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Partners with Families and Children: Spokane

Partners with Families and Children: Spokane (Partners) provides services to families with children under 30 months old who are referred by child protective services, law enforcement, or other public health agencies due to chronic child neglect or risk of child maltreatment. These families generally are low income, marginally integrated into conventional life and family structures, and present multiple needs across life domains. Partners is a multidisciplinary intervention based on wraparound service principles and attachment theory. Its characteristic features are intensive case management using an integrated system of care approach; on-site resources for gender-specific, integrated parental substance abuse and mental health services; parental coaching to improve parent-child interactions and relationships; and a commitment to provide services as long as the family wants and benefits from services.

Families who enter Partners are assigned to a Family Team Coordinator, who completes an initial formal assessment and develops a team of professionals and family members to participate in service plan development and delivery. Based on family need, collaborations are routinely developed with schools, Head Start, and local public health and other agencies to ensure service coordination. When a family enters Partners, the Coordinator arranges an initial home visit, begins a planning process for evaluation, and consults with core team members. The Coordinator continues to provide intensive case management services. Family team meetings typically occur at least once a month and include the professional team as well as individuals personally involved with and identified by the family. Family teams place a strong emphasis on the quality of the parent-child relationship and the quality of interactions, using infant psychotherapy principles to guide treatment goals. Meetings focus on informal modeling of appropriate relationship and behavior with the child, progressive encouragement and support of increasingly competent behavior, and parental self-reflection regarding the parent-child relationship.

Descriptive Information

Areas of Interest Mental health promotion
Mental health treatment
Outcomes Review Date: April 2008
1: Interpersonal violence within families
2: Parenting stress
3: Child behavior problems
4: Caregiver-child attachment
5: Service access
Outcome Categories Family/relationships
Mental health
Social functioning
Violence
Ages 0-5 (Early childhood)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities Black or African American
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Implementation History Partners with Families and Children: Spokane (formerly Casey Family Partners: Spokane) was first implemented in 1998 and has served 559 families to date. Partners participated in its first systematic evaluation when it was chosen as one of 12 sites participating in the Starting Early, Starting Smart (SESS) national outcomes study in 1999-2003.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Indicated

Quality of Research
Review Date: April 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Blodgett, C. (2007). Final report: Starting Early Starting Smart Project: Partners with Families and Children: Spokane (formerly Casey Family Partners). October 2003, updated 2007. Spokane: Washington State University.

Outcomes

Outcome 1: Interpersonal violence within families
Description of Measures Interpersonal violence within families was assessed using the Conflicts Tactics Scale, which measures the presence of verbal and physical aggression in relationships and the use of conflict resolution strategies such as adaptive conflict resolution through reasoning. Reported acts of violence were classified as either severe (i.e., potentially lethal violence such as use of a weapon or choking) or moderate (e.g., being pushed or shoved, slapped, or kicked).
Key Findings Families were randomly assigned to either standard care or the Partners intervention. The standard care condition provided families a typical range of routine services facilitated by child protective services caseworkers, but did not include the coordinated team-based characteristics of the Partners service model.

None of the families who participated in the Partners intervention reported an increase in severe violence from baseline to 6- and 12-month follow-up. In contrast, 18% of families who received standard care reported an increase in severe violence at 6- and 12-month follow-up (p < .05).

There were no differences between groups in the reported presence of moderate violence or use of adaptive conflict resolution as a strategy to defuse conflicts.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)
Outcome 2: Parenting stress
Description of Measures Parenting stress was assessed with the Dysfunctional Interaction subscale of the Parenting Stress Inventory, which measures the degree to which the parent feels isolated from his or her child. This scale asks questions such as "My child rarely does things that make me feel good," "My child is not able to do as much as I expected," and "Most times, I feel that my child does not like me and does not want to be close to me."
Key Findings Families were randomly assigned to either standard care or the Partners intervention. The standard care condition provided families a typical range of routine services facilitated by child protective services caseworkers, but did not include the coordinated team-based characteristics of the Partners service model.

Parents who participated in the Partners intervention reported a reduction of stress on the Dysfunctional Interaction subscale from baseline (53%) to 12-month follow-up (38%; p < .05). In contrast, parents who received standard care did not report a statistically significant reduction in parental stress at 12-month follow-up (53% at baseline vs. 51% at 12-month follow-up).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)
Outcome 3: Child behavior problems
Description of Measures Child behavior problems were measured using the Preschool/Kindergarten Behavior Scales (PKBS) and the Infant Toddler Symptom Checklist (ITSC). The PKBS is a parental report that measures their child's externalized behavior problems (e.g., explosive, overactive, and aggressive behavior), internalized behavior problems (e.g., withdrawal, anxiety, somatic problems), and social skills (e.g., cooperation, interaction, independence). The Infant Toddler Checklist is a parental report that measures their child's regulatory behavior (e.g., behavioral self-regulation, attention, sleeping, eating, dressing, listening and language, attachment, emotional functioning).
Key Findings Families were randomly assigned to either standard care or the Partners intervention. The standard care condition provided families a typical range of routine services facilitated by child protective services caseworkers, but did not include the coordinated team-based characteristics of the Partners service model.

Among families who participated in the Partners intervention, the number of parents who reported concerns about child behavior problems on the PKBS did not significantly change between baseline and 6- and 12-month follow-up (35%, 32%, and 27%, respectively). In contrast, among families who received standard care, the proportion of families reporting concerns with child behavior problems increased significantly from baseline to 6- and 12-month follow-up (25%, 38%, and 39%; p < .05).

Parents who participated in the Partners intervention reported fewer child emotional and behavioral problems on the ITSC between baseline and 6-month follow up (48% vs. 45%) compared with parents who received standard care (51% vs. 54%; p < .05). Parents who participated in the intervention also reported fewer concerns over child emotional and behavioral deficiencies between baseline and 6-month follow-up (15% vs. 8%) compared with parents who received standard care (16% vs. 53%; p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)
Outcome 4: Caregiver-child attachment
Description of Measures Caretaker-child attachment was assessed by videotaping parent and child interactions during play and feeding. The videotapes were then scored by two independent judges using the a standardized scoring protocol from the National Institute of Child Health and Human Development guidelines for rating the quality of parent-child interactions. Aspects of the parent-child free-play interactions measured included the child's positive mood, problem behavior, and parental flat affect (lack of emotional expressiveness). The independent judges were blinded to the assignment of families to the intervention or standard care.
Key Findings Families were randomly assigned to either standard care or the Partners intervention. The standard care condition provided families a typical range of routine services facilitated by child protective services caseworkers, but did not include the coordinated team-based characteristics of the Partners service model.

In free-play sessions between the child and parent at 6-month follow-up, children of families who participated in the Partners intervention exhibited improvements in positive mood (rating of 2.2 at baseline vs. 2.6 at 6-month follow-up; p < .05), and parents showed a reduction in flat affect (rating of 1.9 at baseline vs. 1.5 at 6-month follow-up; p < .05). In contrast, families who received standard care did not show statistically significant differences in child positive mood or parental flat affect during free-play sessions.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.5 (0.0-4.0 scale)
Outcome 5: Service access
Description of Measures Service access was measured in terms of whether a family needed services (a reduction in need indicating better stability within the family) and whether a family actually accessed services it needed (a reduction of unmet needs indicating better problem solving for the family). The level of service need and unmet need was measured by questions administered during interviews on which respondents reported needs in the prior 3 months. In general, the need for domestic violence services was typically related to child maltreatment or family violence, and the need for housing support was related to transience. In addition, unmet legal needs were typically related to the need for representation in housing and child dependency cases, as well as criminal prosecution related to assault, drug, or fraud changes, in addition to more common civil legal problems.
Key Findings Families were randomly assigned to either standard care or the Partners intervention. The standard care condition provided families a typical range of routine services facilitated by child protective services caseworkers, but did not include the coordinated team-based characteristics of the Partners service model. Compared with families who received standard care, families who participated in the Partners intervention reported:

  • Fewer unmet legal needs at 6-month follow-up (5% vs. 20%; p = .04), 9-month follow-up (11% vs. 22%; p = .002), and 12-month follow-up (6% vs. 23%; p = .05). No statistically significant differences were found at 3, 15, and 18 months.
  • Lower use of domestic violence services at 6-month follow-up (5% vs. 19%; p = .05), 9-month follow-up (5% vs. 29%; p = .002), and 12-month follow-up (10% vs. 30%; p = .05). No statistically significant differences were found at 3, 15, and 18 months.
  • Lower transience (i.e., fewer housing relocations) at 6-month follow-up (38% vs. 62%; p < .03) and 12-month follow-up (19% vs. 48%; p = .02). No statistically significant differences were found at 18 months.
  • More use of educational services at 3-month follow-up (36% vs. 17%; p = .03).
  • Fewer unmet needs for child care at 3-month follow-up (9% vs. 39%; p < .03).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood)
26-55 (Adult) 		50.3% Male
49.7% Female 		70.4% White
25.2% Race/ethnicity unspecified
4.4% Black or African American

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Interpersonal violence within families 3.0 2.5 2.5 2.0 2.3 2.5 2.5
2: Parenting stress 3.0 3.0 2.5 2.0 2.3 2.5 2.5
3: Child behavior problems 3.1 2.6 2.5 2.0 2.3 2.5 2.5
4: Caregiver-child attachment 3.0 3.0 2.5 2.0 2.3 2.5 2.5
5: Service access 2.5 2.5 2.5 2.0 2.3 2.5 2.4

Study Strengths

The randomized design of the study minimized a number of confounds. The researchers selected valid and reliable measures, made efforts to track fidelity, and used an intent-to-treat analysis.

Study Weaknesses

Confounds may have been present due to the fact that 28% of families did not have a child living in the home due to foster care placement. The researchers did not include a comparison of the characteristics of participants who left the study and those who completed the study. The ways in which questions were posed by interviewers may also have introduced social desirability bias; the use of blinded interviewers would have reduced this potential confound.
Readiness for Dissemination
Review Date: April 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Altshuler, S. J., & Cleverly-Thomas, A. (2007, October). Partners with Families and Children project: Developing a replicable evaluation model. Final report. Spokane, WA: Partners with Families and Children.

Altshuler, S. J., Plavnick, A., Kriz, D., & Mallonnee, C. (n.d.). Supportive elements of core services: Casey Family Partners and the Starting Early, Starting Smart Program. Spokane, WA: Casey Family Partners and the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.

Casey Family Programs & the U.S. Department of Health and Human Services. (2001). The Starting Early Starting Smart story. Washington, DC: Authors.

Hanson, L., Deere, D., Lee, C., Lewin, A., & Seval, C. (2001). Key principles in providing integrated behavioral health services for young children and their families: The Starting Early Starting Smart experience. Washington DC: Casey Family Programs and the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.

Murphy, M. A. (2003). Key elements of the Casey service model. Spokane, WA: Casey Family Partners.

Partners with Families and Children. (n.d.). Independent evaluation data. Spokane, WA: Author.

Partners with Families and Children. (n.d.). Program description and theory of change. Spokane, WA: Author.

Partners with Families and Children Web site, http://www.partnerswithfamilies.org

Starting Early Starting Smart. (2003). Ordinary miracles: A training package to foster nurturing parent-child relationships: Facilitator Manual [with VHS tapes]. Washington, DC: Casey Family Programs and the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Available online at http://ncadi.samhsa.gov/promos/sess/publications.asp

Starting Early Starting Smart Web site, http://ncadi.samhsa.gov/promos/sess/about.html

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
2.8 1.8 1.8 2.1

Dissemination Strengths

The Facilitator Manual is well organized and clearly articulates the clinical and organizational model, supporting effective implementation. The accompanying videos are highly detailed and sequenced for maximizing practitioner competencies during training. A list of commonly used outcome measures available from the developer can be used to develop a complete quality assurance protocol.

Dissemination Weaknesses

It is unclear how some implementation tools relate to the facilitator manual. Some documents mention the need to conduct a community assessment for program fit, but the full assessment process is not described. There is no mechanism for procuring ongoing support and consultation beyond training for implementers. Though the model relies heavily upon expert clinical supervision and observer ratings to support fidelity, little information is provided on how these tasks are completed or how data are used. Very little guidance is provided on selecting and using outcome measures to support quality assurance.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Ordinary Miracles video $25 Yes
All other program materials Free Yes
Site-tailored training Contact the developer No
Monthly consultation $500 No

Additional Information

The estimated yearly cost of implementation with chronically neglectful families is $8,900 per family per year, or $5,711 per child and $5,117 per parent for individual family members receiving the intervention.
Replications

No replications were identified by the developer.
Contact Information

To learn more about implementation or research, contact:
Kari Grytdal
(509) 473-4832
grytdak@inhs.org

Christopher Blodgett, Ph.D.
(509) 358-7679
blodgett@wsu.edu

Sandra Altshuler, Ph.D., LICSW
(509) 477-6355
saltshuler@spokanecounty.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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