Strong Start Research Essay

Strong Start research and demonstration project provided high fidelity wraparound services to mothers in early recovery from substance use as an intervention to increase protective factors in the mother that are identified as preventative of child maltreatment. The study evaluated the effectiveness of the program in accomplishing this. As well it intended to ensure routine development screening of the infants. Additionally, the study brokered collaboration between community services for coordinated and planned service provision while also integrating natural supports. National Quality Improvement Center on Early Childhood (QIC-EC) funded this as one of four studies which sought to illuminated the effectiveness of prevention–promotion

focused interventions. This framework identified that (a) addressing child maltreatment before it occurs (primary prevention) must be placed within the context of increasing parent capabilities that will promote optimal child development and (b) preventing child maltreatment must also incorporate a focus on both increasing protective factors and decreasing risk factors. From a social ecological perspective this must include building family, community and policy networks to strengthen the capacity of parents and communities to care for their children in ways that promote well-being. (Browne 2014) These are inherent concepts in the wrap around service model, utilized in the Strong Start Program.
The research questions centered on both implementation of the model as well as outcomes for the mothers. In terms of the model the questions involved “How and to what extent do collaborative interventions that increase protective factors and decrease risk factors in core areas of the social ecology result in increased likelihood of optimal child development, increased family strengths, and decreased likelihood of child maltreatment within families of young children at high-risk for child maltreatment.” With regard to outcomes for mothers and children the research questions targeted the following: “How can High Fidelity Wraparound reduce the risks associated with maternal substance use? To what extent can High Fidelity Wraparound increase protective factors for these families? How can women’s substance use treatment join with Part C for collaborative interventions? How can Early Intervention services strengthen protective factors in these families?” The literature reviews thoroughly articulated the relationship between child maltreatment and maternal substance use, as well as the evidence supporting the potential effectiveness of a Wraparound approach to address the complex presentation of addicted pregnant and mothers of very young children.
The Strong Start projects sample was drawn from a Denver area specialized treatment facilities for pregnant women.

The literature suggests that pregnancy is a motivating factor for obtaining substance treatment. Consequently, as a time of crisis, while as high as 50 % of women drop out of treatment, these women have a compelling reason to begin and sustain changes to afford them the opportunity to successfully parent their child by achieving and maintaining recovery. This formative evaluation utilized an experimental design with randomization of families to either a standard of care group or wraparound service provision in the Strong Start program. Pregnant women age 18-44 enrolling in a specialized substance treatment program were informed of the study. Randomization utilized minimization software to ensure the groups were balanced for key indicators such as court ordered to treatment, open child welfare case, or previous termination of parental rights.

In addressing the research questions’ dual pronged nature both qualitative and quantitative measures were used. These included, Life domains/addiction severity index, Brief symptoms inventory, Post-Traumatic Stress Diagnostic scale, Connor -Davidson Resilience Scale, Vineland Social emotional scales and the Wraparound Fidelity Index, as well as focus group interviews and analysis of Wrap around

documentation.
The program sought to develop protective factors in the prevention of child maltreatment that included: parental resilience, social connections, concrete supports, knowledge of child development and parenting, capacity to support child's social-emotional competence. These protective factors were categorized under the life domains of the wraparound model. Family goals are partialized under life domains of health, legal, family, financial, housing and education. Goal attainment was rated by the Wraparound facilitator in each domain on a scale of 1-3, with 3 representing full attainment of the goals, and one representing no evidence of progress. Sustaining recovery was identified as the primary goal which was incorporated into the health domain. Roughly 85% of wraparound participants Data evidenced demonstrated statistically significant difference between families participating in Wraparound and those in the standard care group. As well as fewer and less severe mental health symptoms were reported by the mothers. Family relationships were noted to be improved as demonstrated by lower levels of family conflict. Only 10% of wraparound families evidenced no progress on these goals. Legal financial and housing domains all at 78% of families progressing of attaining their goals in these domains. Overall the findings suggest that “women who begin substance use treatment during their pregnancy and receive adequate supports during the first year postpartum may have better outcomes in sustaining their recovery and in their capacity to parent.” is concluded by the study author. All participants in the study were consented. There appeared to be no ethical or human subject issues.
I would agree that there is much to recommend this strength based model. Significantly supported with concerns around concrete needs, enabled the mothers to reduce stress that might exacerbate mental health symptoms related to trauma histories and impair recovery and parent child relationships. The measurement of child wellbeing by Part C identification has limited value. It does not appear to provide evidence of reduced child maltreatment in the study population. The final follow up at 12 months postpartum seems entirely inadequate to demonstrating meaningful results around this concept. The study demonstrated good fidelity to the wraparound model. As the first study of high fidelity wrap around services with this population although relatively small project it bears further replication. . Personnel challenges unintentionally demonstrated that adherence to the model was essential to successful goal achievement by study participants. The study also made a valuable contribution in revealing policies in place, both state and locally which were counterproductive to effective treatment of both mother and child, including unilateral child welfare decisions to remove infants at birth in 31% of the families, in spite of the safe residential treatment status of mother and baby.

References

Teel, K. M. (2014). Strong Start Wraparound: Addressing the Complex Needs of Mothers in Early Recovery. Zero to Three, 35(1), 27-36.