on the ecological approach to child abuse, the National Center on Child Abuse and ... This paper reports on the second level of the evaluation, designed to assess ..... All the material was presented in interview format, to take into account the ...
Child Abuse & Neglect, Vol. 18, No. 5, pp. 473-485, 1994 Copyright 0 1994 Elsevier Science Ltd Printed in the USA. All rights reserved 01452134194 $6.00 + .OO
Pergamon
01452134(94)E0005-E
EVALUATING A COMMUNITY INTERVENTION TO REDUCE THE RISK OF CHILD ABUSE: METHODOLOGICAL STRATEGIES IN CONDUCTING NEIGHBORHOOD SURVEYS FELTON EARLS Department
of Maternal
and Child Health, Harvard School of Public Health and Developmental Research Unit, Judge Baker Children’s Center, Boston, MA, USA
Epidemiology
JACQUELINE MCGUIRE Department
of Child Psychiatry,
Harvard Medical School and Developmental Epidemiology Baker Children’s Center, Boston, MA, USA
Research
Unit, Judge
SHARON SHAY Dorchester
CARES,
Boston,
MA, USA
Abstract-Building on the ecological approach to child abuse, the National Center on Child Abuse and Neglect is supporting a number of community-based prevention initiatives. One such program, based in Boston, is designed to build a caring community in which families can be empowered to break patterns of abusive and neglectful behavior. Independent evaluation is central to the program. A multi-level strategy has been designed, incorporating information from census and other databases, from random household surveys, and from families participating directly in services provided. This paper reports on the second level of the evaluation, designed to assess community social support, attitudes about parenting, perceptions of the neighborhood, and ways in which these may relate to child abuse. Perceptions of the extent of danger and disorganization in the neighborhood were significantly related to a sense of attachment to the community, and to disciplinary strategies. Parents who perceived more danger were stricter. They also tended to be born locally rather than being immigrants. Place of birth was associated with variation in parenting styles, suggesting that patterns of in- and out-migration are important variables in planning and executing a community based child abuse prevention program. Key Words-Evaluation,
Community,
Intervention,
Survey.
INTRODUCTION SPARKED BY RENEWED interest in persistent poverty in urban areas, sociologists have intensified research to improve an understanding of what ecological factors best explain this phenomenon (Jencks & Mayer, 1990; Wilson, 1987; 1991). The lack of economic and material resources contributes to the weakening of family units and compromises parents’ capacity to rear children competently (Haipem, 1990). At the same time many residents of these communiSubmitted
for publication
Requests for reprints MA 02115.
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Center, 295 Longwood
March 23, 1993. Avenue,
Boston,
F. Earls, J. McGuire, and S. Shay CO-0p
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Nurturing
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Emergencies
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Aides
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of services
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in community-based
...
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ties also experience a variety of social and behavioral pathologies including crime, gang violence, and substance abuse. It should come as no surprise to find high rates of child maltreatment in such areas. Targeting high-risk neighborhoods for the prevention of child maltreatment is an important, but not sufficient, step. Even in the most disorganized areas only a minority of parents abuse their children. Effective interventions should also deal with the interaction between neighborhood, family, and individual factors. The ecological model advanced by Bronfenbrenner (1979) and adapted as a framework to study child maltreatment (Belsky, 1980; Garbarino & Kostelny, 1992; Garbarino & Sherman, 1980) encompasses the multiple levels of risk that are required to improve understanding and design effective interventions. Despite the appeal of this framework for guiding research, there have been surprisingly few efforts to use it as a basis for research (Barry, 1992). In this paper we provide the first report of a study designed to evaluate the impact of a community-based approach to prevent child maltreatment that adheres to this framework. One of the key neighborhood characteristics correlated with child maltreatment is social disorganization (Garbarino & Kostelny, 1992; Garbarino & Sherman, 1980). While other dimensions (e.g., quality of housing, proportion of very poor families, etc.) certainly play a role, it may be that increasing the social support among residents in a disorganized neighborhood is critical to any successful intervention. In the project being evaluated a comprehensive, integrated system of family support services is provided. As shown in Figure 1, the intervention program constitutes an interagency network of services, ranging from a food pantry, home health visitors, literacy training, and a family nurturing program to respite care and other programs to prevent placement of abused or neglected children outside their homes. The design of the evaluation study aims to capture the degree to which the beneficial effects of the intervention actually permeate the neighborhood over time, improving both family stability and parenting attitudes and practices that constitute the risk factors for child maltreatment, as social support networks within the neighborhood are developed and strengthened. The hypothesis evaluated posits that by increasing the level of social organization the neighborhood families will be better situated to provide for their children’s welfare. This should result in an improvement in their management practices and a measurable reduction in harsh, punitive, and violent interaction with children. To assess the program’s effectiveness three strategies are adopted (McGuire, Shay, & Earls, 1992). The first involves monitoring available population markers as a means of tracking changes in the neighborhood. Conceivably, an intervention to reduce the risk of child maltreatment should be reflected in improvements in health indicators, crime rates and school achievement, in addition to reported cases of child maltreatment. Alternatively, the degree of economic and social disadvantage existing in some urban neighborhoods might be too severe to be counteracted by an intervention program of limited scope. Our second strategy involves
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repeated cross-sectional surveys of neighborhood families to assess the risk factors for child maltreatment. These periodic surveys will provide the opportunity to directly assess the changing racial/ethnic composition of the neighborhood as well as risk factors for child maltreatment. The third strategy is to conduct more extensive evaluations of families participating in direct services such as parenting programs, prior to and after their involvement. This paper reports on findings of the first wave of the second level of evaluation, crosssectional surveys in this community. Our plan is to draw repeated random samples of residents in the same geographic area at regular intervals throughout the period of the intervention. With this design we should be in a position to interpret the effects of the intervention as it is influenced by stability and change in the targeted population. The survey data we describe complement these aggregate sources of information by providing a more detailed understanding of how individual families contribute to this dynamic picture. By noting the association of survey data collected during the period of the intervention and data routinely collected from various administrative systems in the city, we expect to be in a position to continue to monitor changes long after the intervention has ended.
METHOD The Area A neighborhood whose historical boundaries conform to a single census tract in Boston was targeted for the development of a continuum of neighborhood and family strengthening services. Child protection workers noted this neighborhood as an area with a particularly high rate of substantiated cases of child abuse and neglect. In fact, this was one reason for its selection for the community intervention. Unfortunately, due to vagaries in methods of coding addresses, we were not able to ascertain rates of child maltreatment for the neighborhood targeted for this intervention. We do know, however, that the number of both reported and substantiated cases of neglect almost doubled between 1987 and 1991 in the city as a whole, and physical abuse rose by about 50%. For instance, substantiated neglect rose from a rate of 2.7 per 1,000 in 1987 to 4.7 in 1991. Substantiated physical abuse cases went from 1.1 per 1,000 in 1987 to 1.6 per 1,000 in 1991 (Massachusetts Department of Social Services, 1992). While rates of neglect rose at a similar rate in the whole state, the increase in physical abuse was less marked in state statistics. The neighborhood is a microcosm of ecological risk factors. Changes toward a higher proportion of minority families and more extreme levels of poverty that characterized this neighborhood over the past 20 years mask a more subtle variation in ethnic composition. Census statistics show that from 1970 to 1990 the proportion of Caucasian residents decreased from 92% to 15%, while the proportion of blacks increased from 8% to 63%, and Hispanics increased from less than 1% to 22%. After three decades of declining infant mortality rates, a rapid reversal occurred in the late seventies and continues to the present for mothers who are black or Hispanic, but not for those who are Caucasian (Boston Department of Health and Hospitals, 1988). Many other population markers, among them the number of families below the poverty line, the number of single parent families, and the homicide victimization rate are available to depict other parameters of this striking neighborhood change. Information from the 1990 census indicates that 46% of households were headed by a single parent (U.S. Bureau of the Census, 1990). Statistics from the 1980 census show that 38% were officially classified as living in poverty, and 55% of residents were under the age of 25 (U.S. Bureau of the Census, 1980). In addition tremendous cultural diversity creates language barriers and social isolation;
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street violence pervades the area; and health indicators such as infant mortality (18.3 per 1000 births from 1984 to 1988 census) and low birth weight (13.4% for 1987 to 1989 census; Massachusetts Department of Public Health, 1990) demonstrate the vulnerability of families with young children. The Sample Over a period of 6 months two surveys were conducted in this neighborhood. The first involved random door-to-door contact to gain some information on the origins and characteristics of families living in the area, their parenting practices, and the utilization of local health and community services. Each street within the tract was surveyed, with interviewers visiting every fifth house, and questioning respondents where there was at least one child in the household. If there was no answer, or if no child lived at the address, then the next house was selected. Of the 118 families thus located, 101 agreed to participate, with a 14% refusal rate. The second survey was conducted approximately 6 months later to collect more detailed and specific information and to examine the utility of several established research instruments in gathering data in this culturally diverse neighborhood. Interviewers revisited the 101 households, and it was possible to conduct interviews at 71 of the original addresses (70%). At the second visit the caretaker of the youngest child in the household was interviewed, and it was this child that served as the subject for those assessment procedures designed to characterize parenting practices and the parent-child relationship. Of the 30 remaining addresses, there was no answer on several occasions at 19, at three the family had moved, in four cases they were not interested in participating, and 1 parent refused after reading the consent form. At the remaining three addresses, all multiple dwelling units, there was no recollection of the original questionnaire. Interviewees were provided with remuneration of $20 for participation. Although the refusal rate was much lower at the second contact (4%), the overall attrition was high despite the short interval between contacts. The sample available for analysis represents roughly 60% of the original sample. Procedure An interview, designed to take between 1 and 1 l/2 hours to complete, was constructed to cover ways that parents and other caregivers manage children, perceptions of the community, social networks within the community, ways in which the neighborhood influences parenting, feelings of personal efficacy, and mental or physical health problems of parents. The interview combined open-ended questions and more formal survey instruments. Openended questions covered the number and ages of children in the family, the place of birth of the respondent, their parents and grandparents, possible influences of ethnic group membership on parenting and the differences between current experiences and the respondent’s own childhood.
SPECIFIC The Simcha-Fagan
Neighborhood
INSTRUMENTS
Questionnaire
The Simcha-Fagan Neighborhood Questionnaire was used to gain information on perceptions of community involvement in the neighborhood, the extent of crime and other dangers within the environment, the quality of life and the extent of social contacts with neighbors (SimchaFagan & Schwarz, 1986). The complete scale of 54 items covers 9 aspects of the neighborhood. The dimensions, derived by factor analysis, represent informal neighboring, neighborhood
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attachment, size and breadth of network, neighborhood organizational involvement, local personal ties, anomie, social disorder, conflict subculture, and illegal economy. Internal consistencies for the subscales range from 64 to 87. The nine can be further reduced to three factors, representing community organizational base (alpha .60), community informal structure of personal ties (alpha .95), and the extent of disorder-criminal subculture (alpha .91). Some of the questions about neighborhood organization were omitted, and some on social contacts, because they were similar in content to items on the Maternal Social Support Index. The Maternal
Social Support
Index
The Maternal Social Support Index (MSSI) (Pascoe & French, 1990) provides information on the amount of social support available for a range of child-rearing activities, and involvement in activities outside the home. The MSSI is an l&item scale that is designed to assess qualitative and quantitative aspects of social support. It has test-retest reliability of .72 over a period of 6 to 8 weeks, in a sample of mothers attending a pediatric clinic, including low income families (Pascoe, Ialongo, Horn, Reinhart, & Perradatto, 1988). Validity has been demonstrated by its relationship to ratings of marital satisfaction, and by an inverse relationship with a measure of maternal depression (Pascoe & French, 1990). Raising
Children
Raising Children (Greenberger, 1988) and the Conflict Tactics Scale (Straus, 1979) were included to assess methods of discipline. Raising Children (Greenberger, 1988; Greenberger & Goldberg, 1989) is designed to reflect three dimensions from Baumrind’s (1967) model of parenting, namely authoritarian (“Harsh control”), authoritative (“Firm/responsive control”), and permissive (“Lax control”). It contains 39 statements about raising preschool age children, with a 7-point Likert response scale from “Strongly agree” to “Strongly disagree.” There are 13 items in each subscale, derived by selecting items thought to reflect the required constructs and including some items from the Child-Rearing Practices Report (Block, 1965). Internal consistencies of the scales for mothers, in a predominantly Caucasian, college educated, and middle class sample are Harsh control .72, Firm control, .69 and Lax control .60. While it was originally designed for use with parents of preschool children, pilot work with families similar to those in this study has found it to be relevant and reliable with families of older children (ages ranging up to 15 years) (McGuire & Earls, 1993). The Conjict
Tactics Scale
The Conflict Tactics Scale (CTS) was developed to give information on intrafamily conflict and violence (Straus, 1979). Parents are asked about the frequency in the past 12 months of using 19 different strategies to resolve problems with their child. The items include “Physical Force” (e.g., Slapped or spanked him/her; Threatened him/her with a knife or gun), “Verbal Aggression” (e.g., Swore at the child; Said something spiteful), and “Reasoning” (e.g., Discussed an issue calmly). The scale has been used in telephone interviews, as a questionnaire and in face-to-face interviews (Straus & Gelles, 1986). Internal consistencies, based on a national survey, range from SO to .76 for Reasoning (3 items), .77 to .88 for Verbal Aggression (5 items) and .62 to .88 for Physical Force (10 items). Parental
Bonding
Instrument
The Parental Bonding Instrument (PBI) (Parker, Tupling, & Brown, 1979) was used to investigate parents’ feelings towards their own mothers. The PBI is a 25-item scale, with a 4point response Likert scale. Adult respondents decide how similar descriptions are to their
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own parent, during their first 16 years (very like to very unlike). Two subscales have been derived from factor analysis; 12 items refer to the “care” dimension (caring versus indifference, e.g., “was affectionate to me”) and 13 to “protection” (control versus overprotection, e.g., “tried to make me dependent on her”). Test-retest over three weeks was .76 for care scale, .63 for protection scale, with very similar split half reliability, .88 for care, .74 for protection. Validity has been demonstrated by comparing PBI responses compared with interviews. Relationships between interviews and questionnaires responses were .77 and .78 for the “care” scale, and .48 and 51 for “protection” dimensions. The Five-Minute
Speech Sample
The Five-Minute Speech Sample (FMSS) (MagaHa et al., 1986) was included in the interview, to examine the relationship between the respondent and their youngest child. The caregiver is asked to speak for 5 minutes about the child and how they get along together. The resulting description is examined for content that is critical or hostile, and for indications of emotional overinvolvement between parent and child. The initial statement is assessed, the quality of the parent-child relationship, the number of critical remarks about the child, the amount of praise, and evidence of overinvolvement such as extreme sacrifices made by the parent, or demonstration of distress as they talk about the child. A final rating signifies high or low “expressed emotion,” which can be critical and hostile, or based on overinvolvement. The concept of expressed emotion was originally assessed with the Camberwell Family Interview (Brown & Rutter, 1966). Interrater agreement for the FMSS has been found to range from .36 to .94, with quality of relationship the weakest area, while for overall EOI categories agreement ranged from .70 to .80. Validity of the FMSS has been demonstrated by comparison with the Camberwell Family Interview, with few false positives, but a tendency for false negatives (8/23 and 15155; Magafia et al., 1986).
ADMINISTRATION All the material was presented in interview format, to take into account the range of literacy levels and languages in the neighborhood. All items were read to the respondents, who had copies of the response scales where appropriate, and the interviewer completed the response sheets. The FMSS part of the interview was tape-recorded for subsequent transcription. Two interviewers were trained to complete the survey, both of whom were multilingual and fluent in the languages known to be prevalent in the neighborhood (Cape Verdean, Haitian Creole, Portuguese, Spanish) and who were familiar with the area. The interview questions were translated as the interviews were administered. During training, detailed discussion had taken place regarding the concepts in the questions, and interviewers provided some additional explanation to respondents who had difficulty interpreting the questions, or the response format (such as a Likert scale). Data Management
and Analysis
Responses to open-ended questions were written by the interviewers, and subsequently coded. Interrater agreement about the coding was .83. Responses to the questionnaires were also recorded by the interviewer, in collaboration with the subject. They were scored according to the test authors’ guidelines, and relevant subscales calculated. Analysis concentrated on the influence of country of origin, the relationship between the neighborhood and social networks with parenting behavior, and the influence of family of
Evaluating Table 1. Selected
a community
Characteristics
intervention of Survey n
Relationship to Target Child Mothers Grandmothers Fathers Others Country of Origin of Respondents USA, Northeast USA, South Cape Verde West Indies Puerto Rico Other Age of Children in Household O-l 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17
479 Respondents %
55 7 5 4 16 7 28 11 6 3
22 10 39 15 8 6
25 23 29 23 20 14 16 12 20
13.7 12.6 15.9 12.6 10.9 7.6 8.7 8.2 5.5
origin. Correlations that are cited are Pearson Product Moment calculations. Findings related to the Five-Minute Speech Sample (FMSS) are not reported in this paper. Because of the considerable time taken in translating the FMSS, the results were not available at the time this paper was prepared. They are reported in elsewhere (McGuire & Earls, 1994). Comparisons between means of questionnaire scores are based on two-tailed r-test statistics.
RESULTS The Sample The 71 respondents were predominantly female and the majority identified themselves as mothers as shown in Table 1. Most families were living near or below the poverty line. The average number of children in this random sample of households is 2.56, a figure that agrees closely with the most recent census data for this area. The mean age of the 182 children identified is 7.6 years. Table 1 shows the proportion at different ages; approximately 13% to 16% are present in the households from infancy to age 10, thereafter the proportion declines. Table 1 also indicates the place of birth of respondents. The largest number were from Cape Verde (39%), followed by the U.S. (32%), and the West Indies (15%). Only a small percentage (8%) were of Puerto Rican background. Because of our interest in migratory patterns in this community over time, we also inquired about place of birth within the U.S. As shown, a minority of respondents were from the southern region. Neighborhood
Factors
Table 2 gives responses to queries about the neighborhood in the Simcha-Fagan naire. Beginning with the definition of the neighborhood, only a small proportion
Questionassigned a
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Table 2. Description of Neighborhood Characteristics Frequency 1. Area delimited on map 20 streets (missing = 2) 2. Do you use a name to identify this neighborhood? Yes No 3. How long do you expect to stay here? 5 years Cannot predict 4. Do you feel at home? In your block Surrounding 2 blocks Surrounding 4 blocks
%
4 20 20 11 14
6 29 29 16 20
10 61
14 86
19 17 5 25 5
27 24 I 35 7
44 29 23
62 41 32
name to the neighborhood, over half described their neighborhood as 10 blocks or less, and about half expected to stay in the neighborhood for a period less than 3 years. Forty-three percent of respondents viewed their neighborhood as less dangerous and 40% as no more dangerous than surrounding areas of the city. While this perception may be correct, it is important to note that arrest and homicide victimization data indicate that the neighborhoods surrounding this one are relatively more dangerous than many others in the city. Nonetheless, only about a third (32%) feel at home beyond a four-block area. This was also reflected in responses to questions about going out at night. The majority (86%) said that it was very risky to go out at night, with 71% saying they were personally afraid. The most frequent violent problems believed to exist in the area were fights with weapons (58%), youth gang disturbances (42%), incidents where someone was wounded (38%), and arguments between neighbors (26%). Selecting from a list of potential neighborhood problems, those noted most often were excessive public drinking (41%), home burglaries (41%), unemployed men hanging about in the street (39%), the presence of drug addicts (32%) and muggings (32%) or assaults (24%). Perceptions of danger within the neighborhood were significantly associated with ratings of the quality of area as a place to live and raise children (r = .64, p < .OOOl), and to a sense of attachment to the neighborhood (r = .55, p < .OOOl). However, perceptions of danger were not related to the size of networks of friends and family in the neighborhood elicited by the Simcha-Fagan Questionnaire or to reports of social support available, using the MSSI. Perceptions of the neighborhood were associated with the respondent’s place of birth. Overall, those who had been born and raised locally, or in other northeastern cities were less positive about the neighborhood than individuals who had been born in other countries, or in the southern U.S. (see Table 3). They perceived it to be more dangerous, and rated it lower in quality of life, as a place to live or raise children. They also expressed less attachment, or sense of belonging to their neighborhood, while those from Cape Verde and the southern U.S. expressed the most neighborhood attachment. When asked how the neighborhood differed from that of their own childhood, dangers in the environment were most often mentioned (22/71, 31%), followed by higher levels of child misbehavior (20/71, 28%) and loss of adult authority (S/71, 11%).
Evaluating
a community
Table 3. Neighborhood N NE USA South USA Puerto Rico West Indies Cape Verde
16 7 6 11 28
Disorder
intervention
Perceptions
and Danger
481
by Country
of Origin
Neighborhood
31.8” 27.0 27.2 28.1 25.7
Attachment
17.8 20.1 18.0 16.7 20.1b
Oualitv
of Life
4.8 6.7 6.8 5.9 6.6
a North East > Cape Verde (p < 0.001); North East > South (p < 0.10); North East > Puerto Rico (p < 0.12). b Cape Verde > West Indies (p < 0.05); Cape Verde > North East (p < 0.10). ‘ North East < Cape Verde (p < 0.001); North East < South (p < 0.05); North East < Puerto Rico (p < 0.05).
Social Support A sense of belonging to the neighborhood was positively, although weakly, associated with the extent of social support available to respondents, as indicated by the Maternal Social Support Index (MSSI) (r = .25, p < .OS), and by a total of responses to items from the SimchaFagan Questionnaire that indicated friendships and extended family within the neighborhood (r = .31, p < .05). Somewhat unexpectedly, quality of life as measured with this scale was not associated with the extent of social support available (r = .08). Discipline Those parents who described more dangers in the neighborhood tended to describe more sharply defined and parent-centered discipline methods (correlation with harsh control from Raising Children: r = .24, p < .05), and more use of both verbal aggression (r = .25, p < .05) and reasoning (r = .27, p < .05) on the CTS. Nonetheless, perceived danger was not associated with more use of physical violence in disciplining children. The caretakers who described a more isolated pattern of child care (i.e., low social support), with sole responsibility for most household duties, were likely to report using more physical violence on the Conflict Tactics measure while disciplining their child (CTS physical violence with MSSI; r = - .36, p < .Ol). Methods of discipline were associated with parents’ place of birth. Specifically those born in Cape Verde reported less verbal and physical violence than the other groups (see Table 4). Table 5 shows the frequency of verbal and physical tactics used in the past 12 months. The most frequently mentioned were slapping or spanking (57%), pushing or grabbing (27%), threatening to hit (24%) and hitting with an object such as a belt (21%). Parents born in the West Indies expressed more agreement with statements indicating harsh discipline (e.g., a well-raised child is one who does not have to be told twice to do something)
Table 4. Harsh Discipline N NE USA South USA Puerto Rico West Indies Cape Verde
16 7 6 11 28
CTS Verbal Aggression 6.6 5.0 5.3 4.0 0.7”
by Country
of Origin
CTS Physical
Violence
5.8 5.6 4.0 4.5 2.5
a Cape Verde < All other groups (p < .Ol). b West Indies > North East (p < 0.01); West Indies > Cape Verde (p < 0.01).
Harsh Control, Raising Children 54.6 56.9 56.0 63.3b 54.5b
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and S. Shay
Use of Verbal and Physical Control in the Past 12 Months, Reported in the Conllict Tactics Scale Percent
CTS Item Swear at child Stomp out of the room Say something spiteful Threaten to hit Throw something Throw something at the Push, grab, shove Slap, spank, hit Kick, punch, bite Hit with something Beat up child Bum, scald
Never 16 80 19 16 86 91 13 43 99 79 99 100
Reporting
Once/Twice 11 10 7 10 8 3 18 27 1 10 0 0
Use Three or More 13 10 14 14 6 6 9 30 0 11 1 0
than parents born in the northeastern U.S. or Cape Verde (difference in Raising Children Scores for harshness at p < .05 level). On the other hand, parents born in Cape Verde were less likely to take a child-centered approach to child rearing (e.g., I give my child a lot of freedom to express anger) than those born in northeastern U.S., southern U.S., or the West Indies (p < .OS). If respondents recalled their own mother (or primary caregiver) as lacking in warmth and caring on the Parent Bonding Instrument, they were more likely to use more verbal aggression in discipline as demonstrated on the Conflict Tactics Scale than respondents who recalled a warm upbringing (r = - .29, p < .Ol). This trend just failed to reach statistical significance for use of physical aggression. These findings are not easily reconciled with the significant association between lack of warmth in the respondent’s mother and their own lax and childcentered style of parenting, as described on Raising Children Questionnaire (1. = - .32, p < .Ol). Recollection of one’s own mother as intrusive and overprotective was related to less use of verbal aggression (r = - .27, p < .OS) and to a lax style of parenting (r = < .25, p < .05). However, perceiving one’s childhood as overprotective was not correlated with perceiving it as warm and caring.
DISCUSSION The least anticipated finding of this study relates to the strong association between the cultural background of parents and their child disciplinary practices. This result is of importance in interpreting the impact of the community-based intervention. It indicates the need to maintain a high degree of flexibility in the programs making up the intervention program. Because the intervention is taking place in the context of a dramatic shift in the resident population, an especially challenging question arises as to how to respond to the potential that such changes in the ethnic composition of the population may continue. It is conceivable that those most likely to benefit from the intervention over the short term are also those most likely to move to more desirable residential areas. By asking residents to describe a neighborhood that has undergone a conspicuous pattern of in- and out-migration, we obtained perceptions that may be conditioned by length of residence and a commitment to remain in this area. The fact that most delineate an area considerably smaller than the objective neighborhood boundaries, do not know it by name,
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and would like to move within 3 years suggests a situation in which a new wave of outmigration might occur during the 5-year cycle of the ongoing intervention. On the other hand, if, as the intervention seeks to accomplish, existing social networks are enriched and new ones developed, the perception of the neighborhood may improve and out-migration become viewed as less desirable. Of course, determining which of these occurs is key to judging the ultimate success of the intervention. While negative perceptions of the neighborhood are associated with more harsh discipline practices, the variation by ethnic group is striking. Although a detailed account of family structure was not made in this pilot study, anecdotal evidence suggests that the Cape Verdean families are more likely to have extended structures and include both fathers and relatives. Because many of these families are relatively recent immigrants, they may not yet be acculturated to urban life in the United States. Data on risk factors for low birth rate for black women in Massachusetts indicate that recent immigrants have substantially lower risk than those born in the U.S. (Morbidity and Mortality Weekly Report, 1991). These findings parallel those described in some populations of Mexican-American women for whom high acculturation appears to be linked to poor pregnancy outcomes (Bautista-Hayes, 1990). The mechanisms accounting for this change have not been delineated, but changes in personal habits and family structure, in addition to exposure to racism, unemployment and job insecurity no doubt all play a role (Earls, 1992). This pilot study has encouraged us to continue to develop and refine our multi-method strategy to evaluate an intervention whose major objective is to improve the character of the neighborhood. As a first step, the study has shown that we can collect detailed survey data from community residents. However, more decisive efforts are needed to minimize attrition. Second, for the most part, the specific variables we investigated appear to be important in characterizing families and in indexing the parent management practices that are the specific risk factors the intervention program aims to modify. The fact that the measures we used were able to detect important cultural differences in this population is consistent with careful selection and preliminary testing of these methods prior to taking them to the field (McGuire & Earls, 1993a). Third, some areas not covered in our interview protocols now stand out more clearly as necessary additions to our continuing work. For example, information on family structure, income and job satisfaction, and access to human services are needed to expand our knowledge about some of the constraining or inhibiting influences that may serve to obstruct or restrict the positive effects of the intervention. At the same time, we have found that other measures, such as those that tap generalized recall of childhood experiences, are not as useful. Fourth, we are in a much better position to understand the significance of cultural differences in interpreting the effects of this intervention over time. These findings dictate the need for a larger sample in our next round of data collection so that the cultural diversity of this neighborhood can be studied in greater detail. Fifth, the relevance of cultural differences suggests that adding an ethnographic component to the design has considerable merit. Such detailed study of a few well-selected families may help to depict how attachments to the neighborhood are formed and become stabilized. Findings from studies of this type may be able to bring into sharper focus than survey data those aspects of community life that are most important to the quality of life for a particular ethnic group. The type of intervention that we are evaluating, one that does not target individuals, but rather is aimed at improving the overall quality of life in a carefully demarcated neighborhood, is broadly supported by both public health and social welfare constituents as a major strategy in strengthening both families and communities (Barry, 1992). However, it may not be sufficient on its own to bring about desirable level of improvement in parenting practices and in lowering the incidence of child maltreatment. The research methods we have employed in the first step of this long-term evaluation project indicate that a systematic approach to data collection,
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and S. Shay
using standardized instruments where feasible, is an important evaluation strategy. By monitoring markers of change at the population level and collecting periodic survey data through cross-sectional sampling of neighborhood residents, the effects of the intervention at the aggregate level can be described. In addition to this approach, the particular intervention program we are evaluating is incorporating a component specifically to address high-risk families (for example, cases where the parents are known to abuse alcohol or drugs). Thus, at the same time we are refining our survey methodology, we will develop a strategy to evaluate this aspect of the overall program as well. Acknowledgement-The authors would like to thank all the families in the community who agreed to complete interviews, and thanks to Ava DePina and Manuel DePina, whose linguistic and interviewing skills were invaluable to the project.
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R&um&Le Centre national pour l’enfance maltraitee et negligee du gouvemement federal americain finance des projets de prevention dans les collectivites, lesquels s’appuyent sur une approche Ccologique. Parmi ceux-ci, un projet a Boston habilite les parents a interrompre leurs comportements abusifs et cherche a bltir des communautes aidantes. Une evaluation indtpendante doit faire partie integrale de ces projets, y compris une strategic a plusieurs volets ou on recuille des informations times du demier recensement. D’autres informations tels des sondages altatoires des foyers et des familles recipiendaires de services et faisant partie du projet sont aussi recueillies. Cet article fait &at de la deuxitme &tape de l’evaluation, soit celle ob on Cvalue les supports communautaires, les attitudes vis-a-vis du role parental, les attitudes des gens du quartier et les fagons don ces elements jouent un role par rapport a la maltraitance. On a remarqut que la facon dont les gens per$oivent le danger et la desorganisation dans leur quartier est reliee au sentiment d’attache envers leur milieu et aux pratiques auxquelles ils ont recours pour discipliner leurs enfants. Les parents qui se sentent menaces dans leur milieu sont plus s&v&es envers leurs enfants. 11 est plus probable que ces parents soient nes dans le quartier plutbt que d’y avoir immigre. La facon dont les parents s’acquittent de leur tdche en tant que parents varie selon le lieu de naissance et ceci suggere que I’immigration hors et vers le quartier est un facteur important lorsqu’il s’agit de planifier et d’implanter un programme de prevention de la maltraitance dans un quartier quelconque. Resumen-Fundamentados en el enfoque ecologico al abuso contra 10s niiios, el Centro National de Abuso y Negligencia a 10s Nifios esta apoyando un nlimero de iniciativas de prevention con base en la comunidad. Uno de estos programas, localizado en Boston, ha sido diseiiado para construir una comunidad que cuide de 10s nitios, en la que las familias puedan tener el poder de romper patrones de conducta abusivas y generadores de negligencia. La evaluaci6n independiente es central para el programa. Se ha diseiiado una estrategia de varios niveles, incorporando information de1 censo y otras fuentes de datos, de encuentas de hogares al azar, y de familias que participan en 10s servicios directos ofrecidos. Este trabajo reporta sobre el Segundo nivel de la evaluacibn, disehado para evaluar el apoyo social de la comunidad, las attitudes de 10s padres sobre la crianza, las percepciones de 10s vecinos y las maneras de relacionarse con el abuso a 10s nitios. Las percepciones de1 grado de peligro y desorganizacidn en el vecindario estaban significativamente relacionados con el sentido de apego a la comunidad, y a estrategias de disciplina. Los padres que percibian mb peligros eran mas estrictos. Tambitn habia una tendencia a que fueran nativos de1 lugar en vez de inmigrantes. El lugar de nacimiento esta asociado con la variacidn en estilos de crianza, sugiriendo que 10s patrones de in- 6 emigracidn son variables importantes al planear y ejecutar un programa de prevencidn de abuso a 10s nitios con base en la comunidad.
