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Organization and staffing barriers to parent involvement in teen pregnancy prevention programs: challenges for community partnerships
Journal of Adolescent Health 37 (2005) S108 –S114
Educational programs
Organization and staffing barriers to parent involvement in teen pregnancy prevention programs: challenges for community partnerships Janet E. Flores, Dr.P.H., Susanne Montgomery, Ph.D.ⴱ, and Jerry W. Lee, Ph.D. Department of Health Promotion and Education, Loma Linda University School of Public Health, Loma Linda, California
Abstract
Purpose: To evaluate parent involvement in a Southern California teen pregnancy prevention community partnership project. Researchers expected to find parent and family-related participation barriers similar to those described in the family support literature, which they could address with program modifications. Methods: Three phases of qualitative evaluation occurred: key informant interviews and focus groups with youth and parents; focus groups with service providers; and key informant interviews with service providers, their supervisor, and the collaborative coordinator. Theory-based, openended question guides directed the interviews and focus groups, and transcriptions were coded and themed using grounded theory methods. Results: Parents and youth sought ways to improve connections and communication with each other, and parents welcomed parenting education from the project. Unexpectedly, the major obstacles to parent participation identified in this project were largely organizational, and included the assignment of parent involvement tasks to agencies lacking capacities to work effectively with parents, inadequate administrative support for staff, and the absence of an effective system for communicating concerns and resolving conflicts among collaborative partners. Conclusions: Youth serving agencies may not be the best partners to implement effective parent involvement or family support interventions. Collaborative leadership must identify appropriate partners, engender their cooperation, and support their staff to further the overall goals of the collaborative. © 2005 Society for Adolescent Medicine. All rights reserved.
Keywords:
Collaborative approaches; Family support programs; Parent involvement; Barriers to parent involvement; Qualitative evaluation methods; Grounded theory
Parents play a protective role in the development of their adolescent children’s abilities to avoid risky behavior. By their concern, supervision, and communication, particularly about sexuality, parents who forge close bonds with their teens provide the socialization that shapes their sexual attitudes, behaviors, and sexual risk perceptions [1]. Although researchers have not systematically studied the effects, nature, or extent of parent involvement in teen pregnancy prevention programs, the current funding trend is for granting agencies to encourage programs that include parents, enhance parenting skills, and improve parent-child relation-
ships [2]. Similarly, community-based multi-agency partnerships are also currently popular strategies for delivering youth risk-reduction and family support interventions when limited evidence exists of their effectiveness [3]. With funding agencies strongly encouraging risk reduction programs to access “at-risk” youth and their parents, it is easy to see the appeal of youth-serving agencies as potential collaborative partners. This article describes a three-year qualitative study to identify and reduce obstacles to parent involvement in a community collaborative teen pregnancy risk reduction project.
ⴱAddress correspondence to: Dr. Susanne Montgomery, Department of Health Promotion and Education, Loma Linda University School of Public Health, Loma Linda, CA 92350. E-mail address: [email protected]
Literature Review Most studies of parental involvement in education, family support, and mental health programs narrowly focus on
1054-139X/05/$ – see front matter © 2005 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2005.05.003
J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
S109
Fig. 1. McCurdy & Daro conceptual model on parent involvement.
identifying family or provider factors that affect parent participation. Parent age, gender, socioeconomic status, marital status, employment status, spoken language, and education have inconsistently predicted attrition from intervention programs [4 – 6]. Common parent involvement barriers identified by Birch and Hallock [4] include changing work schedules, childcare and transportation problems, untimely program outreach, language barriers, and conflicting family responsibilities. Studies have identified the characteristics of program facilitators and parent educators to influence parent retention in family support programs, including their age, gender, race, and teaching and communication styles. Lastly, family support program facilitators who are experienced, culturally competent, and formally educated and trained, are more successful in retaining parents than those who are not [7,8]. Few studies address barriers to parent involvement beyond family circumstances and provider characteristics. Early work by Garbarino and Kostelny [9] suggested that a neighborhood’s social capital affects parents’ willingness to participate in parenting programs. Parents from neighborhoods with high crime and poverty were unlikely to trust or seek help or support from programs associated with the government [10,11]. Hanson [2] demonstrated that administrators of adolescent family life programs who supported their parent outreach staff with training opportunities and used ethnically diverse and graduate-prepared facilitators were more successful in enrolling and retaining parents. McCurdy and Jones [5] demonstrated similarly positive effects for program administrators who nurtured their direct service staff with training and development opportunities, solicited staff input, and provided staff forums to discuss difficult cases. Gross et al [12] showed that family support programs that were scheduled and planned for the parents’
convenience, employed culturally competent and trustworthy staff, and provided free childcare had greater participation than those that did not. Figure 1 illustrates the ecological model proposed by McCurdy and Daro [13] to explain parent involvement that links the influences of family factors, provider attributes, project and organizational characteristics, and neighborhood characteristics to parent intentions, enrollment, and retention in voluntary parenting programs. McCurdy and Daro’s model helps to evaluate emerging multi-agency approaches to teen pregnancy prevention in the prevailing environment of reduced federal funding and devolution of health and social services to states and local governments. Interagency collaborations are popular strategies for addressing a variety of state and local community health and social welfare issues. However, the term collaborative is often used to describe a variety of interagency relationships that are not truly collaborative, including cooperative and coordinated partnerships and coalitions. Reilly [14] described a continuum of collaboration that begins with cooperation, progresses to coordination, and ends with collaboration. Cooperative relationships are characterized as informal partnerships that share information between independent partners. Coordinated partnerships have modest organizational structures and more formal relationships between partners, but partners retain their own authority. Like task forces, coordinated partnerships develop structures within which partners agree to work together, establish specific roles for partners in a project, and emphasize common tasks and channels of communication among partners [14]. Collaboration ideally involves durable partnerships that unite multiple organizations around a common purpose, and require very complex structures and comprehensive planning to accomplish their goals. Authority in
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J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
Table 1 Phase I, II, and III evaluation themes and related quotes Phase
Themes
Representative quotes
Source
I
Parent outreach and marketing
PFG
I
Transportation and safety concerns
I
Social isolation of single parents
I
Enthusiasm for parent education
II
Parent outreach and recruitment
II
Roles of the rec center managers
II
Parent contact at rec centers
II III
Project documentation and reporting was burdensome Increased scopes of work
III
Inadequate compensation
III
Exclusion from the collaborative process
“We didn’t know that there was a family night. If they (recreation staff) just let us know about the family nights, I’m sure most of us will come out.” “Since I don’t drive, I have a hard time getting my kids to sports or other activities.” “You can’t walk down these streets anymore. It’s just not safe.” “I try to come as much as I can, just to get out of the house.” “I keep to myself. I don’t know my neighbors.” “They should offer parenting classes here. Do they offer parenting classes here?” “I need to learn how to talk to my kids without yelling at them. I do that a lot.” “Parents need to know more about sex to help them talk to their kids about it.” “Initially, the (lead agency) did all the recruitment. Over time it became our jobs. It should have remained their responsibility. They’re the professionals.” “Parent recruitment was difficult because so many of the parents don’t speak English, and our staff don’t speak Spanish.” “We are not parent educators or recruiters. “We are recreation specialists.” “Parenting education and sex education needs to be done by professionals.” “We deal with kids whose parents aren’t available and don’t ever come here. To them we are free babysitters.” “None of us expected the amount of paperwork required for this project. It was too much, and we didn’t have the staff to handle it.” “In the original partnership agreement, we were responsible for (only) sports and recreation. In 1999 we were responsible for it all. That wasn’t fair to us.” “There (were) no financial incentives to do more work for this project.” “The allocation of funds should have been proportional to the work done.” “There wasn’t a place to direct our complaints or questions about (the project). The agency directors were not interested in our issues. They met in their group and we met in ours.”
PKI PKI PKI PFG PFG RSM
RSM RSS RSS RSM RSM RSM
PKI ⫽ parent key informant; PFG ⫽ parent focus group; RSM ⫽ recreation site manager; RSS ⫽ recreation site managers’ supervisor.
a collaborative derives from the collaborative structure and the consensus of the partnership [14,15]. The literature, however, has yet to show that community collaborative partnerships are superior to other approaches to adolescent risk-reduction. In a 2002 comprehensive review of Robert Wood Johnson Foundation-supported community anti-drug coalitions, collaborative strategies aimed at youth were found to have few effects, and strategies aimed at adults had negative effects over time [16]. This qualitative study examines a collaborative approach to teen pregnancy prevention, and identifies barriers to parent involvement in the project’s parent education component that were linked directly to difficulties in the collaborative process. The Project The collaborative project described in this article began in 1996 in a Southern California major metropolitan city. The aim of the project was to reduce teen pregnancy rates in several local zip code areas known as the “high-risk” corridor for teen pregnancy, where rates more than doubled national rates. Multiple community-based agencies pooled their services and resources to target 10 –17-year-old youth and their parents with interventions that included youth development, sports and recreation, visual and performing arts residencies, sex education, youth mentoring, parenting education, and cross-referrals for youth services. The local
public health office was the lead agency on the project, and provided curriculum-based programs and experienced parent educators to the other partner agencies when needed. The collaborative partners included two distinct youth recreation agencies, the county arts council, alternative and public schools, and the city youth mentoring program. The initial collaboration agreement limited the roles of the recreation agency staff to youth development and recreation services, whereas the lead agency provided parent education, planning, and facilitation at the recreation sites. The project began in 1996 with four recreation sites, and then later expanded to seven sites in 1999 at the request of one recreation agency director, to enable this agency to meet its quarterly projected numbers of youth served with recreation and youth development activities. The expansion also increased the scope of parenting and family activities and shifted program planning and facilitation responsibilities for these activities away from the lead agency to the recreation agency staff. Originally, parenting/family activities were scheduled monthly, and included family fun and educational activities, family dinners, and periodic parenting classes. Methods This qualitative study employed multiple methods of investigation to evaluate parent involvement in a collaborative teen pregnancy prevention project, including key in-
J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
formant interviews, focus groups, and participatory observation. Three distinct and consecutive phases of project evaluation occurred, with phases II and III proceeding from the outcomes of phase I. Graduate students from Loma Linda University, trained in group-facilitation and interviewing techniques, formed the evaluation team, facilitated the evaluations, analyzed the data, and delivered oral and written summative reports to collaborative partners. Theory based, open-ended question guides directed the interview and focus group discussions. Focus group participant and key informant interview comments were audio-recorded, transcribed, coded for themes, and recoded for sub-themes using grounded theory methods [17,18]. Focus groups were conducted to explore and validate themes identified by the key informant interviews using standard focus group methodologies as discussed in Thomas Greenbaum’s Handbook for Focus Group Research, 1993, and Michael Quinn Patton’s Qualitative Research & Evaluation Methods, 2002 [19,20]. The phase I evaluation occurred between October and December of 1999 and involved key informant interviews and focus groups of program youth and of parents. The purposes of the phase I evaluation included: (a) to identify parent and youth perceptions of parent participation in the project, (b) to develop recruitment strategies to boost parent involvement, and (c) to identify topics of interest for planning future parent and family programs. Key informant interviews were conducted to identify prominent parent involvement themes. Focus groups were then followed by focus groups that either elaborated or invalidated the saliency of these themes. Two recreation sites were used for phase I. A total of 10 black male and eight black female youths between the ages of 10 and 16 years participated in two key informant interviews and one focus group. All youth interviews were done in English. A total of 18 Hispanic and black parents and guardians of adolescents, including 13 single mothers, participated in five parent key informant interviews and one focus group. Four parent interviews were done in English, and one with a Spanish translator. The parent focus group was done in English with simultaneous Spanish translation. The results from the phase I evaluation suggested program barriers to parent involvement (Table 1, phase I), and prompted a second phase of evaluation directed at the project staff responsible for parenting and family activities. Phase II evaluation spanned 2000 –2001, and involved two meetings of the recreation site managers and their supervisor in focus groups conducted seven months apart. The objectives of the first phase II focus group were: (a) to present to the recreation site managers the barriers to parent involvement identified in the phase I evaluation, (b) to obtain their reactions, and (c) to strategize to improve parent and family participation in the project. An outcome of the first phase II focus group was the execution of a plan by recreation site managers and staff for a summer “kick-off”
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Table 2 Parent suggestions for parenting education topics Adolescent emotional and sexual development Anger management and conflict resolution Strengthening parent–youth communication skills Sexuality education for parents and youth separately and together Effective discipline with adolescents Fostering academic success in our children Negotiating the public school system to advocate for our children’s academic needs
family event that helped to identify the parents of youth program participants, and facilitate their recruitment and retention in the program. The second phase II focus group occurred as follow-up to this summer event, to record managers’ perceptions of the event, and to determine their support for continued parenting and family activities at their service sites. Transcripts and observer notes from phase II indicated that the recreation sites’ supervisor verbally dominated each of the phase II focus group discussions, and that her staff deferred to her, which suggested a reticence among recreation site managers to voice their opinions in her presence, and prompted the need for a third phase of evaluation involving private interviews with site managers to assess the veracity of the themes revealed in phase II. Phase III of the evaluation occurred in the summer of 2002, and included five individual interviews with site managers for the purposes of determining managers’ views on parent involvement in the teen pregnancy prevention program, and managers’ perceptions of their own roles and responsibilities for the parenting and family activities in the project. Interviewees each had a 3- to 5-year history with the project. Interviews were conducted in English, recorded in writing, and averaged 40 minutes in length. Lastly, to balance the evaluation, phase III also included separate key informant interviews with the recreation sites’ supervisor and the collaborative coordinator to get their perspectives on parent involvement in the teen pregnancy prevention project. Results Phase I evaluation results Table 1 shows the themes that emerged from each phase of the project. Four parent involvement themes emerged from the phase I data: (a) parents welcomed opportunities for parenting education classes that addressed their own topics of interest (see Table 2), and even volunteered to help organize such events at their neighborhood recreation sites; (b) parents’ comments suggested that parent outreach and project marketing was minimal, (only one of the 18 parent interviewees recognized the project by its name, and none of the focus group parents recalled hearing about or attending site-sponsored parent training events); (c) mothers and
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grandmothers raising children alone referred frequently to feelings of isolation, and foresaw family events at their local recreation sites as social outlets; and (d) mothers who characterized their neighborhoods as unsafe at night, and did not venture out to attend nighttime scheduled family events preferred daytime, summer afternoon, or evening scheduled family programs. Phase II evaluation results Four themes emerged from site managers’ and their supervisor’s comments and reactions to the phase I evaluation results (see Table 1, phase II). Recreation staff reported having conducted door-to-door parent recruitment for family support activities in the initial years of the project with disappointing results, and that little to no parent recruitment or parenting education had occurred at their sites since 1999, when they were made responsible for all family activity program planning and delivery. Managers saw their own roles in the project as youth recreation specialists who served the needs of youth, rather than as family activity planners or facilitators. They saw their facilities as sites where family activities could be facilitated by the lead agency. The supervisor claimed that managers and staff had little daily contact with parents, and felt unqualified to deal with them to the extent that this project required. The supervisor cited the transience of their service population and the “drop-in” nature of their centers as reasons for low parent participation in the project, characterized parents as either too busy or uninterested to participate, and suspected that many youth objected to their parents attending these events. Furthermore, managers felt that greater incentives beyond the free dinners served monthly at family events were needed to entice parent participation. Lastly, managers felt that the amount of data collection and evaluation required for the project was burdensome for staff and parents at family events, to the point that it discouraged parents from attending, particularly Spanish-speaking and low literate parents. Not all project sites had the capacities to facilitate the lengthy registration procedure or the written pre/posttest parent evaluations. Past attempts to train recreation staff on documentation procedures were negated by high staff turnover. Phase III evaluation results The phase III interviews with recreation site managers, the recreation sites’ supervisor, and the collaborative project coordinator revealed three salient themes: (a) staff believed the 1999 program changes that increased their responsibilities for parent/family programs, and required skills they did not possess went beyond the original partnership agreement; (b) staff felt inadequately compensated for the additional workloads that resulted from the project, and (c) staff felt locked out of the collaborative decision-making process. Although the 1999 project expansion was initiated at the
request of the recreation department manager, the recreation staff did not know that the expansion would require them to assume full responsibility for planning and facilitating parent and family activities (see Table 1, phases II and III). The post-1999 project expansion recreation staff claimed no skills or training to plan or deliver parenting education or family activities. Extensive staff training was given recreation personnel in the first two years of the project, but frequent staff turnover since 1997 left the post-1999 staff largely untrained, and resulted in post-1999 family activities being sports and recreation oriented and devoid of formal parent training or education. Managers considered parent/ family activities to be outside their scopes of work, and beyond the roles delineated by the initial collaborative agreement (see Table 1, phases II and III). A majority of the recreation managers felt exploited to do far more work for the project for less compensation than staff from other partner agencies. The collaborative project coordinator clarified that the recreation sites’ own agency director never requested additional financial compensation when negotiating the 1999 project expansion. Lastly, site managers felt excluded from the collaborative process, when both their director and the collaborative project coordinator failed to consult or even fully inform them about the shift in the family activity responsibilities (see Table 1, phase III). The Phase III data presented the image of a project fraught with communication failures between the lead agency and the staff expected to deliver parenting classes and family activities. Additionally, both partners lacked capacities to perform and deliver parent education and family activities as originally proposed by the project. Discussion The major barriers to parent participation identified in this project stemmed from intrinsic difficulties in the collaborative process rather from the parents and families themselves. The results of the Phase I evaluation identified a need for creative and flexible planning strategies for parent and family events. Contrary to recreation site managers’ beliefs, parents wanted parenting education on specific topics that could be scheduled at safe and convenient times. Inadequate parent outreach and a lack of meaningful parenting and family activities warranted a closer look at how these activities were planned, implemented, coordinated, and monitored within the project. Many of the Phase I recommendations were incorporated into plans for a major summer family support event that successfully “kicked off” the 2001–2002 project year, drew 49 parents and 126 youth from six project sites, and featured parenting and youth workshops planned and facilitated by professional and culturally competent staff. The lead agency hoped that the success of this particular event would convince recreation staff of the value of hosting ongoing parent and family activities at their own sites. The recreation staff,
J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
on the other hand, perceived this one event to effectively fulfill their parent involvement objective for the year, and saw no need for further parent events. These contrasting perceptions between the lead agency and recreation staff illustrate the dangers of failing to: (a) clarify the mission and goals of a collaborative project, (b) obtain partners’ “buy-in” to the mission, and (c) assess partners’ task capacities. Bowman and Kieren [21] warned family support program planners that child and adolescent specialists do not necessarily work well with parents. Reilly [14] stressed how failure to obtain partner “buy-in” on a project’s goals and objectives can weaken the collaborative and hobble the entire project. Phase II data identified project barriers consistent with the McCurdy and Daro model [13]. Multiple organizational barriers in this project effectively blocked delivery of family support interventions. Youth recreation agencies were initially perceived as ideal project partners for their numerous sites in the targeted geographic area and their sizeable service populations of youth in the target age range. Recreation staff were effective recreation specialists, but lacked basic capacities to serve parents in ways that were needed by the project. The 1999 project expansion compromised the staffing and delivery of family activities at the recreation sites, strained relations between the lead agency and the recreation staff, and effectively blocked delivery of the parent education that parents wanted. The data demonstrate that teen pregnancy prevention projects that lack staff capacity, fail to train staff to deal with parents of teens, and fail to offer parents relevant parenting/family activities, can be their own biggest obstacles to parent involvement and retention. The Phase III data suggest that the collaborative leadership failed to establish effective systems for consensus building and communication between agency partners, and failed to support the staff responsible for parent and family activities. The recreation staffs’ perceptions of unfair and unreasonable work demands and their limited capacities to deliver the proposed family support programs created significant barriers to parents seeking meaningful family activities and parenting support. Information on parents’ needs for education and training, and their concerns for their children’s academic success gathered in phase I were applied to a local middle school’s efforts to enhance parent involvement in school activities. The lead agency for the collaborative arranged for nine consecutive weeks of daytime and evening parent education sessions facilitated by culturally competent professionals to occur on the school grounds. Parent recruitment was done by telephone in English and Spanish by the professional parent educators, and resulted in the training of 115 Spanish-speaking parents as partners in their children’s educational process, the formation of a school parent-advisory panel, and active parent participation on two formal school committees. The success of this project reinforces the value of qualitative evaluation
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methods in identifying family, structural, and project barriers to parent involvement, and how the application of qualitative data can be used to design successful parent and family programs. A limitation of this longitudinal study was that surveyed samples of parents, youth, recreation management and staff were not randomly selected, sample sizes were small, and the study results cannot be generalized to the greater population of multi-agency approaches to family support. Evaluation phases II and III were not planned, but evolved as logical consequences of the phase I evaluation. It is likely that the focus group format used in phase II and the unforeseen dominance of the recreation sites’ supervisor in these focus groups contributed to a reticence in managers to discuss parent involvement. The evaluation team did not expect the supervisor to attend the manager’s focus groups, nor was it their place to ask her to excuse herself from these meetings. Nonetheless, individual interviews with managers were an appropriate choice in phase III to test the validity and reliability of the phase II themes. Reilly [14] proposed that the formative and implementation stages are the most critical to establish the following five essential elements of collaboration: (a) a shared vision, (b) member “buy-in” to this vision, (c) representative membership, (d) effective leadership, and (e) a structure that supports open communication and consensual decisionmaking. Failure to address these essential elements can cripple the collaborative process. Similarly important to the success of a collaborative prevention project is the careful initial selection of organizational partners for their particular capacities and resources they can contribute to the organization’s mission [22,23]. In conclusion, youth-serving agencies that appear “ideal” may not be the best partners in multi-agency family support and teen pregnancy risk reduction projects. Although they can be attractive for their sizeable populations of accessible youth and their parents, youth serving agency staff may not be suited for the parent involvement aspects of the mission. This project experienced success at family support interventions when culturally competent trained professionals planned and facilitated family activities and parent training. However, when untrained youth recreation staff were expected to assume these responsibilities, the project ceased delivery of meaningful family activities or parent training. Whether collaborative approaches to family support are the best means of delivering successful programs still remains to be seen. Further studies are needed that compare the outcomes and effectiveness of multi-agency approaches to enhancing parent involvement in teen pregnancy prevention programs with single agency approaches. Acknowledgment The evaluation team wishes to thank the project’s management, staff, youth and parent participants for their coop-
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eration and candor in the program evaluation process. This evaluation was made possible by grants from the Centers for Disease Control and Prevention, Community Coalition Partnership for the Prevention of Teen Pregnancy, U88/ CCU912375-06, and the California Office of Community Challenge Grant Program, 99-85642-A2.
References [1] Miller BC, Benson B, Galbraith KA. Family relationships and adolescent pregnancy risk: a research synthesis. Dev Rev 2001;21:1–38. [2] Hanson SL. Involving families in programs for pregnant adolescents: practices and obstacles. Fam Soc 1992;73:274 – 81. [3] Tsai Roussos S, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Am Rev Public Health 2000;21:369 – 402. [4] Birch DA, Hallock BA. School nurses’ perceptions of parental involvement in school health. J Sch Nurs 1998;14:32–7. [5] McCurdy K, Jones L. Supporting Families: Lessons from the Field. Thousand Oaks, CA: Sage, 2000. [6] McCurdy K, Hurvis S, Clark J. Engaging and retaining families in child abuse prevention programs. APSAC Advis 1996;9:3– 8. [7] Harris R. Attrition revisited. Am J Eval 1998;19:293–305. [8] Josten L, Mullett W, Savik K, et al. Client and provider factors associated with not keeping appointments for public heath nursing home visits. Public Health Nurs 1995;12:305–31. [9] Garbarino J, Kostelny K. Child maltreatment as a community problem. Child Abuse Neglect 1992;16:455– 64. [10] Mueller MI, Patton MQ. Working with poor families: lessons learned from practice. Marriage Fam Rev 1995;21:65–90.
[11] Peterman PJ. Parenting and environmental considerations. Am J Orthopsychiatry 1981;51:351–5. [12] Gross D, Julion W, Fogg L. What motivates participation and dropout among low-income urban families of color in a prevention intervention? Family Relat 2001;50:246 –54. [13] McCurdy K, Daro D. Parent involvement in family support programs: an integrated theory. Family Relat 2001;50:113–22. [14] Reilly T. Collaboration in action: an uncertain process. Admin Soc Work 2001;25:53–74. [15] Bailey D, McNally Koney K. Inter-organizational community-based collaboratives: a strategic response to shape the social work agenda. Social Work 1996;41:602–11. [16] Hallfors D, Hyunsan C, Livert D, Kadushin C. Fighting back against substance abuse: are community coalitions winning? Am J Prev Med 2002;23(4):237– 45. [17] Charmaz K. The grounded theory method: on explications and interpretation. In: Emerson RM, ed. Contemporary Field Research. Prospect Heights, IL: Waveland Press, 1983:109 –126. [18] Strauss AL, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 2nd edn. Thousand Oaks, CA; Sage, 1998. [19] Greenbaum T. Handbook for Focus Group Research, revised and expanded edition. New York, NY: Maxwell MacMillan International, 1993. [20] Patton MQ. Qualitative Research & Evaluation Methods, 3rd edn. Thousand Oaks, CA: Sage, 2002. [21] Bowman T, Kieren DK. Underwhelming participation: inhibitors to family enrichment. J Contemp Soc Work 1985;December:617–22. [22] Anderson SG. The collaborative research process in complex human services agencies: identifying and responding to organizational constraints. Admin Soc Work 2001;25:1–19. [23] Russel JF, Flynn RB. Commonalities across effective collaboratives. Peabody J Educ 2000;75:196 –204.
Educational programs
Organization and staffing barriers to parent involvement in teen pregnancy prevention programs: challenges for community partnerships Janet E. Flores, Dr.P.H., Susanne Montgomery, Ph.D.ⴱ, and Jerry W. Lee, Ph.D. Department of Health Promotion and Education, Loma Linda University School of Public Health, Loma Linda, California
Abstract
Purpose: To evaluate parent involvement in a Southern California teen pregnancy prevention community partnership project. Researchers expected to find parent and family-related participation barriers similar to those described in the family support literature, which they could address with program modifications. Methods: Three phases of qualitative evaluation occurred: key informant interviews and focus groups with youth and parents; focus groups with service providers; and key informant interviews with service providers, their supervisor, and the collaborative coordinator. Theory-based, openended question guides directed the interviews and focus groups, and transcriptions were coded and themed using grounded theory methods. Results: Parents and youth sought ways to improve connections and communication with each other, and parents welcomed parenting education from the project. Unexpectedly, the major obstacles to parent participation identified in this project were largely organizational, and included the assignment of parent involvement tasks to agencies lacking capacities to work effectively with parents, inadequate administrative support for staff, and the absence of an effective system for communicating concerns and resolving conflicts among collaborative partners. Conclusions: Youth serving agencies may not be the best partners to implement effective parent involvement or family support interventions. Collaborative leadership must identify appropriate partners, engender their cooperation, and support their staff to further the overall goals of the collaborative. © 2005 Society for Adolescent Medicine. All rights reserved.
Keywords:
Collaborative approaches; Family support programs; Parent involvement; Barriers to parent involvement; Qualitative evaluation methods; Grounded theory
Parents play a protective role in the development of their adolescent children’s abilities to avoid risky behavior. By their concern, supervision, and communication, particularly about sexuality, parents who forge close bonds with their teens provide the socialization that shapes their sexual attitudes, behaviors, and sexual risk perceptions [1]. Although researchers have not systematically studied the effects, nature, or extent of parent involvement in teen pregnancy prevention programs, the current funding trend is for granting agencies to encourage programs that include parents, enhance parenting skills, and improve parent-child relation-
ships [2]. Similarly, community-based multi-agency partnerships are also currently popular strategies for delivering youth risk-reduction and family support interventions when limited evidence exists of their effectiveness [3]. With funding agencies strongly encouraging risk reduction programs to access “at-risk” youth and their parents, it is easy to see the appeal of youth-serving agencies as potential collaborative partners. This article describes a three-year qualitative study to identify and reduce obstacles to parent involvement in a community collaborative teen pregnancy risk reduction project.
ⴱAddress correspondence to: Dr. Susanne Montgomery, Department of Health Promotion and Education, Loma Linda University School of Public Health, Loma Linda, CA 92350. E-mail address: [email protected]
Literature Review Most studies of parental involvement in education, family support, and mental health programs narrowly focus on
1054-139X/05/$ – see front matter © 2005 Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2005.05.003
J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
S109
Fig. 1. McCurdy & Daro conceptual model on parent involvement.
identifying family or provider factors that affect parent participation. Parent age, gender, socioeconomic status, marital status, employment status, spoken language, and education have inconsistently predicted attrition from intervention programs [4 – 6]. Common parent involvement barriers identified by Birch and Hallock [4] include changing work schedules, childcare and transportation problems, untimely program outreach, language barriers, and conflicting family responsibilities. Studies have identified the characteristics of program facilitators and parent educators to influence parent retention in family support programs, including their age, gender, race, and teaching and communication styles. Lastly, family support program facilitators who are experienced, culturally competent, and formally educated and trained, are more successful in retaining parents than those who are not [7,8]. Few studies address barriers to parent involvement beyond family circumstances and provider characteristics. Early work by Garbarino and Kostelny [9] suggested that a neighborhood’s social capital affects parents’ willingness to participate in parenting programs. Parents from neighborhoods with high crime and poverty were unlikely to trust or seek help or support from programs associated with the government [10,11]. Hanson [2] demonstrated that administrators of adolescent family life programs who supported their parent outreach staff with training opportunities and used ethnically diverse and graduate-prepared facilitators were more successful in enrolling and retaining parents. McCurdy and Jones [5] demonstrated similarly positive effects for program administrators who nurtured their direct service staff with training and development opportunities, solicited staff input, and provided staff forums to discuss difficult cases. Gross et al [12] showed that family support programs that were scheduled and planned for the parents’
convenience, employed culturally competent and trustworthy staff, and provided free childcare had greater participation than those that did not. Figure 1 illustrates the ecological model proposed by McCurdy and Daro [13] to explain parent involvement that links the influences of family factors, provider attributes, project and organizational characteristics, and neighborhood characteristics to parent intentions, enrollment, and retention in voluntary parenting programs. McCurdy and Daro’s model helps to evaluate emerging multi-agency approaches to teen pregnancy prevention in the prevailing environment of reduced federal funding and devolution of health and social services to states and local governments. Interagency collaborations are popular strategies for addressing a variety of state and local community health and social welfare issues. However, the term collaborative is often used to describe a variety of interagency relationships that are not truly collaborative, including cooperative and coordinated partnerships and coalitions. Reilly [14] described a continuum of collaboration that begins with cooperation, progresses to coordination, and ends with collaboration. Cooperative relationships are characterized as informal partnerships that share information between independent partners. Coordinated partnerships have modest organizational structures and more formal relationships between partners, but partners retain their own authority. Like task forces, coordinated partnerships develop structures within which partners agree to work together, establish specific roles for partners in a project, and emphasize common tasks and channels of communication among partners [14]. Collaboration ideally involves durable partnerships that unite multiple organizations around a common purpose, and require very complex structures and comprehensive planning to accomplish their goals. Authority in
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J.E. Flores et al. / Journal of Adolescent Health 37 (2005) S108 –S114
Table 1 Phase I, II, and III evaluation themes and related quotes Phase
Themes
Representative quotes
Source
I
Parent outreach and marketing
PFG
I
Transportation and safety concerns
I
Social isolation of single parents
I
Enthusiasm for parent education
II
Parent outreach and recruitment
II
Roles of the rec center managers
II
Parent contact at rec centers
II III
Project documentation and reporting was burdensome Increased scopes of work
III
Inadequate compensation
III
Exclusion from the collaborative process
“We didn’t know that there was a family night. If they (recreation staff) just let us know about the family nights, I’m sure most of us will come out.” “Since I don’t drive, I have a hard time getting my kids to sports or other activities.” “You can’t walk down these streets anymore. It’s just not safe.” “I try to come as much as I can, just to get out of the house.” “I keep to myself. I don’t know my neighbors.” “They should offer parenting classes here. Do they offer parenting classes here?” “I need to learn how to talk to my kids without yelling at them. I do that a lot.” “Parents need to know more about sex to help them talk to their kids about it.” “Initially, the (lead agency) did all the recruitment. Over time it became our jobs. It should have remained their responsibility. They’re the professionals.” “Parent recruitment was difficult because so many of the parents don’t speak English, and our staff don’t speak Spanish.” “We are not parent educators or recruiters. “We are recreation specialists.” “Parenting education and sex education needs to be done by professionals.” “We deal with kids whose parents aren’t available and don’t ever come here. To them we are free babysitters.” “None of us expected the amount of paperwork required for this project. It was too much, and we didn’t have the staff to handle it.” “In the original partnership agreement, we were responsible for (only) sports and recreation. In 1999 we were responsible for it all. That wasn’t fair to us.” “There (were) no financial incentives to do more work for this project.” “The allocation of funds should have been proportional to the work done.” “There wasn’t a place to direct our complaints or questions about (the project). The agency directors were not interested in our issues. They met in their group and we met in ours.”
PKI PKI PKI PFG PFG RSM
RSM RSS RSS RSM RSM RSM
PKI ⫽ parent key informant; PFG ⫽ parent focus group; RSM ⫽ recreation site manager; RSS ⫽ recreation site managers’ supervisor.
a collaborative derives from the collaborative structure and the consensus of the partnership [14,15]. The literature, however, has yet to show that community collaborative partnerships are superior to other approaches to adolescent risk-reduction. In a 2002 comprehensive review of Robert Wood Johnson Foundation-supported community anti-drug coalitions, collaborative strategies aimed at youth were found to have few effects, and strategies aimed at adults had negative effects over time [16]. This qualitative study examines a collaborative approach to teen pregnancy prevention, and identifies barriers to parent involvement in the project’s parent education component that were linked directly to difficulties in the collaborative process. The Project The collaborative project described in this article began in 1996 in a Southern California major metropolitan city. The aim of the project was to reduce teen pregnancy rates in several local zip code areas known as the “high-risk” corridor for teen pregnancy, where rates more than doubled national rates. Multiple community-based agencies pooled their services and resources to target 10 –17-year-old youth and their parents with interventions that included youth development, sports and recreation, visual and performing arts residencies, sex education, youth mentoring, parenting education, and cross-referrals for youth services. The local
public health office was the lead agency on the project, and provided curriculum-based programs and experienced parent educators to the other partner agencies when needed. The collaborative partners included two distinct youth recreation agencies, the county arts council, alternative and public schools, and the city youth mentoring program. The initial collaboration agreement limited the roles of the recreation agency staff to youth development and recreation services, whereas the lead agency provided parent education, planning, and facilitation at the recreation sites. The project began in 1996 with four recreation sites, and then later expanded to seven sites in 1999 at the request of one recreation agency director, to enable this agency to meet its quarterly projected numbers of youth served with recreation and youth development activities. The expansion also increased the scope of parenting and family activities and shifted program planning and facilitation responsibilities for these activities away from the lead agency to the recreation agency staff. Originally, parenting/family activities were scheduled monthly, and included family fun and educational activities, family dinners, and periodic parenting classes. Methods This qualitative study employed multiple methods of investigation to evaluate parent involvement in a collaborative teen pregnancy prevention project, including key in-
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formant interviews, focus groups, and participatory observation. Three distinct and consecutive phases of project evaluation occurred, with phases II and III proceeding from the outcomes of phase I. Graduate students from Loma Linda University, trained in group-facilitation and interviewing techniques, formed the evaluation team, facilitated the evaluations, analyzed the data, and delivered oral and written summative reports to collaborative partners. Theory based, open-ended question guides directed the interview and focus group discussions. Focus group participant and key informant interview comments were audio-recorded, transcribed, coded for themes, and recoded for sub-themes using grounded theory methods [17,18]. Focus groups were conducted to explore and validate themes identified by the key informant interviews using standard focus group methodologies as discussed in Thomas Greenbaum’s Handbook for Focus Group Research, 1993, and Michael Quinn Patton’s Qualitative Research & Evaluation Methods, 2002 [19,20]. The phase I evaluation occurred between October and December of 1999 and involved key informant interviews and focus groups of program youth and of parents. The purposes of the phase I evaluation included: (a) to identify parent and youth perceptions of parent participation in the project, (b) to develop recruitment strategies to boost parent involvement, and (c) to identify topics of interest for planning future parent and family programs. Key informant interviews were conducted to identify prominent parent involvement themes. Focus groups were then followed by focus groups that either elaborated or invalidated the saliency of these themes. Two recreation sites were used for phase I. A total of 10 black male and eight black female youths between the ages of 10 and 16 years participated in two key informant interviews and one focus group. All youth interviews were done in English. A total of 18 Hispanic and black parents and guardians of adolescents, including 13 single mothers, participated in five parent key informant interviews and one focus group. Four parent interviews were done in English, and one with a Spanish translator. The parent focus group was done in English with simultaneous Spanish translation. The results from the phase I evaluation suggested program barriers to parent involvement (Table 1, phase I), and prompted a second phase of evaluation directed at the project staff responsible for parenting and family activities. Phase II evaluation spanned 2000 –2001, and involved two meetings of the recreation site managers and their supervisor in focus groups conducted seven months apart. The objectives of the first phase II focus group were: (a) to present to the recreation site managers the barriers to parent involvement identified in the phase I evaluation, (b) to obtain their reactions, and (c) to strategize to improve parent and family participation in the project. An outcome of the first phase II focus group was the execution of a plan by recreation site managers and staff for a summer “kick-off”
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Table 2 Parent suggestions for parenting education topics Adolescent emotional and sexual development Anger management and conflict resolution Strengthening parent–youth communication skills Sexuality education for parents and youth separately and together Effective discipline with adolescents Fostering academic success in our children Negotiating the public school system to advocate for our children’s academic needs
family event that helped to identify the parents of youth program participants, and facilitate their recruitment and retention in the program. The second phase II focus group occurred as follow-up to this summer event, to record managers’ perceptions of the event, and to determine their support for continued parenting and family activities at their service sites. Transcripts and observer notes from phase II indicated that the recreation sites’ supervisor verbally dominated each of the phase II focus group discussions, and that her staff deferred to her, which suggested a reticence among recreation site managers to voice their opinions in her presence, and prompted the need for a third phase of evaluation involving private interviews with site managers to assess the veracity of the themes revealed in phase II. Phase III of the evaluation occurred in the summer of 2002, and included five individual interviews with site managers for the purposes of determining managers’ views on parent involvement in the teen pregnancy prevention program, and managers’ perceptions of their own roles and responsibilities for the parenting and family activities in the project. Interviewees each had a 3- to 5-year history with the project. Interviews were conducted in English, recorded in writing, and averaged 40 minutes in length. Lastly, to balance the evaluation, phase III also included separate key informant interviews with the recreation sites’ supervisor and the collaborative coordinator to get their perspectives on parent involvement in the teen pregnancy prevention project. Results Phase I evaluation results Table 1 shows the themes that emerged from each phase of the project. Four parent involvement themes emerged from the phase I data: (a) parents welcomed opportunities for parenting education classes that addressed their own topics of interest (see Table 2), and even volunteered to help organize such events at their neighborhood recreation sites; (b) parents’ comments suggested that parent outreach and project marketing was minimal, (only one of the 18 parent interviewees recognized the project by its name, and none of the focus group parents recalled hearing about or attending site-sponsored parent training events); (c) mothers and
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grandmothers raising children alone referred frequently to feelings of isolation, and foresaw family events at their local recreation sites as social outlets; and (d) mothers who characterized their neighborhoods as unsafe at night, and did not venture out to attend nighttime scheduled family events preferred daytime, summer afternoon, or evening scheduled family programs. Phase II evaluation results Four themes emerged from site managers’ and their supervisor’s comments and reactions to the phase I evaluation results (see Table 1, phase II). Recreation staff reported having conducted door-to-door parent recruitment for family support activities in the initial years of the project with disappointing results, and that little to no parent recruitment or parenting education had occurred at their sites since 1999, when they were made responsible for all family activity program planning and delivery. Managers saw their own roles in the project as youth recreation specialists who served the needs of youth, rather than as family activity planners or facilitators. They saw their facilities as sites where family activities could be facilitated by the lead agency. The supervisor claimed that managers and staff had little daily contact with parents, and felt unqualified to deal with them to the extent that this project required. The supervisor cited the transience of their service population and the “drop-in” nature of their centers as reasons for low parent participation in the project, characterized parents as either too busy or uninterested to participate, and suspected that many youth objected to their parents attending these events. Furthermore, managers felt that greater incentives beyond the free dinners served monthly at family events were needed to entice parent participation. Lastly, managers felt that the amount of data collection and evaluation required for the project was burdensome for staff and parents at family events, to the point that it discouraged parents from attending, particularly Spanish-speaking and low literate parents. Not all project sites had the capacities to facilitate the lengthy registration procedure or the written pre/posttest parent evaluations. Past attempts to train recreation staff on documentation procedures were negated by high staff turnover. Phase III evaluation results The phase III interviews with recreation site managers, the recreation sites’ supervisor, and the collaborative project coordinator revealed three salient themes: (a) staff believed the 1999 program changes that increased their responsibilities for parent/family programs, and required skills they did not possess went beyond the original partnership agreement; (b) staff felt inadequately compensated for the additional workloads that resulted from the project, and (c) staff felt locked out of the collaborative decision-making process. Although the 1999 project expansion was initiated at the
request of the recreation department manager, the recreation staff did not know that the expansion would require them to assume full responsibility for planning and facilitating parent and family activities (see Table 1, phases II and III). The post-1999 project expansion recreation staff claimed no skills or training to plan or deliver parenting education or family activities. Extensive staff training was given recreation personnel in the first two years of the project, but frequent staff turnover since 1997 left the post-1999 staff largely untrained, and resulted in post-1999 family activities being sports and recreation oriented and devoid of formal parent training or education. Managers considered parent/ family activities to be outside their scopes of work, and beyond the roles delineated by the initial collaborative agreement (see Table 1, phases II and III). A majority of the recreation managers felt exploited to do far more work for the project for less compensation than staff from other partner agencies. The collaborative project coordinator clarified that the recreation sites’ own agency director never requested additional financial compensation when negotiating the 1999 project expansion. Lastly, site managers felt excluded from the collaborative process, when both their director and the collaborative project coordinator failed to consult or even fully inform them about the shift in the family activity responsibilities (see Table 1, phase III). The Phase III data presented the image of a project fraught with communication failures between the lead agency and the staff expected to deliver parenting classes and family activities. Additionally, both partners lacked capacities to perform and deliver parent education and family activities as originally proposed by the project. Discussion The major barriers to parent participation identified in this project stemmed from intrinsic difficulties in the collaborative process rather from the parents and families themselves. The results of the Phase I evaluation identified a need for creative and flexible planning strategies for parent and family events. Contrary to recreation site managers’ beliefs, parents wanted parenting education on specific topics that could be scheduled at safe and convenient times. Inadequate parent outreach and a lack of meaningful parenting and family activities warranted a closer look at how these activities were planned, implemented, coordinated, and monitored within the project. Many of the Phase I recommendations were incorporated into plans for a major summer family support event that successfully “kicked off” the 2001–2002 project year, drew 49 parents and 126 youth from six project sites, and featured parenting and youth workshops planned and facilitated by professional and culturally competent staff. The lead agency hoped that the success of this particular event would convince recreation staff of the value of hosting ongoing parent and family activities at their own sites. The recreation staff,
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on the other hand, perceived this one event to effectively fulfill their parent involvement objective for the year, and saw no need for further parent events. These contrasting perceptions between the lead agency and recreation staff illustrate the dangers of failing to: (a) clarify the mission and goals of a collaborative project, (b) obtain partners’ “buy-in” to the mission, and (c) assess partners’ task capacities. Bowman and Kieren [21] warned family support program planners that child and adolescent specialists do not necessarily work well with parents. Reilly [14] stressed how failure to obtain partner “buy-in” on a project’s goals and objectives can weaken the collaborative and hobble the entire project. Phase II data identified project barriers consistent with the McCurdy and Daro model [13]. Multiple organizational barriers in this project effectively blocked delivery of family support interventions. Youth recreation agencies were initially perceived as ideal project partners for their numerous sites in the targeted geographic area and their sizeable service populations of youth in the target age range. Recreation staff were effective recreation specialists, but lacked basic capacities to serve parents in ways that were needed by the project. The 1999 project expansion compromised the staffing and delivery of family activities at the recreation sites, strained relations between the lead agency and the recreation staff, and effectively blocked delivery of the parent education that parents wanted. The data demonstrate that teen pregnancy prevention projects that lack staff capacity, fail to train staff to deal with parents of teens, and fail to offer parents relevant parenting/family activities, can be their own biggest obstacles to parent involvement and retention. The Phase III data suggest that the collaborative leadership failed to establish effective systems for consensus building and communication between agency partners, and failed to support the staff responsible for parent and family activities. The recreation staffs’ perceptions of unfair and unreasonable work demands and their limited capacities to deliver the proposed family support programs created significant barriers to parents seeking meaningful family activities and parenting support. Information on parents’ needs for education and training, and their concerns for their children’s academic success gathered in phase I were applied to a local middle school’s efforts to enhance parent involvement in school activities. The lead agency for the collaborative arranged for nine consecutive weeks of daytime and evening parent education sessions facilitated by culturally competent professionals to occur on the school grounds. Parent recruitment was done by telephone in English and Spanish by the professional parent educators, and resulted in the training of 115 Spanish-speaking parents as partners in their children’s educational process, the formation of a school parent-advisory panel, and active parent participation on two formal school committees. The success of this project reinforces the value of qualitative evaluation
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methods in identifying family, structural, and project barriers to parent involvement, and how the application of qualitative data can be used to design successful parent and family programs. A limitation of this longitudinal study was that surveyed samples of parents, youth, recreation management and staff were not randomly selected, sample sizes were small, and the study results cannot be generalized to the greater population of multi-agency approaches to family support. Evaluation phases II and III were not planned, but evolved as logical consequences of the phase I evaluation. It is likely that the focus group format used in phase II and the unforeseen dominance of the recreation sites’ supervisor in these focus groups contributed to a reticence in managers to discuss parent involvement. The evaluation team did not expect the supervisor to attend the manager’s focus groups, nor was it their place to ask her to excuse herself from these meetings. Nonetheless, individual interviews with managers were an appropriate choice in phase III to test the validity and reliability of the phase II themes. Reilly [14] proposed that the formative and implementation stages are the most critical to establish the following five essential elements of collaboration: (a) a shared vision, (b) member “buy-in” to this vision, (c) representative membership, (d) effective leadership, and (e) a structure that supports open communication and consensual decisionmaking. Failure to address these essential elements can cripple the collaborative process. Similarly important to the success of a collaborative prevention project is the careful initial selection of organizational partners for their particular capacities and resources they can contribute to the organization’s mission [22,23]. In conclusion, youth-serving agencies that appear “ideal” may not be the best partners in multi-agency family support and teen pregnancy risk reduction projects. Although they can be attractive for their sizeable populations of accessible youth and their parents, youth serving agency staff may not be suited for the parent involvement aspects of the mission. This project experienced success at family support interventions when culturally competent trained professionals planned and facilitated family activities and parent training. However, when untrained youth recreation staff were expected to assume these responsibilities, the project ceased delivery of meaningful family activities or parent training. Whether collaborative approaches to family support are the best means of delivering successful programs still remains to be seen. Further studies are needed that compare the outcomes and effectiveness of multi-agency approaches to enhancing parent involvement in teen pregnancy prevention programs with single agency approaches. Acknowledgment The evaluation team wishes to thank the project’s management, staff, youth and parent participants for their coop-
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eration and candor in the program evaluation process. This evaluation was made possible by grants from the Centers for Disease Control and Prevention, Community Coalition Partnership for the Prevention of Teen Pregnancy, U88/ CCU912375-06, and the California Office of Community Challenge Grant Program, 99-85642-A2.
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