Issue Editor, Susan Landry\u27s point of view and summary of the articles in Family Well-Being and Social Environments

Landry, Susan H.

Name not available

Family Well-Being: A Complex Challenge Worth Pursuing

DigitalCommons@The Texas Medical Center

Journal of Applied Research on Children: Informing Policy forChildren at RiskVolume 5Issue 1 Family Well-Being and Social Environments Article 22014Family Well-Being: A Complex Challenge WorthPursuingSusan H. LandryUniversity of Texas Health Science Center at Houston, Susan.Landry@uth.tmc.eduFollow this and additional works at: http://digitalcommons.library.tmc.edu/childrenatriskThe Journal of Applied Research on Children is brought to you for free andopen access by CHILDREN AT RISK at DigitalCommons@The TexasMedical Center. It has a "cc by-nc-nd" Creative Commons license"(Attribution Non-Commercial No Derivatives) For more information,please contact digitalcommons@exch.library.tmc.eduRecommended CitationLandry, Susan H. (2014) "Family Well-Being: A Complex Challenge Worth Pursuing," Journal of Applied Research on Children:Informing Policy for Children at Risk: Vol. 5: Iss. 1, Article 2.Available at: http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  Over many decades there has been increasing concern over the well-being of families and the ability of society to support families to develop their potential and support their children’s health and development. With great economic and political challenges that communities, cities, and nations continue to face, there is the need to have research that informs policy and development of interventions for families’ well-being. This Journal of Applied Research or Children: Family Well-Being and Social Environments (JARC) issue on Family Well-Being and Social Environments includes articles that cover a broad range of areas on child and family well-being from a number of different perspectives. A number of themes can be found among the nine research articles, including the negative effect of poverty in relation to a higher risk for many persistent difficulties families and children face. These include teenage pregnancy, poor parenting, a high incidence of childhood obesity, and a child’s risk for being abused or neglected. Other themes include the influence of parents and other caregivers on child outcomes, as well as the importance of education and the provision of information to families about child health and development.  The range of themes in this issue is closely aligned with the major areas or domains important in understanding family and child well-being as described in national reports. For example, the 10th Anniversary Edition 1Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  of America’s Children: Key National Indicators of Well-Being 2007 published by the Federal Interagency Forum on Child and Family Statistics, considers seven major domains in the characterization of children and family well-being.1 Many of these domains are closely aligned with the family and child areas of concern described in the research articles in this issue of JARC and are best understood as being interrelated and having synergistic effects on children and families’ well-being. When considering together the various topics addressed in this issue, the inter-relation and synergism among factors like family and social influences, families’ economic situation, health and education, all key domains in the Forum’s 10th Anniversary Report, become very apparent.  One of the seven domains, “Family and Social Environments” is important as it relates to a number of the problems described in papers in this issue. For example, from several articles we learn that the lack of responsive and sensitive parenting can result in parents’ lack of appropriate stimulation, as well as to the more troubling problem of neglect and abuse of children. The family and social environment is also the key to prevention of childhood obesity, including families assuring that their children have healthy diets and environments that promote adequate amounts of physical activity. Close links can also be found between the family and social environments of children and teens in understanding why 2Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  we continue to have unacceptably high rates of teenage pregnancy in the United States. A family’s cultural norms and the attitudes of family members and peers can influence teenagers’ expectations about their own goals for education and a career versus acceptance of an early pregnancy. A second major domain in the Forum’s Anniversary publication is “Economic Circumstances” of families and children. A careful reading of the papers in this issue of JARC reveals a direct relation between many of the problems that plague families and children with their inadequate economic circumstances. In fact, many of the additional domains addressed in the Forum’s anniversary report (e.g., health, education, safety) are often compromised by inadequate economic circumstances, particularly when they reach high levels of poverty. As children are our most important asset and define our future, it is important to note that the number of children ages 0 – 17 years of age in the United States has increased since 1950 and is projected to continue to increase at least through 2020, and probably beyond. With that projection in mind, it is critically important to acknowledge that our poverty rate is high and persistent and that children and families from particular ethnic backgrounds (e.g., African-American, Hispanic) are much more likely to live in poverty than children from Caucasian households. This fact 3Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  becomes even more troubling given that one of the fastest growing groups in the United States are children from Hispanic households and they are also more likely to grow up in poverty. In light of the numerous family and child life difficulties that can compromise well-being, an encouraging theme, present in a number of papers in this issue, is the idea that there are prevention and intervention programs that, when implemented with good fidelity, can help ameliorate some of the problems families and their children face. The article, “Project Passport: An Integrated Group-Centered Approach Targeting Pregnant Teens and Their Partners (Buzi et al) describes an intervention for pregnant teens and their partners. The health and social ramifications of having a baby as a teenager are highlighted including risks for poor health, less education, as well as economic and social difficulties for both the teen mother and child. Project Passport takes a somewhat unique approach to the problem of teenage pregnancy by including partners in an integrated approach that addresses health and selected education and social behaviors that will better assure positive outcomes across multiple domains. This intervention has the potential to place teens, at high risk for negative life outcomes, on a positive trajectory as it targets, through a well-conceptualized model, support for teens to learn how to make 4Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  decisions that will have potentially long term significant impacts on their lives. As an example of the inter-relation among issues related to family well-being, “The Prevention of Child Physical Abuse and Neglect: An Update”  by Nelson and Caplan highlights a societal problem that is negatively impacted by poor parenting and often associated with teen parents, poverty, and low levels of education. The continued high incidence of abuse and neglect across the last decade in the United States, as compared to other countries, calls for a better understanding of the characteristics of prevention programs that can decrease this problem. It becomes apparent from this review that information-only programs will not decrease rates of abuse and neglect but more intensive, highly targeted programs, particularly those with a home visitation coaching component can result in decreases in this devastating problem. As the effects of some of the more effective programs are still small and very few programs are in the effective category, much more work is needed to better understand the most promising characteristics of programs and community efforts that will have long lasting positive effects. As we learn more about characteristics of effective parenting programs, new approaches are being incorporated into the development and implementation of parenting interventions. Two articles in this issue 5Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  describe innovative strategies that may be particularly effective in engaging families that might be more difficult to engage in home-based programs. The article, “Using Live Coaching and Video Feedback to Teach Responsive Parenting Skills: Experience from the PALS Project” by Guttentag describes a process called reflective coaching, where a home visiting coach facilitates a caregiver’s practice of new behaviors in interactions with their young child while videotaping this practice. The caregiver is then guided by the coach to critique their own behavior while viewing the video, reflecting on what they did that helped their child stay engaged and what they did that was not as effective in supporting their child’s learning and development. This article describes how this reflective process can help caregivers make dramatic changes in how they respond and support their children’s learning. The article by Feil et al, “Who Participates in an Internet-Based Program for Mothers of Infants? A Secondary Prevention Research Study Among Low-Income Families” goes one step further in using reflective coaching by incorporating an effective home visitation program into a web-based approach so that families are learning by viewing the parenting sessions each week on a laptop they receive, and then taking a video of themselves using the responsive behaviors with their child. This video is then uploaded and a remote coach views it and initiates, long distance, a 6Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  reflective coaching call. Innovative strategies like the ones described in these two articles have the potential to advance our knowledge about effective approaches for engaging difficult-to-engage families and how the use of technology may ultimately allow effective programs to be taken to scale. In light of encouraging information on the effectiveness of a number of parenting programs, especially those with a home-based approach using a coach, the article, “Early Lessons Learned from Building Local Early Childhood Comprehensive Systems in Texas”  by Osborne et al describes the process of building comprehensive early childhood systems in communities in Texas. One goal of these systems is to integrate the national Maternal, Infant, and Early Childhood Home Visiting program (MIECHV) into local integrated systems, to better assure home visiting programs are interfacing with other organizations, particularly those providing additional services to families and their children. While this article gives a sense of the many challenges associated with building integrated partnerships and how these challenges vary by characteristics of each community, the message about the importance of persisting in efforts to build and sustain these systems is clear. Interventions that facilitate families to be more responsive to their children’s emotional and cognitive needs can sometimes prevent abuse 7Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  and neglect. However, “Contact in Foster Care: Bridge or Collision between Two Worlds?” by Carvalho and Delgado tells the story of what happens when families either doesn’t receive support to improve their parenting skills or the programs they do receive fail to prevent negative outcomes. This article looks at the foster care system in Portugal and presents the outcomes of this system through a systematic collection of many pieces of information. The story reveals the complexity of this system in terms of assuring children that have been abused or neglected are cared for properly by their foster families while also finding ways to allow the child to have contact with their biological families. We are guided to understand how, in spite of a national policy of having children ultimately reunited with their biological families, characteristics of the system compromise this goal and many children never leave their foster care homes. The inter-relation between a child’s health and parents’ knowledge and skills is highlighted in the findings that Athamneh et al present in their article concerning parents’ knowledge and practices for childhood fever management in Jordan. Through an observational, survey based study of Jordanian adult parents; the study reveals that parents have poor knowledge of basic information regarding managing their child’s fevers. High proportions of parents did not know basic facts such as at what 8Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  temperature should the parents consider that the child has a fever, the appropriate type and dose of medication, and how to take an accurate measurement of body temperature. While this survey was taken from adult parents in Jordan, this problem has been reported in other countries and underscores the need for programs to educate parents about fever management. It is also likely that there is other child health information that could be integrated into a parent education program. Children’s physical development is also important for children’s health and well-being. This is another area where parents have an important role and in this case it is to assure that their children have regular physical activity and thus receive the health benefits of this practice. However, the article, “Examining the Potential Disconnect Between Parents’ Perceptions and Reality Regarding the Physical Activity Levels of their Children” by Faulkner and colleagues reveals that this is another health-related area of parenting where parents lack appropriate beliefs and perceptions. They provide data, including testimonies from parents, based on semi-structured interviews conducted to determine the perceived impact of a mass media campaign in Canada to raise the awareness of parents to the importance of 60-minutes per day of physical activity for children aged 5 – 11 years. The campaign also attempted to increase mothers’ awareness that their own children were not active 9Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  enough. It is interesting and noteworthy that most parents (83%) liked the PSA’s that were part of the campaign and thought they were important for other parents. However, they most often responded that it was not an important message for them, as their children got adequate amounts of physical activity. The discouraging message in this study is that most of these children did not get adequate physical activity. The disconnect between parents’ perceptions of how active their children were and the children’s actual time in physical activity, a finding also reported in other studies, is one of the major challenges in changing perceptions, attitudes, and behavior. In line with the major theme throughout this diverse group of articles of the need for parents to be aware and accepting of their role to support their children’s health and well-being, the article by Johnson et al raises important questions. In this article, “Impact of Pediatric Obesity on Grades in Elementary School,” we are reminded of the increasing severity of childhood obesity and the numerous negative health and social consequences associated with it. While obesity has been related to academic performance in other research studies, the relation is usually reported for older children in middle and high schools and not for grades but with more objective measures of academic achievement (e.g., standardized tests of cognitive skills). The authors of this article raise the 10Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  question of whether significantly lower grades for children in the obese category, as compared to normal weight children, were due to teacher bias (psychological explanation) rather than to the obese children actually having worse academic performance possibly due to physiological reasons. Negative perceptions and expectations have been reported in a number of studies for people who are obese. In this study, the question is raised concerning the possibility of teachers having lower expectations for obese children because they view them as less capable (e.g., lacking self-discipline, less intelligent). While there may be many other explanations for these reported findings, more research on this issue will be critically important in order to better understand how individuals, such as children’s teachers perceive obesity and form expectations based on their perceptions. Across the nation there are many organizations accepting the challenge of educating families to better understand the many risks associated with pediatric obesity so that they provide healthy low-calorie diets and encourage physical activity for their children. An implicit question from the research described in this article is whether families would be more motivated to support their children maintaining normal weight status if they thought it would prevent their children from being stigmatized. 11Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014  In conclusion, this issue includes a group of research articles on a range of diverse topics, related to family well-being. Many of the articles describe research on interventions that target finding solutions to assure the well-being of families. All of the articles provide information that has implications for developing policy and programs that can support families, including children, to reach their potential. Hopefully this issue will spark the development of new ideas that advance our understanding of how to support our families.   12Journal of Applied Research on Children:  Informing Policy for Children at Risk, Vol. 5 [2014], Iss. 1, Art. 2http://digitalcommons.library.tmc.edu/childrenatrisk/vol5/iss1/2  References 1. Federal Interagency Forum on Child and Family Statistics. America’s Children: Key National Indicators of Well-Being, 2007. Federal Interagency Forum on Child and Family Statistics, Washington, DC: U.S. Government Printing Office. 2007.  13Landry: Family Well-Being: A Complex Challenge Worth PursuingPublished by DigitalCommons@The Texas Medical Center, 2014

Family Well-Being: A Complex Challenge Worth Pursuing

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