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Project 12-ways: Measuring outcome of a large in-home service for treatment and prevention of child abuse and neglect
Chrld Ahuw & Ne&w. Vol R. pp 519.524. Pnnred m the USA All nghts reserved
1984
0145-2134/X4 $3.00 + .W Copyright ‘I 1984 Pergamon Pres\ Ltd.
PROJECT 12-WAYS: MEASURING OUTCOME OF A LARGE IN-HOME SERVICE FOR TREATMENT AND PREVENTION OF CHILD ABUSE AND NEGLECT JOHN R. LUTZKER. PH.D. Professor and Coordinator,
Behavior Analysis and Therapy Program and Project IZ-Ways, Southern Illinois University at Carbondale, IL 62901
JAMES M. RICE, RH.D. Assistant Professor. Department of Psychology, Indiana University/Purdue
University at Indianapolis, IN, 46223
Abstract-Described here is Project 12-Ways, a large service project employing an ecobehavioral approach to the treatment and prevention of child abuse and neglect. By ecobehavioral it is meant that multifaceted in-home services are provided to clients, and that in-home data are collected on as many variables related to these services as possible. Four levels of research, data collection, and assessment are used to evaluate these services: Included here is a discussion of these levels of assessment. They are: (a) data collected for clinical purposes; (b) data from single-case experiments; (c) research through the use of single-subject design logic applied to several subjects or groups of subjects, or by group statistical research designs; and (d) program evaluation. The particular focus here is the program evaluation data which compare incidents of abuse and neglect during and after treatment between 50 families served by Project 12-Ways and 47 comparison protective service families. The data showed significantly fewer combined abuse and neglect incidents among the families served by Project 12-Ways. Suggestions for additional program evaluation data are provided along with a discussion of the limitations of the current analysis.
DESCRIBED HERE IS PROJECT IZWAYS, an ecobehavioral approach to the treatment and prevention of child abuse and neglect. “Ecobehavioral” refers to the multifaceted inhome services provided to clients and in-home data collected on as many variables related to these services as are practical and relevant. The purpose of this description is to provide an overview of this effort to date and to provide program evaluation data suggestive of a positive impact by Project 12-Ways in reducing recurrence of abuse and neglect during treatment and in reducing recidivism (after treatment).
OVERVIEW The need to focus on child abuse and neglect as a multifaceted problem in need of multifaceted treatment is well documented [l-5]. Among the efforts made in this direction have been a residential treatment program [6] and a stress-reduction program for inner city families [7]. Although each of these programs have offered innovative efforts, Project 12-Ways has attempted to incorporate multiple strategies to treat and prevent child abuse and neglect through in-home services to families in southern Illinois. Presented at the Fourth International Congress on Child Abuse and Neglect, Paris, September 1982. Reprint requests should be sent to John R. Lutzker, Ph.D., Behavior Analysis and Therapy Program, Rehabilitation Institute. Southern Illinois University at Carbondale. IL 62901 519
520
John R. Lutzker
and James
ECOBEHAVIORAL
M. Rice
SERVICES
The aim of Project 12-Ways is to reduce repeated and recidivistic child abuse and neglect among the clients served. Ecobehavioral service is provided with the understanding that child abuse and neglect is neither seen nor treated as being as simplistic as parental disciplining deficits or as molecular as parental deficiencies in handling stress. Rather, in-home services (treatment and training) are provided in several areas such as parent-child training, stress reduction, self-control, social support, assertiveness training, basic skills [8], leisure time, health maintenance and nutrition [9], home safety [IO], job placement, marital discord counseling [ 111, alcoholism referral, money management, and a variety of pre- and postnatal prevention services for young and unwed mothers.
STRUCTURE Project 12-Ways receives its funding through Federal Title XX money allocated by the state of Illinois under the Governor’s Donated Funds initiative. This is a three-party contract among the Department of Children and Family Services, the Department of Public Aid, and Southern Illinois University at Carbondale. The Project is housed and operated out of the Behavior Analysis and Therapy Program, a master’s degree program in the Rehabilitation Institute of the College of Human Resources at Southern Illinois University at Carbondale. Direct services are provided to clients in their homes by counselors, most of whom are advanced graduate students, some of whom hold master’s degrees. Counselors are assisted in data collection and some treatment efforts by graduate assistants, almost all of whom are first-year students in the Behavior Analysis and Therapy Program. Supervision of counselors is provided by experienced master’s level chief rehabilitation counselor and the program manager [12]. These are professionals who have their primary training in behavior analysis and therapy. The chief rehabilitation counselors and the program manager are supervised by the coordinator of the Behavior Analysis and Therapy Program, an experienced researcher/ academician in applied behavior analysis. In addition, considerable gratis supervision is provided by other faculty members in the Behavior Analysis and Therapy Program and the Department of Psychology. This is in addition to the extensive formal course work and practicum/internship required of the students in the Program. Thus, through a sophisticated hierarchy of supervision, these master-level trainees are provided with an unusually rich background of clinical behavior change strategies. All referrals to Project 12-Ways come from the Illinois Department of Children and Family Services, the state’s child protective service agency. Table 1 displays demographic data from all protective service clients served by Project I2-Ways in FY ‘80. These data include the type of referral and the number of families served.
Table 1.
Fiscal Year 1980 Proiect 12-Ways
Families Served = 169 Reason for Referral Abuse Neglect Prevention
15% 40% 45%
Outcome
of an in-home
PROGRAM
service
52%
EVALUATION
Four levels of treatment assessment occur on Project 12-Ways [4]. The first level involves data collection for clinical purposes. Examples of this would include counselors asking parents to record information about their children’s behavior, about family dietary intake, or personal problems such as the frequency and duration of headaches [I I]. Also, counselors may cullect data through direct observations during their home visits. These parent-collected data and counselor-collected data serve to help the parents and counselor monitor and assess various problems in the home. The data are of little scientific value, but they can be of great value in the implementation of the multiple treatment services offered by the Project 12-Ways stag_ The second level of assessment is more formal. It involves single case experiments [ 131. For example, Campbell, O’Brien, Bickett and Lutzker [ 1I] described one family for whom they successfully treated the mother with stress reduction techniques for migraine headaches, provided parent training to the mother so that she could effectively manage her noncompliant daughter’s behavior, and provided marital counseling to the couple based on the reciprocity counseling techniques that have been described by AZ.&, Naster, and Jones $14]_ Singlesubject. experimental research designs wherein the subject serves as his/her own control served to demonstrate that it was, in fact, the treatments used that produced the productive behavior changes. These and similar single-case experiments provide empirical documentation for some of the treatment techniques used by Project 12-Ways. The third level of assessment of services on Project 12sWays is through research, either through the use of single-subject research design logic applied to several subjects or groups of subjects, or by group statistical research designs. This level of assessment and research provides some documentation of the generality of treatment procedures used by Project 12Ways, and may contribute to a further understanding of factors relating to abuse and neglect. For example, in the former case, Tertinger, Greene, and Lutzker [lo] reported success in reducing safety hazards in the homes of six families. Using a validated home accident prevention inventory, they formally assessed the multiple accident and injury hazards in these homes and then utilized several beha~or~~educatjon~ treatment strategies to cause the families to make their homes much safer for their children” An example of group statistical research design aimed at understanding factors associated with abuse and neglect was described by Campbell, Twardosz, Lutzker, and Cuvo [15]. They examined the affectionate behav+or in low SES Project I2-Ways abuse and neglect famihes and compared these data to a group of low SES families who had no history of abuse and neglect. Affectionate behavior was directly observed and defined on several dimensions of physical and verbal behavior such as physical proximity and affectionate words. Additional analyses examined the role of various tasks on affectionate and coercive behavior and, finally, on whether or not parent training had an effect on affectionate interactions between the mothers and their children. It was found that the comparison group families engaged in more affectionate behavior than the abuse families who, in turn, engaged in more a~~~on~te behavior than neglect families. Also, certain tasks were shown to increase the likelihood of coercive responding, and parent training produced affectionate responding in abuse and neglect families. It is hoped that this kind of research adds to the understanding of some of the dynamics of deviant family systems [16]. The fourth level of assessment for Project 12-Ways is program evaluation. While there are countless variables of interest in this area, of primary concern has been an examination of the possible impact of Project 12-Ways in reducing reincidence of abuse and neglect during treatment and in reducing recidivistic abuse or neglect (incidents after treatment). The first data of this nature were reported by Lutzker, Frame, and Rice [5] who noted an inverse
522
John R. Lutzker and James M. Rice
relationship between the number of reports of neglect and the number of hours Project 12Ways served a field office during its first year of operation. That is, the negative correlation showed that the more hours of service that Project 12-Ways provided to any one of the 10 protective service field offices in the region that year, the fewer reports of neglect occurred. Of course, this kind of analysis was subject to much interpretation. Thus, a more sophisticated program evaluation was attempted. This effort is described here.
METHOD Subjects
In order to compare the efficacy and impact of Project 12-Ways services, 50 abuse and neglect farnihes were randomly selected from the 150 families served by Project 1ZWays in Fiscal Year, 1980, and not served for one year subsequently. A comparison group of families not served by Project 1ZWays was also selected. These families made up a stratified sample to the extent that famihes were matched by field office. For example, if five families from the Project 12-Ways sample were from field office A, then five families not served by Project 12Ways were also randomly selected from that field office. Subsequently, the potential biasing contribution of field office differences was eliminated. The families from both groups were protective service clients who had at least one previous incident of child abuse or neglect, or they were considered high risk for abuse or neglect. A thorough examination of the 50 comparison families identified three families who had received some Project 12-Ways’ services. Thus, these three families were dropped from the sample. Procedure
The lists of these families, who were identified by code numbers, were submitted to the Illinois State Centeral Register in order to determine if there were any incidents of child abuse or neglect during treatment (reincidence), or after treatment services were terminated (recidivism). With these data, the total recurrence incorporating both reincidence and recidivism could be determined. Only substantiated child abuse and neglect incidents were recorded. Unsubstantiated reports and pending reports were not available. A &i-square analysis of these data was performed.
RESULTS Table 2 illustrates the results. Fifty Project 1ZWays families were compared to 47 comparison group families. During treatment, one Project 1ZWays family was involved in an abuse or neglect incident (2%) while five comparison group families (11%) had a substantiated instance of abuse or neglect. The recidivism data, that is, abuse or neglect after the termination of services, showed four (8%) incidents among Project IZWays clients and five (11 W) among the comparison group subjects. No statistical analysis was performed on the recidivism data alone since it was obvious that no significant differences would be found. One interesting finding was the breakdown of repeated incidents of abuse or neglect. None of the five Project 12-Ways families who had abused or neglected their children during or after treatment had more than one substantiated incident of abuse or neglect, while three comparison group families had at least two incidents, and two of the families had at least three incidents of abuse or neglect.
Outcome of an in-home service Table 2.
Comparison
Number of children abused Number of children abused Number of children abused Total number of abuse and Total Dercent recurrence
523
of Protective !3ervices Clients Receiving or Not Receiving Proiect 12-Wavs Services
or neglected during TX or neglected after TX or neglected 2 times neglect incidents
Project 12-Ways Protective Services Clients
Comparison Group Protective Services Clients
N = 50
N = 41
1 (2%) 4 (8%) 0 (0%) 5 10%
5 (11%)
5 (11%) 3 (6%) I5 21%
The total number of abuse or neglect incidents during or after treatment for the Project 12Ways group was five, and for the comparison group was 15. A cl&square analysis of these frequencies produced a significant result (&i-square = 5.00, df = 1, p < .05). Thus, the total number of children abused or neglected during or after treatment was 10% for the Project 12Ways group, and 21% for the comparison group. Additional data provided by the State Central Register to the Regional Office indicated that the 21% for the comparison group reflected the recurrence frequency for the entirety of Illinois Region V which is the region from which both samples were selected.
DISCUSSION The results of the program evaluation data suggest that if a family received services from Project 12-Ways during fiscal year, 1980, there was less likelihood of repeated abuse or neglect during treatment or incidents after treatment in the next year than if the family received the state’s routine services. Nonetheless, interpretation of these data requires caution. If these differences, indeed, exist, one might question how durable over time they are. For example, it might be suggested that the lower frequency of incidents in families served by Project 1ZWays might be a function of what the families could perceive as surveillance. That is, since Project 12-Ways staff members are able to see clients more frequently than the agency’s caseworkers can, the clients might be more fearful of being caught in abuse or neglect incidents or their aftermath. Also, the recidivism data were less impressive than the reincidence data. Only long-term follow-up data from both samples can produce any conclusions about any potential superiority services provided by Project 1ZWays. Unfortunately, lack of sufficient demographic data on control group subjects precluded an analysis of group equivalences (such as age, sex, etc.) between the two groups. Of course, it was hoped that the random selection of subjects produced equivalence; however, subsequent comparisons from more recent fiscal years (currently under way) should include such analyses if data are available. Another concern might be that it would be difficult to replicate Project 1ZWays as a model service in any setting outside a university. This is not necessarily the case, especially if Project 12-Ways can produce validated training packages that could be disseminated to service providers who are not affiliated with universities. Finally, it might be assumed that biasing of one sort or another exists in that clients may be assigned to Project 1ZWays according to particular formal or informal criteria established by a given field office. Again, the only control for this possibility would be an analysis of group equivalences. The data presented here, however, are encouraging because they are a measure of outcome of services after the Project’s first year of operation. During that first year, the stafI’ were more
524
John R. Lutzker and James M. Rice
inexperienced than current staff, their supervision was less systematic, and the adminis- trative structure was not as smooth as currently exists on the Project. In order to determine results with clients served in more recent years, we are currently analyzing data in a similar fashion.
CONCLUSION Project 1ZWays is a large scale, in-home ecobehavioral service aimed at the treatment and prevention of child abuse and neglect in southern Illinois. In its first four years of existence Project 1ZWays has been funded at a $2 million cumulative level. Over 300 families have been served during that time. Thus, any effort of this magnitude should be accountable on several levels. Hence, four levels of research and data collection and assessment are used to evaluate the effects of these services. Preliminary group evaluation data suggest that Project 1ZWays has a significant impact on reducing repeated abuse and neglect during treatment and recidivism following treatment. Acknowledgemenr-The authors express appreciation for the assistance of John Allen, Alan D. Bickett, Denise La Berdia, Sherry Seibel, Dennis Stuckey, Michael Tristano and David Wesch.
REFERENCES 1. GIL, D. G. Violence Againsf Children in the United States. Harvard University Press, Cambridge, MA (1970). 2. ISAACS, C. D. Treatment of child abuse: A review of behavioral interventions. Journal of Applied Behavior Analysis 15:253-294 (1982). 3. ISA&X, C. D. A brief review of the characteristics of abuse prone parents. The Behavior Therapist 4:5-8 (1981). 4. LUTZKER, J. R. Project 12-Ways: Treating child abuse and neglect from an ecobehavioral perspective. In: Parent Training: Foundations of Research and Practice, R. F. Dangel and R. A. Polster (Eds.). Guilford (1984). 5. LUTZKER, J. R., FRAME, R. and RICE, J. Project 12 Ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect. Education and Treatment of Children 5: 141-155 (1982). 6. MCBOGG, D., MCQUISTON, M. and ALEXANDER, H. Circle House residential treatment program. Child Abuse & Neglect 3:863-867 (1979). 7. GABINET, L. Prevention of child abuse and neglect in an inner city population: II. The program and the results. Child Abuse & Neglect 3:809-g 17 (1979). M., SARBER, R., BUENO, G., GREENE, B. and LUTZKER, J. R. Maintain8. ROSENFIELD-SCHLICHTER, ing accountability for a ecobehavioral treatment of one aspect of child neglect: Personal cleanliness. Educarion and Treatment of Chihben 6: 153-164 (1983). 9. SARBER, R., HALASZ, M., MESSMER, M., BICKE’IT, A., and LUTZKER, J. R. Teaching menu planning and grocery shopping skills to a mentally retarded mother. Mental Retardation 21: 101-106 (1983). IO. TERTINGER, D., GREENE, B. and LUTZKER, J. Home safety: Development and validation of one component of an ecobehavioral treatment program for abused and neglected children. Journal of Applied Behavior Analysis 17: 159-174 (1984). 11. CAMPBELL, R., O’BRIEN, S., BICKETT, A. and LUTZKER, J. R. In-home parent training, treatment of migraine headaches, and marital counseling as an ecobehavioral approach to prevent child abuse. Journal of Behavior Therapy and Experimental Psychiatty 14: 147- 154 (1983). 12. RICE, J. M. and LUTZKER, J. R. Group and individual feedback, public posting and prompting to increase counselor supervision. The Clinical Supervisor 1:77-90 (1983). 13. HERSEN, M. and BARLOW, D. Single Case Experimemal Designs: Strategies for Studying Behavior Change. Pergamon, New York (1976). 14. AZRIN, N., NASTER, B. and JONES, R. Reciprocity counseling: A rapid learning-based procedure for marital counseling. Behavior Research and Therapy 11:365-382 (1973). 15. CAMPBELL, R., TWARDOSZ, S., LUTZKER, J., and CUVO, A. Comparison study of affectionate behavior across status of abuse, neglect and nonabuse neglect. Paper presented at the 9th Annual Meeting of the Association for Behavior Analysis, Milwaukee, WI (May 1983). 16. LUTZKER, J. Deviant family systems. In: Advances in Clinical Child Psycho/ogv, (Vol. III), B. Lahey and A. Kazdin (Eds.). Plenum, New York (1980).
1984
0145-2134/X4 $3.00 + .W Copyright ‘I 1984 Pergamon Pres\ Ltd.
PROJECT 12-WAYS: MEASURING OUTCOME OF A LARGE IN-HOME SERVICE FOR TREATMENT AND PREVENTION OF CHILD ABUSE AND NEGLECT JOHN R. LUTZKER. PH.D. Professor and Coordinator,
Behavior Analysis and Therapy Program and Project IZ-Ways, Southern Illinois University at Carbondale, IL 62901
JAMES M. RICE, RH.D. Assistant Professor. Department of Psychology, Indiana University/Purdue
University at Indianapolis, IN, 46223
Abstract-Described here is Project 12-Ways, a large service project employing an ecobehavioral approach to the treatment and prevention of child abuse and neglect. By ecobehavioral it is meant that multifaceted in-home services are provided to clients, and that in-home data are collected on as many variables related to these services as possible. Four levels of research, data collection, and assessment are used to evaluate these services: Included here is a discussion of these levels of assessment. They are: (a) data collected for clinical purposes; (b) data from single-case experiments; (c) research through the use of single-subject design logic applied to several subjects or groups of subjects, or by group statistical research designs; and (d) program evaluation. The particular focus here is the program evaluation data which compare incidents of abuse and neglect during and after treatment between 50 families served by Project 12-Ways and 47 comparison protective service families. The data showed significantly fewer combined abuse and neglect incidents among the families served by Project 12-Ways. Suggestions for additional program evaluation data are provided along with a discussion of the limitations of the current analysis.
DESCRIBED HERE IS PROJECT IZWAYS, an ecobehavioral approach to the treatment and prevention of child abuse and neglect. “Ecobehavioral” refers to the multifaceted inhome services provided to clients and in-home data collected on as many variables related to these services as are practical and relevant. The purpose of this description is to provide an overview of this effort to date and to provide program evaluation data suggestive of a positive impact by Project 12-Ways in reducing recurrence of abuse and neglect during treatment and in reducing recidivism (after treatment).
OVERVIEW The need to focus on child abuse and neglect as a multifaceted problem in need of multifaceted treatment is well documented [l-5]. Among the efforts made in this direction have been a residential treatment program [6] and a stress-reduction program for inner city families [7]. Although each of these programs have offered innovative efforts, Project 12-Ways has attempted to incorporate multiple strategies to treat and prevent child abuse and neglect through in-home services to families in southern Illinois. Presented at the Fourth International Congress on Child Abuse and Neglect, Paris, September 1982. Reprint requests should be sent to John R. Lutzker, Ph.D., Behavior Analysis and Therapy Program, Rehabilitation Institute. Southern Illinois University at Carbondale. IL 62901 519
520
John R. Lutzker
and James
ECOBEHAVIORAL
M. Rice
SERVICES
The aim of Project 12-Ways is to reduce repeated and recidivistic child abuse and neglect among the clients served. Ecobehavioral service is provided with the understanding that child abuse and neglect is neither seen nor treated as being as simplistic as parental disciplining deficits or as molecular as parental deficiencies in handling stress. Rather, in-home services (treatment and training) are provided in several areas such as parent-child training, stress reduction, self-control, social support, assertiveness training, basic skills [8], leisure time, health maintenance and nutrition [9], home safety [IO], job placement, marital discord counseling [ 111, alcoholism referral, money management, and a variety of pre- and postnatal prevention services for young and unwed mothers.
STRUCTURE Project 12-Ways receives its funding through Federal Title XX money allocated by the state of Illinois under the Governor’s Donated Funds initiative. This is a three-party contract among the Department of Children and Family Services, the Department of Public Aid, and Southern Illinois University at Carbondale. The Project is housed and operated out of the Behavior Analysis and Therapy Program, a master’s degree program in the Rehabilitation Institute of the College of Human Resources at Southern Illinois University at Carbondale. Direct services are provided to clients in their homes by counselors, most of whom are advanced graduate students, some of whom hold master’s degrees. Counselors are assisted in data collection and some treatment efforts by graduate assistants, almost all of whom are first-year students in the Behavior Analysis and Therapy Program. Supervision of counselors is provided by experienced master’s level chief rehabilitation counselor and the program manager [12]. These are professionals who have their primary training in behavior analysis and therapy. The chief rehabilitation counselors and the program manager are supervised by the coordinator of the Behavior Analysis and Therapy Program, an experienced researcher/ academician in applied behavior analysis. In addition, considerable gratis supervision is provided by other faculty members in the Behavior Analysis and Therapy Program and the Department of Psychology. This is in addition to the extensive formal course work and practicum/internship required of the students in the Program. Thus, through a sophisticated hierarchy of supervision, these master-level trainees are provided with an unusually rich background of clinical behavior change strategies. All referrals to Project 12-Ways come from the Illinois Department of Children and Family Services, the state’s child protective service agency. Table 1 displays demographic data from all protective service clients served by Project I2-Ways in FY ‘80. These data include the type of referral and the number of families served.
Table 1.
Fiscal Year 1980 Proiect 12-Ways
Families Served = 169 Reason for Referral Abuse Neglect Prevention
15% 40% 45%
Outcome
of an in-home
PROGRAM
service
52%
EVALUATION
Four levels of treatment assessment occur on Project 12-Ways [4]. The first level involves data collection for clinical purposes. Examples of this would include counselors asking parents to record information about their children’s behavior, about family dietary intake, or personal problems such as the frequency and duration of headaches [I I]. Also, counselors may cullect data through direct observations during their home visits. These parent-collected data and counselor-collected data serve to help the parents and counselor monitor and assess various problems in the home. The data are of little scientific value, but they can be of great value in the implementation of the multiple treatment services offered by the Project 12-Ways stag_ The second level of assessment is more formal. It involves single case experiments [ 131. For example, Campbell, O’Brien, Bickett and Lutzker [ 1I] described one family for whom they successfully treated the mother with stress reduction techniques for migraine headaches, provided parent training to the mother so that she could effectively manage her noncompliant daughter’s behavior, and provided marital counseling to the couple based on the reciprocity counseling techniques that have been described by AZ.&, Naster, and Jones $14]_ Singlesubject. experimental research designs wherein the subject serves as his/her own control served to demonstrate that it was, in fact, the treatments used that produced the productive behavior changes. These and similar single-case experiments provide empirical documentation for some of the treatment techniques used by Project 12-Ways. The third level of assessment of services on Project 12sWays is through research, either through the use of single-subject research design logic applied to several subjects or groups of subjects, or by group statistical research designs. This level of assessment and research provides some documentation of the generality of treatment procedures used by Project 12Ways, and may contribute to a further understanding of factors relating to abuse and neglect. For example, in the former case, Tertinger, Greene, and Lutzker [lo] reported success in reducing safety hazards in the homes of six families. Using a validated home accident prevention inventory, they formally assessed the multiple accident and injury hazards in these homes and then utilized several beha~or~~educatjon~ treatment strategies to cause the families to make their homes much safer for their children” An example of group statistical research design aimed at understanding factors associated with abuse and neglect was described by Campbell, Twardosz, Lutzker, and Cuvo [15]. They examined the affectionate behav+or in low SES Project I2-Ways abuse and neglect famihes and compared these data to a group of low SES families who had no history of abuse and neglect. Affectionate behavior was directly observed and defined on several dimensions of physical and verbal behavior such as physical proximity and affectionate words. Additional analyses examined the role of various tasks on affectionate and coercive behavior and, finally, on whether or not parent training had an effect on affectionate interactions between the mothers and their children. It was found that the comparison group families engaged in more affectionate behavior than the abuse families who, in turn, engaged in more a~~~on~te behavior than neglect families. Also, certain tasks were shown to increase the likelihood of coercive responding, and parent training produced affectionate responding in abuse and neglect families. It is hoped that this kind of research adds to the understanding of some of the dynamics of deviant family systems [16]. The fourth level of assessment for Project 12-Ways is program evaluation. While there are countless variables of interest in this area, of primary concern has been an examination of the possible impact of Project 12-Ways in reducing reincidence of abuse and neglect during treatment and in reducing recidivistic abuse or neglect (incidents after treatment). The first data of this nature were reported by Lutzker, Frame, and Rice [5] who noted an inverse
522
John R. Lutzker and James M. Rice
relationship between the number of reports of neglect and the number of hours Project 12Ways served a field office during its first year of operation. That is, the negative correlation showed that the more hours of service that Project 12-Ways provided to any one of the 10 protective service field offices in the region that year, the fewer reports of neglect occurred. Of course, this kind of analysis was subject to much interpretation. Thus, a more sophisticated program evaluation was attempted. This effort is described here.
METHOD Subjects
In order to compare the efficacy and impact of Project 12-Ways services, 50 abuse and neglect farnihes were randomly selected from the 150 families served by Project 1ZWays in Fiscal Year, 1980, and not served for one year subsequently. A comparison group of families not served by Project 1ZWays was also selected. These families made up a stratified sample to the extent that famihes were matched by field office. For example, if five families from the Project 12-Ways sample were from field office A, then five families not served by Project 12Ways were also randomly selected from that field office. Subsequently, the potential biasing contribution of field office differences was eliminated. The families from both groups were protective service clients who had at least one previous incident of child abuse or neglect, or they were considered high risk for abuse or neglect. A thorough examination of the 50 comparison families identified three families who had received some Project 12-Ways’ services. Thus, these three families were dropped from the sample. Procedure
The lists of these families, who were identified by code numbers, were submitted to the Illinois State Centeral Register in order to determine if there were any incidents of child abuse or neglect during treatment (reincidence), or after treatment services were terminated (recidivism). With these data, the total recurrence incorporating both reincidence and recidivism could be determined. Only substantiated child abuse and neglect incidents were recorded. Unsubstantiated reports and pending reports were not available. A &i-square analysis of these data was performed.
RESULTS Table 2 illustrates the results. Fifty Project 1ZWays families were compared to 47 comparison group families. During treatment, one Project 1ZWays family was involved in an abuse or neglect incident (2%) while five comparison group families (11%) had a substantiated instance of abuse or neglect. The recidivism data, that is, abuse or neglect after the termination of services, showed four (8%) incidents among Project IZWays clients and five (11 W) among the comparison group subjects. No statistical analysis was performed on the recidivism data alone since it was obvious that no significant differences would be found. One interesting finding was the breakdown of repeated incidents of abuse or neglect. None of the five Project 12-Ways families who had abused or neglected their children during or after treatment had more than one substantiated incident of abuse or neglect, while three comparison group families had at least two incidents, and two of the families had at least three incidents of abuse or neglect.
Outcome of an in-home service Table 2.
Comparison
Number of children abused Number of children abused Number of children abused Total number of abuse and Total Dercent recurrence
523
of Protective !3ervices Clients Receiving or Not Receiving Proiect 12-Wavs Services
or neglected during TX or neglected after TX or neglected 2 times neglect incidents
Project 12-Ways Protective Services Clients
Comparison Group Protective Services Clients
N = 50
N = 41
1 (2%) 4 (8%) 0 (0%) 5 10%
5 (11%)
5 (11%) 3 (6%) I5 21%
The total number of abuse or neglect incidents during or after treatment for the Project 12Ways group was five, and for the comparison group was 15. A cl&square analysis of these frequencies produced a significant result (&i-square = 5.00, df = 1, p < .05). Thus, the total number of children abused or neglected during or after treatment was 10% for the Project 12Ways group, and 21% for the comparison group. Additional data provided by the State Central Register to the Regional Office indicated that the 21% for the comparison group reflected the recurrence frequency for the entirety of Illinois Region V which is the region from which both samples were selected.
DISCUSSION The results of the program evaluation data suggest that if a family received services from Project 12-Ways during fiscal year, 1980, there was less likelihood of repeated abuse or neglect during treatment or incidents after treatment in the next year than if the family received the state’s routine services. Nonetheless, interpretation of these data requires caution. If these differences, indeed, exist, one might question how durable over time they are. For example, it might be suggested that the lower frequency of incidents in families served by Project 1ZWays might be a function of what the families could perceive as surveillance. That is, since Project 12-Ways staff members are able to see clients more frequently than the agency’s caseworkers can, the clients might be more fearful of being caught in abuse or neglect incidents or their aftermath. Also, the recidivism data were less impressive than the reincidence data. Only long-term follow-up data from both samples can produce any conclusions about any potential superiority services provided by Project 1ZWays. Unfortunately, lack of sufficient demographic data on control group subjects precluded an analysis of group equivalences (such as age, sex, etc.) between the two groups. Of course, it was hoped that the random selection of subjects produced equivalence; however, subsequent comparisons from more recent fiscal years (currently under way) should include such analyses if data are available. Another concern might be that it would be difficult to replicate Project 1ZWays as a model service in any setting outside a university. This is not necessarily the case, especially if Project 12-Ways can produce validated training packages that could be disseminated to service providers who are not affiliated with universities. Finally, it might be assumed that biasing of one sort or another exists in that clients may be assigned to Project 1ZWays according to particular formal or informal criteria established by a given field office. Again, the only control for this possibility would be an analysis of group equivalences. The data presented here, however, are encouraging because they are a measure of outcome of services after the Project’s first year of operation. During that first year, the stafI’ were more
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inexperienced than current staff, their supervision was less systematic, and the adminis- trative structure was not as smooth as currently exists on the Project. In order to determine results with clients served in more recent years, we are currently analyzing data in a similar fashion.
CONCLUSION Project 1ZWays is a large scale, in-home ecobehavioral service aimed at the treatment and prevention of child abuse and neglect in southern Illinois. In its first four years of existence Project 1ZWays has been funded at a $2 million cumulative level. Over 300 families have been served during that time. Thus, any effort of this magnitude should be accountable on several levels. Hence, four levels of research and data collection and assessment are used to evaluate the effects of these services. Preliminary group evaluation data suggest that Project 1ZWays has a significant impact on reducing repeated abuse and neglect during treatment and recidivism following treatment. Acknowledgemenr-The authors express appreciation for the assistance of John Allen, Alan D. Bickett, Denise La Berdia, Sherry Seibel, Dennis Stuckey, Michael Tristano and David Wesch.
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