Recent News Releases

For Vulnerable Families, Pandemic’s Effect on Mental Health is Swift and Harsh

September 2, 2020

DURHAM, N.C. – In just a few months, the COVID-19 pandemic swiftly and substantially worsened mental health among U.S. hourly service workers and their children – especially those experiencing multiple hardships, according to new research from the Center for Child and Family Policy at Duke University and Barnard College.

The study leverages real-time, daily survey data collected from Feb. 20, before the pandemic hit the U.S., to April 27, when it was well underway, to examine how the crisis affected parents’ and children’s mental well-being. The 645 survey respondents were parents of young children working in hourly service-industry positions in retail, food service or hotel industries in a large U.S. city. Nearly half (49.5%) of the participants were Black Americans, 23% were Hispanic Americans, and 83% were women.

The findings appear today in Pediatrics.

The surveys showed strong, immediate impacts of the pandemic on vulnerable families. Parents saw quick deterioration in their own mental well-being, reporting more frequent “negative moods” since March 14, the day after the first major restrictions in response to COVID-19 were announced. The majority of respondents experienced multiple hardships, including household job loss (60%), income decline (69%), caregiving burden (45%) and illness (12%).

“The COVID pandemic has created substantial hardship for working families,” said Anna Gassman-Pines, co-author of the study and associate professor of public policy at Duke’s Sanford School of Public Policy. “What’s worse is that the more hardship families experienced, the worse parents’ and children’s mental health.”

Not surprisingly, those who experienced two and three hardships reported more negative moods, worse sleep quality and more uncooperative child behavior than those who did not. For both parents and children, mental health was worst among those who suffered all four hardships.

“These results should raise concern, given the strong links between parental psychological well-being and the well-being of children,” the authors write.

Gassman-Pines and co-author Elizabeth Ananat of Barnard College suggest pediatricians should screen for mental health problems among children in their practices, with particular attention to children whose families are especially vulnerable to both the economic and health aspects of the crisis.

During the stressful pandemic, pediatricians should also help parents understand and watch for potential signs of mental distress, the authors write. Those may include uncooperative behavior and acting out.

The authors also urge the government to provide more support for families, through restarting expanded unemployment insurance benefits and increasing the generosity of the Supplemental Nutrition Assistance Program.

“What we really see here is that, as hardships pile up, the combined weight causes severe distress for families. Resilience only takes you so far, and the multiple dimensions of hardship caused by this pandemic — lost jobs, lost child care and education, sickness — are stretching families to the breaking point,” said Ananat. “Families need support, from their pediatricians and, hopefully, from the government.”

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (Grant #1R21HD100893-01), the National Science Foundation (Award # SES-1921190), the Russell Sage Foundation (Grant #1811-10382) and Washington Center for Equitable Growth.


CITATION: “COVID-19 and Parent-Child Psychological Well-Being,” Anna Gassman-Pines, Elizabeth Ananat and J. Fitz-Henley II. Pediatrics. 2020; DOI: 10.1542/peds.2020-007294

Home Visiting Program Linked to Reductions in Child Abuse

November 11, 2019

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.

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.

Rachel Scheckter and James Soliah reading to baby Eleanor

“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.


Parental Incarceration Increases Children’s Risk of Substance Abuse, Anxiety in Adulthood

Mom holding kid hand through prison bars August 23, 2019

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.


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

New Study Sheds Light on Varying Degrees of Food Insecurity Among Low-Income Families

Two young girls staring into empty fridge July 9, 2019

Food insecurity is often thought of as a state of economic well-being, with families being categorized as either food secure or insecure. However, a new study from the Center for Child and Family Policy at Duke University sheds light on the varying degrees to which low-income families experience food insecurity on a day to day basis. Published online in the Journal of Marriage and Family on July 9, the study leveraged daily survey reports from a sample of Supplemental Nutrition Assistance Program (SNAP) recipient parents with young children to examine daily variability in food insecurity within the SNAP benefit cycle. Researchers measured daily levels of food insecurity by assessing three different components of food insecurity: worry about running out of food, insufficiency in the quantity of food available, and concern about being able to afford balanced meals.

Based on the survey results and analysis, the study concludes that SNAP recipients experience considerable instability in their food insecurity from one day to the next, and that the severity of recipients’ daily food insecurity is higher at the end of the SNAP month than at the beginning. These findings add to growing evidence that SNAP benefits may not be sufficient to many families.

The study is the first of its kind to gather and analyze food insecurity diary data from SNAP recipients on a daily basis, allowing researchers to examine within-family change over time. “The key innovation of our approach was to gathering survey reports from SNAP recipients every day for a whole month. This allowed us to really see how much food insecurity varied from day to day,” said Anna Gassman-Pines, lead author of the study. “Our finding that food insecurity increases substantially in the second half of the SNAP month adds to the growing understanding that SNAP benefits are not enough for many families. Our results suggest that increasing benefit amounts, or possibly making SNAP disbursements more frequent, would also have the added benefit of reducing parents’ food insecurity.” Gassman-Pines is a professor in the Duke Sanford School of Public Policy and an associate director of the Center for Child and Family Policy. She co-authored the study with Anika Schenck-Fontaine, a postdoctoral researcher at the Leibniz Institute and former doctoral fellow at the Sanford School.


Babinski Named Director of Sanford’s Center for Child and Family Policy

Leslie Babinski, director of the Duke Center for Child and Family Policy June 6, 2019

Leslie Babinski, associate research professor in the Sanford School of Public Policy, will be the new director of the Duke Center for Child and Family Policy, Sanford School Dean Judith Kelley announced today.

Babinski succeeds interim director Seth Sanders, who will leave Duke at the end of the summer to assume the Ronald Ehrenberg Chair in the Economics Department at Cornell University. Babinski’s appointment is effective July 1.

“Leslie has really impressed me with her vision for CCFP as an intellectual hub for expanded research and collective grant activity,” said Kelley. “She is a stellar citizen who brings a true collective mindset that will benefit the Center and all who affiliate with it. I am very excited for her leadership and for where she will take research on children and families at Sanford and Duke.”

Since 1999, upon its establishment at the Sanford School, the center has sought to discover and evaluate strategies for improving the lives of children and families, and to share those findings with policymakers and public agencies.

Babinski has been with the center for more than 10 years and has long served as an associate director. In addition, she served as Director of Undergraduate Studies for the public policy major. She has also led the Child Policy Research certificate program and the Duke School Research Partnership, both housed within the center.

“I am so impressed with the high-quality work of the researchers, staff and faculty in the center,” said Babinski. “I am excited about the opportunity to build on this strong foundation and expand our contributions to make a difference in the lives of children and their families.”

Babinski is a licensed psychologist whose research focuses on school-based interventions for children and adolescents, and teacher professional development. She has designed curricular innovations for English Learners, middle school students at risk, and high school health education students. Among her current projects includes a large efficacy trial of a professional development program for English as a Second Language (ESL) and classroom teachers. She is also working with colleagues from UNC-Chapel Hill on a program to support middle school students’ self-regulation. Babinski’s current research has been awarded nearly $8 million in external funding from the U.S. Department of Education’s Institute of Education Sciences.

Babinski’s earlier work at Duke included evaluation contracts with America’s Promise Alliance and United Way Worldwide.

A magna cum laude graduate of the University of Scranton, Pennsylvania, Babinski received both her M.A. in educational psychology and human development and Ph.D. in educational and school psychology from the University of California, Berkeley. She participated in the North Carolina Educational Policy Fellowship Program (EPFP) with the NC Public School Forum and Institute for Educational Leadership.

Prior to Duke, Babinski held faculty positions at the University of North Carolina Chapel Hill, and Bucknell University as well as research and clinical positions at nonprofit organizations.

As a publicly engaged scholar, Leslie also serves as a member of Durham Public Schools’ Research Review Committee and consultant to education nonprofits including Teachers2Teachers Global, The Hill Center and El Centro Hispano.

Babinski resides in Chapel Hill with her husband, Steve Knotek. They have three children: Anna, a recent graduate of UNC-Chapel Hill; Katie, a rising junior at Duke; and Chris, a junior at Carrboro High School.

Paid Family Leave Insurance in North Carolina Would Improve Family Health and Economic Outcomes, Study Suggests

March 13, 2019

A paid family and medical leave insurance program in North Carolina would reduce infant mortality, nursing home costs and use of government assistance, according to a new report from the Center for Child and Family Policy at Duke University.

In the report, “Paid Family Leave in North Carolina: An Analysis of Costs and Benefits,” researchers model the costs, benefits and feasibility of two policy proposals for instituting a PFLI program in North Carolina. The proposals are based on existing policies in other states and recommendations from the bipartisan American Enterprise Institute (AEI)-Brookings Institution Project on Paid Family Leave.

In evaluating the proposals’ effects on families and society, researchers estimated that both options would reduce infant mortality, low birth weight, nursing home costs and the use of state government assistance through Temporary Assistance for Needy Families (TANF).

News release » Full report »

Adolescents who self-harm more likely to commit violent crime

January 4, 2019

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.

“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.”

Read More »

Blue Cross NC Invests in Family Connects International

BlueCross BlueShield NC logo December 3, 2018

Family Connects International (FCI) has received new funding from Blue Cross and Blue Shield of North Carolina (Blue Cross NC) as part of the Blue Cross NC’s $1.7 million investment in improving maternal and infant health across the state. The funds will go toward supporting the expansion of the Family Connects model across the state.

“We’re honored to be partners with Blue Cross NC,” said Executive Director Scott Hippert in the press release. “With this sponsorship, we’ll build our capacity to promote early childhood systems transformation across North Carolina and the U.S.”

FCI is a program of the Center for Child and Family Policy and Sanford School of Public Policy at Duke University. The program provides an evidence-based model for community-wide nurse home visiting for all newborns. Designed to connect families to the early childhood resources they need, the program has been shown to effectively reduce infant emergency medical care and improve maternal and infant health outcomes.


Obesity Linked with Teen Exposure to Violence

candy, potato chips, soda and other junk food August 1, 2017

Teens consumed more unhealthy foods and beverages on days they were exposed to violence and suffered from fatigue due to poor sleep the next day, according to a new study in the journal Social Science and Medicine. Children exposed to violence are at greater risk for obesity, but exactly how that occurs is not well understood, the researchers said. Authors included Center-affiliated researchers Joy Pointak, William E. Copeland, Rick H. Hoyle and Candice L. Odgers.

Duke Today »

College Attendance Drops After Widespread Job Loss

Photo of an abandoned Factory June 16, 2017

A new study by Center faculty fellows Liz Ananat and Anna Gassman-Pines suggests that the negative effects of parental job loss (children perform worse in school and are less likely to go to college) aren’t limited to the families of those who lost their jobs.

Duke Today »