Care Improves for Vulnerable Children

Youngsters who participate in a national program for at-risk children receive greater access to critically important health and social services, improve learning skills that are crucial for their future school success, and strengthen their family ties, according to early findings of a study sponsored by SAMHSA and the Casey Family Programs.

The early findings were from a study of 2,908 children from 12 sites across the Nation who participate in Starting Early Starting Smart (SESS). This program targets children from birth to age 7 whose family or community environments put them at risk for mental and addictive problems.

The 4-year grant study is a collaborative effort among all three SAMHSA Centers and the Casey Family Programs, which is a private foundation with services that include support for children from foster care to adoption.

"Eighty percent of parents who participate in the program stay in the program. This is a clear indication of the program's positive influences," said Ruth Sanchez-Way, Ph.D., Director of SAMHSA's Center for Substance Abuse Prevention.

"We know that removing children from their families during their formative, bonding years needs to be avoided," said Ruth Massinga, president and CEO of Casey Family Programs. "Starting Early Starting Smart shows that there are viable strategies and approaches to prevent out-of-home placement. When we provide a system of integrated services and consistent, skilled supports required to ensure safe, nurturing, and loving homes, parents who may be struggling with substance abuse and mental health issues stand a much better chance of keeping their families together."

Based on the success of previous, similar programs, SESS uses a child-centered, family-focused, community-based approach that includes assistance in substance abuse prevention, mental health services, and substance abuse treatment. These services, defined as behavioral health services, are provided in settings that parents with infants and preschool children normally frequent.

The demonstration project includes a total of 12 sites (see box) and a coordinating center—Evaluation, Management & Training Associates, located in Folsom, CA.

The SESS program figures were collected by the 12 grantees, with nearly 3,000 children participating in the study. Rigorous evaluation of the project has produced five major early findings demonstrating that SESS programs have succeeded in:

• Increasing access to needed services for participating families.

SESS programs increased caregiver participation in educational and therapeutic services concerning parenting and family functioning. Thirteen percent more SESS caregivers participated in these programs compared to similar families receiving a basic standard of care. Moreover, in programs that emphasized the selection of families in need of substance abuse services, 7 percent more of the SESS caregivers in need of services received treatment, compared to the standard-of-care families. Similarly, 12 percent more SESS than comparison families in need of mental health services received treatment.

• Helping participating families strengthen the ways in which they guide and support the development of their young children.

In several areas of family functioning and parenting behaviors, SESS families made significant improvements compared to standard-of-care families. For example, SESS families reduced verbal aggression in the home 17 percent more than comparison families, where reported verbal aggression actually increased on average. SESS families also reported statistically significant improvements relative to comparison families in the use of appropriate discipline (3.2 percent), the use of positive reinforcements (2.2 percent), and in the variety of experience provided children in homes with limited opportunity (4.1 percent).

• Decreasing drug use among caregivers when programs targeted caregivers and infants in the early months of life.

In SESS programs operating in pediatric care settings, caregivers in need of substance use treatment reduced their reported drug use 35 percent more than comparison caregivers in need of substance abuse treatment services.

• Strengthening positive interaction between participating caregivers and infants in the early months of life.

Coding of videotaped interactions between caregivers and infants was more positive for SESS caregivers and children than for comparison caregiver-child dyads in both feeding and play situations. At 6 months into the program, randomly assigned caregiver-child dyads in SESS programs interacted more positively than randomly assigned comparison caregiver-child dyads by statistically significant margins.

• Strengthening the development of young children in the program in ways that are crucial for school success.

Preschool-age children in SESS improved significantly in social-emotional and cognitive development relative to comparison youth. These developmental areas are crucial to school readiness. For example, SESS children improved their performance on use of linguistic concepts 8 percent more than comparison youth. For children with high need in this area, SESS children did better by 21 percent. As reported by teachers, SESS children reduced externalizing problem behaviors 21 percent more than comparison children, and reduced internalizing problem behaviors 23 percent more than comparison children.

To learn more about Starting Early Starting Smart, visit ncadi.samhsa.gov/promos/sess/about.html.

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