Care Improves for Vulnerable Children
Youngsters who participate in a national program for at-risk children
receive greater access to critically important health and social
services, improve learning skills that are crucial for their future
school success, and strengthen their family ties, according to early
findings of a study sponsored by SAMHSA and the Casey Family Programs.
The early findings were from a study of 2,908 children from 12
sites across the Nation who participate in Starting Early Starting
Smart (SESS). This program targets children from birth to age 7
whose family or community environments put them at risk for mental
and addictive problems.
The 4-year grant study is a collaborative effort among all three
SAMHSA Centers and the Casey Family Programs, which is a private
foundation with services that include support for children from
foster care to adoption.
"Eighty percent of parents who participate in the program
stay in the program. This is a clear indication of the program's
positive influences," said Ruth Sanchez-Way, Ph.D., Director
of SAMHSA's Center for Substance Abuse Prevention.
"We know that removing children from their families during
their formative, bonding years needs to be avoided," said
Ruth Massinga, president and CEO of Casey Family Programs. "Starting
Early Starting Smart shows that there are viable strategies and
approaches to prevent out-of-home placement. When we provide a system
of integrated services and consistent, skilled supports required
to ensure safe, nurturing, and loving homes, parents who may be
struggling with substance abuse and mental health issues stand a
much better chance of keeping their families together."
Based on the success of previous, similar programs, SESS uses
a child-centered, family-focused, community-based approach that
includes assistance in substance abuse prevention, mental health
services, and substance abuse treatment. These services, defined
as behavioral health services, are provided in settings that parents
with infants and preschool children normally frequent.
The demonstration project includes a total of 12 sites (see box)
and a coordinating center—Evaluation, Management & Training
Associates, located in Folsom, CA.
The SESS program figures were collected by the 12 grantees, with
nearly 3,000 children participating in the study. Rigorous evaluation
of the project has produced five major early findings demonstrating
that SESS programs have succeeded in:
- Increasing access to needed services for participating
SESS programs increased caregiver participation in educational
and therapeutic services concerning parenting and family functioning.
Thirteen percent more SESS caregivers participated in these programs
compared to similar families receiving a basic standard of care.
Moreover, in programs that emphasized the selection of families
in need of substance abuse services, 7 percent more of the SESS
caregivers in need of services received treatment, compared to the
standard-of-care families. Similarly, 12 percent more SESS than
comparison families in need of mental health services received treatment.
- Helping participating families strengthen the ways in
which they guide and support the development of their young children.
In several areas of family functioning and parenting behaviors,
SESS families made significant improvements compared to standard-of-care
families. For example, SESS families reduced verbal aggression in
the home 17 percent more than comparison families, where reported
verbal aggression actually increased on average. SESS families also
reported statistically significant improvements relative to comparison
families in the use of appropriate discipline (3.2 percent), the
use of positive reinforcements (2.2 percent), and in the variety
of experience provided children in homes with limited opportunity
- Decreasing drug use among caregivers when programs targeted
caregivers and infants in the early months of life.
In SESS programs operating in pediatric care settings, caregivers
in need of substance use treatment reduced their reported drug use
35 percent more than comparison caregivers in need of substance
abuse treatment services.
- Strengthening positive interaction between participating
caregivers and infants in the early months of life.
Coding of videotaped interactions between caregivers and infants
was more positive for SESS caregivers and children than for comparison
caregiver-child dyads in both feeding and play situations. At 6
months into the program, randomly assigned caregiver-child dyads
in SESS programs interacted more positively than randomly assigned
comparison caregiver-child dyads by statistically significant margins.
- Strengthening the development of young children in the
program in ways that are crucial for school success.
Preschool-age children in SESS improved significantly in social-emotional
and cognitive development relative to comparison youth. These developmental
areas are crucial to school readiness. For example, SESS children
improved their performance on use of linguistic concepts 8 percent
more than comparison youth. For children with high need in this
area, SESS children did better by 21 percent. As reported by teachers,
SESS children reduced externalizing problem behaviors 21 percent
more than comparison children, and reduced internalizing problem
behaviors 23 percent more than comparison children.
To learn more about Starting Early Starting Smart, visit ncadi.samhsa.gov/promos/sess/about.html.
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