practice Spotlight: Evaluating Child Welfare Reform

early_child_01For years, the N.C. Division of Social Services responded to all allegations of child abuse and neglect by launching an investigation. But in the early 2000s, state officials had begun questioning that one-size-fits-all approach. Some reports clearly warranted a forensic investigation. Often, though, parents were brought to court on charges of neglect stemming from poverty, mental health challenges and other ills. Many of these families needed help. The adversarial nature of the social services system limited the system’s ability to link families with needed services that could improve overall family stability and reduce the risk to children. Families were frustrated, and social workers complained about spending time in court rather than helping families.

In 2002, state officials decided to field test a new approach modeled after efforts in other states, called the Multiple Response System (MRS). Under MRS, the nature of the complaint determines how cases are handled. Some, including any that involve alleged child sexual abuse, are pursued using a traditional investigation. Others are handled using a family assessment track, which involves a careful examination of the needs, strengths and weaknesses of the child and family.

The new approach was promising, but there was a lot at stake. For help, the state turned to experts from the Center for Child and Family Policy, including Kenneth Dodge, who recommended a methodical transition and careful monitoring of results to ensure that children’s best interests were served.

R. Patrick Betancourt, who directs child welfare policy administration for the state Division of Social Services, was working for the Franklin County Department of Social Services at the time. Working in a small rural county had given him little experience with program evaluation.

“We didn’t have as solid an idea about implementation science then as we do now,” Betancourt said. “It was one of the first exposures I had to any kind of evaluation process. The Center did a great job of making it an easy process for us. It could have been an intimidating process, but it wasn’t.

The state legislature had ordered the Division of Social Services to evaluate the success of MRS, but provided no evaluation funding. Center staff stepped in and conducted the initial evaluation pro bono.

“Having this evaluation done for us at no charge was huge,” Betancourt said. “The state office can say all day long that we think something is a good idea. But when you have an independent evaluation from one of our major university partners, that helps lawmakers understand and appreciate it.”

Center staff created an extensive database, and conducted hours of interviews with families and caseworkers. They also observed team meetings to assess how closely DSS staff were adhering to the new model.  Center researchers, including research scientists Christina Christopoulos, Katie Rosanbalm and Nicole Lawrence, ultimately conducted four separate reviews of the MRS system in 2004, 2006, 2009 and 2011. The reviews showed the program was helping families, but also suggested improvements.

Holly McNeill, MRS consultant with the state Division of Social Services, says Center staff helped her understand the importance of grounding reform efforts in rigorous science.

“The Center was my closest partner, honestly,” McNeill said. “They provided us with valuable technical expertise and an understanding of the numbers. They helped me understand the science, certainly.”

Former Center senior research scholar Joel Rosch has followed the evolution of the state’s MRS process since its early days.

“Because of its documented success, North Carolina’s MRS program is now considered to be a national model,” Rosch said. “North Carolina’s social services staff has helped other states develop similar programs.”

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Research Into Practice Spotlight: A Panel Discussion Featuring Voices from Duke and South AfricaBernhard Gaede and Mosa Moshabele of Durban, South Africa, shared their views on translating research into policy.

Scientific research doesn’t reach the ears of policy makers often enough. But when it does, the results can be significant, said participants in an April 10 panel on translating research into policy, which featured  visiting South African researchers and Duke researchers and policy experts. (At right: Bernhard Gaede and Mosa Moshabela of Durban, South Africa.)

Kathryn Whetten, a Professor of Public Policy and Global Health at Duke, described her recent successes in influencing proposed legislation regarding the world’s orphaned children.

The U.S. Senate bill stated that institutions are bad for orphaned children, causing brain damage and other ills. However, Whetten knew from her research that the reality was more nuanced: While impersonal, poorly run institutions can impair infant brain development, orphaned children in many countries often fare as well in group settings as in family placements.

An op-ed on the subject helped Whetten gain an audience with the bill’s sponsors in Congress. She also reached out to the Harvard researcher whose studies were cited in the original bill, and the two collaborated to suggest improved language.

In commenting on the bill, Whetten said she has remained anchored in the research she knows best.

“We have to keep asking ‘Are we sticking to the science’?” Whetten said. “We must be really clear about what the science actually says.”

In South Africa, meanwhile, academic research has had a tremendous impact on HIV treatment and AIDS prevention, said Bernhard Gaede, who directs the Centre for Rural Health at the University of KwaZulu-Natal in Durban, South Africa.  AIDS activists from outside the academy used scientific research to gain traction with South African policymakers, Gaede said. Access to antiretroviral drugs in South Africa has since ballooned, with life-saving consequences.

Other policy-relevant research languishes on the pages of a journal, said Gaede’s colleague Mosa Moshabela. Moshabela, head of department and chief medical specialist at the Centre for Rural Health, said he has watched hundreds of studies pour out of his home country.

“I believe in the good of generating knowledge,” Moshabela said. “But we generate that data using people. And if you go into the communities that have been studied, there’s often nothing to show for it.”

The panel discussion, “Using Research to Inform Policy and Practice: Strategies and Lessons Learned from the U.S., South African and Nigeria,” took place in Rubenstein Hall and was part of the series Rural Health & Rural Academic Excellence in South Africa. The series was coordinated by Jenni Owen, former director of policy initiatives with the Center for Child and Family Policy and a lecturer in public policy with the Sanford School of Public Policy. It was supported by the Duke Africa Initiative in cooperation with the Sanford School of Public Policy and the Center for Child and Family Policy and the Duke Global Health Institute.