Guest Blog by

Erin Cowan, MSW, Program Director

Child Crisis Arizona, Home Visiting Program

Mesa, Arizona

Child Crisis Arizona, Home Visiting Program (CCAZ-HV) is a program for expecting mothers and families with children up to 5 years old in Mesa, Arizona.  It is a program within Child Crisis Arizona and funded by First Things First Arizona.  In 2013 the Parents as Teachers national center awarded CCAZ-HV the Losos Prize for Excellence for our innovative central intake program and our commitment to high standards of quality when serving our families

 CCAZ-HV’s goals are for children to start school ready to succeed and eager to learn.  CCAZ-HV provides home visits (2 or more per month), parent group meetings, child screening and referral to community resources.  CCAZ-HV currently serves 352 families, of whom 55% are White/Non-Hispanic and 34% are Hispanic, in Southeastern Maricopa County. Nearly a quarter (21%) are considered “high needs” families (e.g., low income, low education, single parent, child or parent with disabilities).  Families participate in CCAZ-HV an average of 27.4 months.  An independent evaluation team, LeCroy & Milligan Associates, is contracted to inform the management and staff regarding participating child and family characteristics, services they received, and the progress they show toward program outcomes.

Our funders and Board of Directors wanted to know, beyond assessing fidelity to the model, how do we prove that our investment in Child Crisis Arizona is making a difference for families?  We knew that we were following the Parents as Teachers curriculum, setting goals with families and serving our contracted numbers.  But we had no way of showing where parents were when they started with us and if they improved.  We needed to find a way to assess parenting.  After an extensive review, we chose the Keys to Interactive Parenting Scale (KIPS) because it fit well with the Parents as Teachers curriculum and had proven reliability and validity. 

We used the KIPS eLearning online training course to certify our staff in using KIPS.  We have used the online course to train staff individually and adapted the online course for use in group training.  For both approaches, training takes about 10 hours, and over 90% pass the certification exam on the first time through the course. 

KIPS Assessment Shows CCAZ-HV Makes a Difference in Parenting

We tracked all of the assessments and services for children and families enrolled in CCAZ-HV using Visit Tracker. Our evaluation team analyzed process and outcome data and provided summaries and recommendations in the Child Crisis Arizona, Home Visiting Program Evaluation Annual Report.   Regarding parenting assessment, CCAZ-HV began to use the KIPS in July 2011. A pre-KIPS assessment was conducted for families enrolled at the time, and at 90 days post intake for families enrolled thereafter.  For each of these families, a follow-up KIPS assessment was conducted annually and as families left the program.  CCAZ-HV home visitors used KIPS to identify service focus, to inform family goals, to open dialogues with families about parenting strategies that promote their child’s development and learning, to monitor changes in parenting behavior, and to evaluate parenting outcomes.

From July 2011 through June 2017, CCAZ-HV conducted 1814 initial KIPS assessments; 920 parents/caregivers were initially assessed and had between 1 and 9 follow-up assessments.  The families showed an average KIPS mean score of 3.87 on their initial assessments. 

There were 509 families with a KIPS score for both an initial (pre) and follow-up (post) KIPS assessment (post = last assessment completed, either annually or at program exit) included in the analysis for the program evaluation. A Paired-Samples T-Test revealed that the total average KIPS score improved significantly from initial assessment (average of 3.94) to last follow-up assessment (average of 4.38) (t=13.065; df=508; p=.000), yielding an increase in average score by .44 points. These results suggest that participants of the Home Visiting Program who completed both a pre and post (annual/exit) KIPS assessment demonstrated a significant improvement in parenting quality over time.  Thus, KIPS showed how the quality of parenting grew significantly more nurturing for the families who received CCAZ-HV services.  For clinical reflection, most of the positive shifts (gains of .50 to .56 on average KIPS scores) were seen in KIPS items related to Promoting Learning and Supporting Confidence.  This was good news since CCAZ-HV aims to get children ready for school and eager to learn! 

Based on the results, the Evaluation Team recommended that CCAZ-HV:

1) support  home visitors in setting achievable goals with families and

2) continue to evaluate parenting behaviors and skills, using data to target family services.

Using Parenting Assessment to Improve CCAZ-HV Family Engagement

One of the challenges our program faced was high family attrition.  KIPS helped getting families to “buy in” to our program.  To learn about and respect each parent’s view of their parent-child interactions, we developed a brief set of questions corresponding to the KIPS items to help parents reflect on their interactions before doing the KIPS assessment.  Then the staff assessed their parent-child play interactions, as guided by KIPS.  By providing our staff with specific insights into the parent-child relationship, we can tailor our services to match their needs.  Having new insights into the parent-child relationship allows our staff to provide more specific feedback to families.  We also found that using this observational tool expanded our view of parenting, so we provide feedback on a wider range of parenting behaviors. Since implementing the KIPS parenting assessment, we are seeing less attrition and more engagement by families.  

 Assessing parenting with KIPS has improved how we set specific goals with families and how we approach working on parenting skills, in partnership with the family, to achieve positive family outcomes.  After Child Development, the second most common area of goals set by 243 families was focused on Parenting Behavior and their Parent-Child Relationship.  Examples of goals include:

• Increasing parent-child activities
• Learning positive disciplining strategies
• Developing consistent routines e.g., for bed time, bath, toileting, chores

Parenting Assessment to Improve Our Work with Families

The Parent Educators review the KIPS play videos with the families, identifying areas of strengths and challenges.  For those families who have lower scores on specific areas of the parenting assessment tool, the Parent Educators bring them up while reviewing the video.  Then in partnership, they explore goals for improving in these areas.  For example, when there’s a lower score on the Limits and Consequences item, the Parent Educator and family partner to explore options to address it together.  As they explore, the Parent Educator brings materials on positive discipline, various discipline techniques, information on temperament, etc., to guide their work.  Together, they identify small steps needed to improve in setting reasonable limits and consequences, which provides a sense of family ownership in the process.  The goals established with the parents are reviewed formally every 90 days, so the process is well documented.  

At Child Crisis Arizona, Home Visiting Program we have found KIPS shows the improvement parents make from our services.  Further, we found that KIPS improved family engagement.  Clinically, we find KIPS deepens and broadens our understanding of the parent-child interaction and informs our work with individual families.