Evaluation

The initial Nurturing Parenting Program for Parents and Children 4 to 12 Years and each subsequent program were extensively field tested. The initial study funded by the National Institute of Mental Health included 121 abusive adults and 150 abused children. The average age was 30 years for adults and 6 years for children. The program was field tested in five States: Indiana, Minnesota, Ohio, Pennsylvania, and Wisconsin. Ninety-two percent of the parents and 90 percent of the children were Caucasian. The remaining parents and children were African American (6 percent), American Indian (2 percent), and Hispanic (1 percent). The initial field trial and all subsequent studies used the battery of inventories and forms described below. Each inventory was administered before the program began (pretest), at the end of the program (posttest), and 12 to 18 months after completion of the program.

• The Adult Adolescent Parenting Inventory (AAPI): A norm-referenced, standardized inventory designed to assess the parenting and childrearing attitudes of adults and adolescents. Responses generated from the inventory measure the expectations parents have of their children, empathy toward children's needs, belief in the use of corporal punishment, and parent-child role clarification.

• The Children's Personality Inventory (CPI): An informal parenting inventory for young children designed to assess the same parenting attitudes as described in the AAPI. The children respond to parenting examples with "I agree," "I'm not sure," or "I disagree."

• The 16 Personality Factor (PF): A standardized, norm-referenced personality inventory measuring the polarities of 16 primary personality factors and 4 secondary personality factors.

• The Children's Personality Questionnaire (CPQ) and the Early School Personality Questionnaire (ESPQ): Inventories based on the same 16 primary personality factors and 4 secondary personality factors measured by the 16 PF.

• The Family Environment Scale (FES): Inventory designed to assess 10 characteristics of family interaction patterns.

• The Nurturing Quiz: An informal, criterion-referenced inventory designed to measure knowledge of appropriate behavior management strategies.

• The Family Social History Questionnaire: An inventory designed to gather demographic data (age, gender, level of education) and perceptions of childhood experience. (Questions include: Do you feel you were abused as a child? If yes, what kind of abuse did you experience?)

• Observational Data Collection Forms: Forms used to collect data during longitudinal in-home observations of family interactions.

• Program Evaluation Forms: Forms that parents complete at the end of each weekly session, after the completion of the entire 15-week treatment program, and 1 year after completion of the program. Parents are asked to rate the quality of the instruction (1 = low to 5 = high), the usefulness of the information taught, and the likelihood that they would use the new information.

Results

Program participants.¹ Of the 121 adults who participated in the initial study, 95 (79 percent) completed the program. Of the 150 children who participated, 125 (83 percent) completed the program. Trainers rated 88 (93 percent) of the adults who completed the program as having successfully modified their abusive parent-child interactions. Seven adults (7 percent) who committed new acts of child abuse or did not achieve program goals were rated as having failed the program.

Parents' attitudes about parenting practices. Pretest and posttest data gathered from administration of the AAPI indicated that significant (p<0.05) positive changes occurred in the parenting and childrearing attitudes of the parents. These changes included expectations more appropriate to the development of their children, an increased empathic awareness of children's needs, a decrease in the use of corporal punishment, and a decrease in parent-child role reversal.

Data gathered from parents 1 year after they completed the program indicated a retention of empathic attitudes toward children's needs and a clear differentiation of appropriate parent-child roles. Approval of alternatives to the use of corporal punishment increased, as did the appropriateness of the parents' expectations of their children relative to their developmental level, which showed a significant (p<0.01) increase.

Children's attitudes about parenting practices. Data generated from the administration of CPI indicated that prior to their involvement in the treatment program, abused children supported the use of corporal punishment by parents, showed little empathic awareness of the needs of others, and tended to support parent-child role reversals. Responses concerning developmental expectations tended to show a low level of self-awareness.

Posttest data indicated significant (p<0.05) increases in self-awareness and understanding of appropriate parent-child roles. The followup scores of abused children 1 year after their participation in the program indicated a significant (p<0.01) increase in self-awareness and a concomitant decrease (p<0.01) in their support of corporal punishment.

Personality characteristics of parents. The 16 PF was used to develop a personality profile of the parents who participated in the study. Prior to participation in the program, they received high scores in intelligence (abstract thinking), aggression, anxiety, independence, and radicalism (e.g., experimenting and free thinking). Their scores further indicated a highly undisciplined self-concept and disregard for rules. Posttest results showed significant increases in intelligence (p<0.01), enthusiasm (p<0.01), social boldness (p<0.01), and self-assuredness (p<0.05) and significant decreases in radicalism (p<0.05), anxiety (p<0.02), and tough demeanor (p<0.05).

When the personality characteristics of parents who completed the program were compared with those of parents who dropped out, the dropouts were found in general to be less intelligent and more suspicious, apprehensive, radical, frustrated, anxious, and tough minded. The data also indicate that the dropouts were more affected by feelings and more detached (aloof), careless of social rules, independent, and tougher in demeanor. In comparison with parents who successfully completed the program, those identified as "failures" (i.e., who completed the program but did not achieve program goals) tended to be more detached (aloof), threat sensitive, tough minded, practical, apprehensive, careless of social rules, frustrated, and anxious but less tough in demeanor.

Personality characteristics of children. The CPQ and ESPQ were used to develop a personality profile of the abused children who participated in the study. Their pretest responses showed personality traits that fell within the normal range for their age group, with two exceptions: they tended to be more concrete in their thinking and undemonstrative in nature. Posttest results indicated a significant increase in assertiveness (p<0.05), enthusiasm (p<0.01), and tough demeanor (p<0.03).

Family interaction patterns. The FES was used to develop an interaction profile of the families who participated in the study. Pretest responses indicated that abusive families tended to demonstrate low family cohesion, low expressiveness, low independence, and low achievement but a high degree of family conflict. The responses also indicated a low orientation toward intellectual, cultural, and recreational activities among abusive families.

Posttest results showed significant increases in family cohesion (p<0.03), family expressiveness (p<0.03), and family independence (p<0.01) and a concurrent significant decrease in family conflict (p<0.001). When posttest responses were compared with responses gathered 1 year after completion of the program, further significant increases were seen in family cohesion (p<0.05), family expressiveness (p<0.04), family organization (p<0.02), and moral-religious emphasis (p<0.02); a significant decrease was seen in family conflict (p<0.05).

When responses of parents who successfully completed the program were compared with those of parents who dropped out, the dropout parents were found in general to have lower scores for family cohesion, expressiveness, independence, organization, and control. Dropout families also tended to score lower for moral-religious emphasis and orientation toward intellectual, cultural, and recreational activities. In comparison with families who successfully completed the program, families who were identified as "failures" (i.e., who completed the program but did not achieve program goals) tended to demonstrate less family independence and organization and greater orientation toward family achievement and control.

Nurturing Quiz. Posttest data generated from administration of the Nurturing Quiz indicated a significant (p<0.05) increase in acquired knowledge related to behavior management concepts and techniques. No significant changes in test scores were found when the Nurturing Quiz was administered 1 year after completion of the program.

Followup in-home observations. Trained program observers conducted in-home observations of 52 families who completed the program. Each family was visited twice, and each observation lasted 2 hours. The observer engaged the family in structured interactions using an ethnographic recording strategy in which the observer wrote down what was heard and seen without subjective interpretation. The written observations were then categorized into family interaction patterns.

Data generated from the in-home observations were divided into two categories: empathy and behavior management. The most frequently observed empathic behaviors are presented in rank order in table 1. A review of the table shows that two behaviors, recognition and acceptance of feelings/needs, accounted for 54 percent of observed behaviors among family members. Dominance (demanding obedience)/submissiveness, disinterest/coldness (not paying attention to the child's needs/wants), inappropriate expectations of children, and anger accounted for 15 percent of observed family interactions.

Behavior management concepts can be applied appropriately and inappropriately. The behavior management techniques observed are presented in table 2. The appropriate use of praise was the most frequently observed behavior management technique, while ignoring was the most widely misused. The parents tended to ignore behavior that warranted either intervention or punishment.

Involvement with helping professionals. Fifty-eight percent of the families in the initial study were required to attend parenting classes or seek counseling with departments of social services for child abuse prior to their participation in the program. One year after completing the program, only 16 percent of the families were still receiving such services, a decline of 42 percent. Of the families who completed the treatment program, 7 percent were charged with additional counts of child abuse.

Fifty-five percent of the families were involved in Parents Anonymous prior to their participation in the program. One year after completing the program, only 30 percent of the families were attending Parents Anonymous groups, a decline of 25 percent. Forty-seven percent of the families were receiving additional services while participating in the program. These included marital and individual counseling, family therapy, and alcohol and chemical dependency counseling. On a scale from 0 to 10 (0 = unsuccessful, 5 = successful, and 10 = very successful), program facilitators rated the overall success of the program in modifying abusive parenting behavior at 6.93.

Parent evaluation of program. Parents were asked to complete a program evaluation questionnaire immediately after they completed the program and again 1 year later. Parents were asked to use a four-point scale (1 = strongly agree, 2 = agree, 3 = disagree, and 4 = strongly disagree) to indicate whether the program helped them increase their knowledge of age-appropriate developmental expectations and behavior management techniques and their degree of self-awareness and empathy. The results of the questionnaire are presented in table 3.

Additional research. Evaluations of subsequently developed Nurturing Parenting Programs have yielded similar results. Program participants showed significant pretest and posttest changes in parenting attitudes and childrearing practices.²

The Nurturing Parenting Programs are family-centered programs proven to help parents and children learn to care for themselves and each other and to replace old, unwanted abusive interactions with newer, more nurturing ones. Continued revisions and updates of the programs will ensure that families can achieve success in developing their nurturing parenting skills and that generations of abuse can finally come to an end.

2 The evaluation report on continued research on the Nurturing Parenting Programs is available from the Juvenile Justice Clearinghouse (JJC). To request a copy, contact JJC at 800-638-8736 or 410-792-4358 (fax) or through www.ncjrs.org/puborder. An online abstract of the evaluation report is available from the National Criminal Justice Reference Service Abstracts Data Base: http://abstractsdb.ncjrs.org/.