Families as Nurturing Systems

Support Across the Life Span

Donald G Unger, Douglas Powell

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781138990913
• eBook ISBN: 9781317765615
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Here is a major new volume for practitioners, researchers, and those concerned with future policies to promote the welfare of children and families. The patterns of support and the ability of family members to care for each other have changed along with the problems for the health and functioning of families. In Families as Nurturing Systems, respected scholars examine the new and emerging directions in the design and implementation of family resources and support programs. They describe and analyze a wide range of program models in the areas of prevention, social support, family resource, and empowerment that have been implemented in schools, the Afro-American church, early intervention programs, the workplace, and the public policy arena, reflecting the needs of families at different stages in the family life cycle.

Family Support across the Life Span and within Different Settings

Early Family Intervention: Focussing on the Mother’s Adaptation-Competence and Quality of Partnership

Christoph M. Heinicke

SUMMARY. Two general hypotheses relating to studies of early family intervention are discussed: (1) Pervasive and sustained gains in family development are correlaries of changes in the multi-risk mother’s adaptation-competence and partnership quality, and (2) Efforts to change this functioning are most likely to be successful if the mother can develop a sustained and working relationship with the intervenor. The paper reviews sources which support these hypotheses: (1) Eight controlled follow-up intervention studies assessing and attempting to intervene in different family domains; and (2) Current ongoing studies focussing on the nature of the mother’s relationship to the intervenor.

The efforts of the UCLA Family Development Service to enhance the multi-risk family as a nurturing system has been guided by the assumption that lasting change is not likely to occur unless the adaptation-competence and/or quality of the primary caretaker’s partnership is also changed in a progressive direction. In this paper we will (1) Define adaptation-competence and partnership in the context of other dimensions of family functioning; (2) describe the approach and give the outcome results of early family intervention studies that have also been guided by the above assumption; and (3) describe the home-visiting approach being used by the UCLA Family Development Service.

Adaptation-competence is defined as the person’s effective and flexible coping with the balance of internal and external demands. It has been specified empirically by a factor including ratings of the ability to meet one’s own needs, flexibility in adaptation, low anxiety, and effective use of support systems (Heinicke, Diskin, Ramsey-Klee & Oates, 1986). The mother’s capacity for partnership is defined as the ability to maintain a mutually satisfying personal relationship. One example of such a partnership, the husband-wife relationship, has been specified empirically by a factor including ratings of the husband’s fostering the confidence of his wife, the mother’s sense of success as a wife, the husband’s empathy towards his wife, and ratings of her perception of the positivity and communication in the marriage (Heinicke et al., 1986).

It is recognized that the concepts of adaptation-competence and capacity for partnership can be measured in different ways. Equally important, if they are used in family intervention studies they must be placed in a family systems context. Previous publications have provided such a theoretical framework (Belsky, 1984; Heinicke, 1984; Cowan & Cowan, 1987). It is also recognized that any one aspect of the interacting family system can influence and be influenced by another aspect. Thus, it has been shown that the pre-birth characteristics of maternal warmth and adaptation-competence as well as husband-wife adaptation interacting with early stable infant characteristics such as soothability and visual attention are significant predictors of the positive parent-child mutuality in the first two years of life (Heinicke et al., 1986). Moreover, maternal warmth and adaptation-competence, measured before birth predict assessments of the same qualities in the pre-school years and are at that time part of a cluster of variables including positive parent-infant mutuality (Heinicke & Lampl, 1988). It follows that changes in these parental qualities as a function of intervention are likely also to have an impact on the positive parent-child mutuality. More generally, one can argue that the more pervasive and sustained positive outcome of intervention is not likely to occur unless parental characteristics as well as the quality of the family interaction and the child’s development are addressed.

Outcome of Intervention and Change in Parent Adaptation Competence and Quality of Partnership

What evidence is there that those early family intervention studies showing a pervasive as well as sustained effect included both an explicit effort to alter and in fact reported success in changing the adaptation-competence and/or the quality of the partnership of the parents?

In a recent review of controlled studies of early family intervention (Heinicke, Beckwith, & Thompson, 1988), ten studies were reported that showed pervasive effects as defined by three or more positive findings in different subcategories of family functioning. Two further studies meeting the criteria of pervasiveness have come to our attention since publication of this review (Wieder, Poisson, Lourie & Greenspan, 1988; Lally, Mangione & Honig, 1988). Of these twelve (12) studies, eight (8) also demonstrated through follow-up that the results were sustained for at least a year after the intervention had ceased. In all eight studies there was both an explicit effort to change and reported success in actually changing the adaptation-competence and/or quality of the partnership of the parents.

Before turning to the specific documentation of this characteristic of the studies, other common descriptors should be noted. All eight of these intervention programs involved a minimum of 11 contacts over a 3 month period, but the variation in the number of contacts was considerable with the median being 75. Six of the eight targeted low-income multi-risk families and were at the same time “comprehensive” in providing more than one kind of service. Most important, in all eight instances the delivery of the services was made possible through the ongoing relationship to the intervenor. In seven of the eight instances that relationship was to a home visitor. In the paragraphs below we will briefly summarize for each of the eight studies the functions targeted and which indices of parent adaptation-competence and/or quality of partnership changed.

The first of these projects intervened with mentally retarded, poverty level mothers with full term babies (Heber & Garber, 1975; Garber & Heber, 1981). The project offered comprehensive family intervention that included occupational training, job placement, home-making, and childrearing training for the mothers and center-based education for the child in order to prevent cultural-familial retardation in infants. An ongoing relationship with a home visitor provided much of this information. Intervention focused on changing family ecology, maternal adaptation-competence, and child cognitive development. Various assessments determined that the intervention not only enhanced many aspects of the mother-child interaction and the child’s development but led to the mother’s increased literacy, a more stable work history, and increased earnings. The adaptation-competence of the mothers clearly was improved.

Nurcombe, Howell, Rauh, Teti, Ruoff, Brennan, and Murphy (1984) intervened with married couples raising a premature infant. A programmed series of contacts with a pediatric intensive care nurse included enhancing sensitivity of parents to cues of the premature infant and promoting enjoyment of play. Both hospital contact and home visits were involved. Functions targeted were maternal adaptation, parent-infant interactional synchrony, affective closeness, and infant temperament. The authors report that in addition to positive effects in the family interaction and child development domains, the mothers who experienced the intervention showed greater role satisfaction and confidence than the mothers in the control group.

Similarly, Minde, Shosenberg, and Thompson (1983) found that their intervention with low socio-economic status families of premature infants affected not only the mother-child interaction and the child’s development, but led to the mother’s improvement in her relationship with others generally, a greater knowledge of community resources, and a greater sense of autonomy. In this project a self-help group provided ongoing support, specific assistance, and a forum for discussion in order to improve parents’ sense of mastery and autonomy and their interaction with a stressful premature infant. The group was led by a veteran mother and nurse group coordinator who was also available for individual support between group meetings.

Olds, Henderson, Tatelbaum and Chamberlin (1986a; 1986b) intervened with teenage, mostly single, poverty mothers. A nurse home visitation program including parent education, enhancing the informal support system, and linking families to community resources was designed to improve maternal health behaviors, the quality of parenting including prevention of abuse, the effective use of support, and the health of the infant. In addition to an ongoing relationship with a nurse visitor, free transportation to clinics and developmental screening were provided. Changes in the mother child interaction and the child’s development were found and mothers experiencing the intervention showed a more positive adaptation: They made better use of community resources and informal support, had fewer kidney infections, better diets, and reduced their smoking.

Seitz, Rosenbaum, and Apfel (1985) has reported the evaluation of comprehensive family services for single, inner city, poverty-level mothers designed to enhance the mother’s adaptation, the quality of her relationship to her child, and the child’s development. An ongoing relationship with a home visitor, pediatric care, high quality day care, and developmental examinations were provided. Changes in the family interaction and the child behavior as well as changes in the adaptation-competence and relationship capacity of the mothers were found. At the seven and a half year post-intervention follow-up the program mothers were characterized as follows: They completed more years of education, waited longer to have a second child, were more frequently a part of a nuclear family, were more frequently self-supporting, more frequently initiated contacts with teachers, and made greater use of remedial and supportive services.

Cowan and Cowan (1987) have evaluated the impact of couples groups for first-time parents. The groups were led by married couples and provided ongoing support, normalization of experiences, and discussion of all family issues to enhance positive marital quality and parent adaptation. At follow-up, couples attending the group when compared with a control group showed greater improvement in the following different dimensions: Marital satisfaction, self-esteem, and mutual role arrangements.

Wieder, Poisson, Lourie and Greenspan (1988) have reported the five-year follow-up of 32 multi-risk families who received intensive, comprehensive services through the Clinical Infant Development Program (CIDP). Three components made up this intervention:

1. Organizing basic services for adequate food, housing, medical care and educational opportunities, to deal with day-to-day survival and future family stability;
2. Providing a constant emotional relationship with the family through which trust could be established with the parents and the infant; and
3. Providing specialized services to the infant and parents geared to meet the challenges at each stage of development, given each infant’s and parent’s individual vulnerabilities and strengths.

The follow-up assessments were relevant to these three goals. In so far as the first goal was to deal with basic survival and sustenance, when compared with both the beginning and the end of intervention point, both the adult and especially the adolescent mothers had made striking gains in their work status and in being independent of public assistance. The increased freedom to work outside the home was very likely due to avoiding the repeat pregnancies which in the past further drained the limited resources.

The provision of an ongoing relationship opportunity by the CIDP staff was reflected in the mother’s increasing capacity to form mutually satisfying partner relationships. Five years after the intervention ended, 42% of adult mothers were married or had sustained relationships. There was a striking decline in the abusive aspects of these relationships as well as those with their children. Thus, spousal abuse for the older mothers decreased from 60% to 5.3% and from 50% to 18% for the adolescents.

Wieder et al. (1988) also cite findings on the children which indicate average IQ performance (103), placement in regular as opposed to special education classes, and active involvement in team sports and local youth organizations.

Although it would seem clear that the persistent, clinically skilled and comprehensive program outlined above did indeed produce sustained gains in parent and child functioning, some reservation is introduced by the fact that a comparison group was not available to highlight which positive changes were a function of the intervention and which might have occurred without intervention.

Another major project, the Syracuse University Family Development Program has also recently published dramatic follow-up results (Lally, Mangione, Honig & Wittner, 1988; Lally, Mangione & Honig, 1988). The intervention was designed to influence the permanent environment of the child, the family and the home. A poverty, largely black, young, mostly single population was recruited in late pregnancy. The contact with the parent was viewed as primary and child care as supplementary.

A cadre of paraprofessional home visitors called Child Development Trainers (CDTs) was recruited and trained intensively to encourage strong, nurturing mother-child relationships that involved giving affectionate bodily contact, respecting children’s needs, and responding positively to young children’s efforts to learn. CDTs offered positive support and encouragement to mothers as they interacted with their children and also responded positively and actively to the parent’s need to fulfill her aspirations for herself. Many mothers came to rely on the CDT as an advisor and confidant on personal relations, finances, career changes, and education. The CDT served as a liaison between the family and community support services, including the child care component of FDRP; in addition, she helped families to learn to find and use neighborhood resources on their own; for example, giving families specific practice in learning how to make and maintain contact with school personnel as children reached school age.

In addition, parent associations were encouraged and the Children’s Center provided child and pre-school education to three age groups: 6 to 15 months, 15 to 18 months, and 18 to 60 months.

The follow-up conducted ten years after the end of the program revealed that the program children showed both a significantly lower rate of...

Table of contents

• Cover
• Title
• Copyright
• CONTENTS
• Acknowledgements
• List of Contributors
• Preface
• Families as Nurturing Systems: An Introduction
• NEW DIRECTIONS FOR FAMILY RESOURCE AND SUPPORT PROGRAMS
• FAMILY SUPPORT ACROSS THE LIFE SPAN AND WITHIN DIFFERENT SETTINGS