CPN is designed and maintained by ONline @ UW: Electronic Publishing Group.

Topics: Families and Gender

Dorchester CARES

Dorchester CARES uses community-based and community organizing approaches to promote the well-being of young children. This paper reviews the applicability of community-based and community organizing approaches to the policy goal of preventing child abuse and neglect and enhancing the well-being of young children up to age three. It includes an in-depth case study of Dorchester CARES, which stands for key components of the model, namely Collaboration, Advocacy, Resource development, Education, and Services, and offers family strengthening programs and services. Case study plus.

Case Study Plus: Dorchester CARES

John Lippitt, Heller School for Advanced Studies in Social Welfare
Brandeis University, 1996

Introduction

This paper reviews the applicability of community-based and community organizing approaches to the policy goal of preventing child abuse and neglect and enhancing the well-being of young children up to age three.

Child abuse and neglect has documented, potentially long-term, adverse effects on the physical, cognitive, social, and emotional development of children. After the fact treatment cannot reverse and eliminate all of the impacts of such maltreatment. Preventive approaches may well be the only real solution. Successful prevention programs can cost less than treatment programs. "Not only do preventive approaches spare the child the pain, which would be ample reason enough to pursue them, but they can also save money "; (Willis, 1992, xiii).

A growing body of evidence indicates that subtle deprivation can also have long-term, sometimes irreversible impacts on children, particularly when the deprivation occurs during the early years. Under-nourishment, lack of appropriate cognitive and physical stimuli, inappropriate levels or types of social interaction, and insufficient emotional support and feedback in the first two or three years of life can have permanent impacts. (Newsweek 1996) Early, preventive interventions are the only way of addressing these issues that are critical to child well-being. They may well also represent a true investment that produces a return many times its cost.

Community-based Strategies

In addressing the issues of children, especially young children, an ecological approach is clearly necessary. The ecological model recognizes that individuals are inseparable from the context in which they live and that this context has significant influences on them. For children, this context includes their family, community, and culture. The individuals, institutions, and organizations that are part of these entities are also part of the child's ecological environment. (Shay 1995, Bronfenbrenner 1986)

Because children are dependent, ecological factors are critically relevant. The most immediate and powerful influence is, of course, the family. The family, however, is embedded within interdependent social and institutional systems. The neighborhood or community that the family lives in has effects on the family and on the children in it. Therefore it is only logical that the community can be, and perhaps must be, an important element in strategies to prevent child maltreatment and enhance child well-being.

Hendrickson and Omer's schematic representation of ecological factors affecting the child is presented in Exhibit 1[not available online] (Hendrickson and Omer in Adams and Nelson 1995, page 150). The broad ecological bands of institutions and geography are presented on the top half of the diagram. The bottom half of the diagram presents specific ecological factors including societal, institutional, organizational, community, family, and personal attributes.

Key family level factors include the parents' social relationships, economic position, and living situation. Key community level risk factors for child maltreatment are lack of support networks for parents, isolation from extended family and neighbors, lack of accessible social services, and low socioeconomic status. Social and community support for the family can reduce stress and provide other assistance that can enhance child well-being. It can be received from extended family, friends, and informal and formal systems in the community. Such support can take the form of emotional support, reinforcement of decision making, sharing of difficulties and other experiences, and problem solving assistance. It encompasses social expectations and encouragement of appropriate parenting and sanctions for inappropriate parenting.

Evidence is mounting that comprehensive services for parents, with a goal of modifying parental behavior, can positively affect poor children at least in the short-term, and some evidence exists for long-term benefits as well (Weissbourd and Kagan 1989). Although socioeconomic and demographic factors have been correlated with child abuse rates, significant variations across neighborhoods from what these factors would predict have been observed (Garbarino and Kostelny 1992, Garbarino and Sherman 1980). Apparently characteristics of communities, even beyond socioeconomic and demographic characteristics, have an impact on child abuse, and presumably other indicators of child well-being. There is evidence that social impoverishment has a significant impact on child abuse rates (Garbarino and Kostelny 1992, Bronfenbrenner 1986, Garbarino and Sherman 1980).

Social impoverishment's manifestations include social isolation and the lack of support from and contact with other adults in the community. Family stress is associated with child maltreatment, and a lack of formal and informal social support is a key element of stress. "Without support, stress becomes unmanageable, and without social sanctions precluding the use of force, unmanageable stress can erupt into violence against children. "; (Shay 1995, page 6) Increasingly parents are raising children without supportive adult family members or others nearby and without supportive communities. Many of these parents are single parents which exacerbates the situation. Young or single parents, who are poor and in situations where social support and guidance from other adults is lacking, are at high risk for child maltreatment. Extreme symptoms of social impoverishment can include mental health problems, especially depression, and alcohol or drug abuse - all of which are associated with abusive parenting.

The ecological model postulates that isolation contributes to harsh parenting and to low monitoring of children. These can in turn lead to abuse or neglect. It recognizes the protective potential of social networks to reduce stress, provide role models, break feelings of isolation, and provide social support.

This ecological model dictates an operational model that is multi-disciplinary, community-based, family-centered, and client-directed. The operational goals of strengthening families and family functioning are inextricably tied to the goal of reducing social isolation by building community. The operational model dictates providing a comprehensive continuum of formal and informal prevention services focused on increasing nurturing values and skills, and empowering parents in their caregiving and community roles. The model also dictates that services be universally available, on-demand. Shay's schematic presentation of such a model as operationalized in the Dorchester CARES project is presented as Exhibit 2 [not available online] (Shay 1995, page 10).

Such a model focuses on building on the strengths of individuals, families, organizations, and the community. It targets the maximization of the impact of available resources through better coordination of existing resources and development of new ones to fill gaps identified by the residents of the neighborhood. A key synergy of these concepts can occur if service recipients are also asked to contribute by volunteering time and skills. This provides needed resources and simultaneously builds on strengths, building individuals' self-esteem and the sense of community. Residents' participation can include roles as volunteers, as paid and volunteer paraprofessionals, as paid staff, and as decision makers and leaders. This contributes to community residents by developing expertise through experience and training. This also results in culturally and linguistically appropriate service delivery and the building of employment opportunities and skills of community members.

Community level strategies can include building formal and informal supportive networks for families, building a sense of community responsibility for children, encouraging community sanctions on inappropriate parenting, and increased awareness, accessibility, and coordination of services within the community.

The ecological model implies the need to maximize the nurturing capacity of the community, while minimizing the dependency on outside resources and services. This model shares many attributes with the model John McKnight presents in The Careless Society. The core of his model, "increasing interdependence in community life through a focus on the gifts and capacities of people", is certainly applicable. (McKnight 1995, page 122) Reducing dependency on formal, government provided social services may also be applicable although the primary focus is on increasing the well-being of children. This may require, possibly temporarily, increased services. The last component of his policy statement, that people "have been excluded from community life because of their labels", is least applicable. (McKnight 1995, page 122) These families are more likely not to have been involved in community life because of geographic mobility, language and cultural barriers, fear due to neighborhood violence, and other factors of their lives and living condition. His concept of "community guides" is applicable but seems limited in that he presents these guides in many ways as another, different type of service, albeit a temporary and informal one. He seems to fail to recognize that community guiding can be a two way relationship, with the parties "guiding" each other simultaneously or perhaps in different ways or at different times. This "guiding" can be and perhaps should be a long term relationship. McKnight identifies trust as a key component of these guiding relationships, but seems to fail to recognize that trust only develops over time.

Community-based, ecological, family support models are being tried. Patch-based community social work in Britain and the Decategorization Project in Iowa share the following attributes (Adams and Krauth 1994):

Community-based Family Support Program Attributes neighborhood-based; program staff and methods reflect the community; build community by changing interactions among community members and with service providers; collaborative, team approach; recipients and the network of service providers function as partners in planning and delivering services; formal and informal services are interwoven; community members deliver services as volunteers, para-professionals, and professionals; focused on families with a goal of changing patterns of interaction among family members; focused on individual, family, and community strengths not deficits; and intervention sooner, less aggressively, and often on a voluntary basis.

Family support programs are typically provided by community centers that hark back to the settlement houses of the early 1900's, and to the multi-dimensional, neighborhood-based programs of the War on Poverty. The Head Start and Parent-Child Development Centers of the 1960's and their focus on parent involvement and education brought family support programs into the public policy arena (Weissbourd and Kagan 1989).

The Carnegie Corporation's report "Starting Points: Meeting the Needs of Our Youngest Children" was issued in April 1994. It notes that although we know how important the first three years of life are, and although we know much about the requirements for optimal development in this period, the care and nurturing of these young children are deteriorating badly. The report calls for a comprehensive strategy and effort to address the urgent problems jeopardizing the healthy development of millions of children under age three. It calls for integrated action in four areas: promoting responsible parenting, guaranteeing the availability of quality child care, ensuring basic health and safety, and mobilizing community support for families and their young children. The report calls for home visiting services on a voluntary basis for all first time parents and the availability of more intensive home visiting services for at-risk families that request them.

In addition to the patch-based community social work in Britain and the Decategorization Project in Iowa mentioned above, nine National Center on Child Abuse and Neglect (NCCAN) projects in communities from Chicago to Puerto Rico, and including Dorchester CARES in Boston, were examples of family support programs that share key attributes. These nine demonstration projects were run from 1990 - 1994. They were focused on the prevention of child abuse and neglect, and they all adopted a community-based, family support approach.

The federal Family Preservation and Support Act was passed in August 1993 and provides ongoing funding to family support programs as an innovative approach to child maltreatment through prevention. Roughly $1 million was provided to Massachusetts under this Act in 1995 to begin the process. The Department of Social Services (DSS) is implementing community-based, family support programs under an initiative entitled "Community Connections ". Dorchester CARES is being used as the model for these programs and has become one of the seventeen sites.

Dorchester CARES

Dorchester CARES was initiated by the Massachusetts Committee for Children and Youth, a child advocacy organization. It partnered with the Federated Dorchester Neighborhood Houses (FDNH), a group of community centers reminiscent of the settlement house tradition. CARES is an acronym for key components of the model, namely Collaboration, Advocacy, Resource development, Education, and Services.

The original plan had been to develop a five year plan for all of Dorchester (90,000 people) and to begin operation in a targeted neighborhood. The CARES Director met with hundreds of people and organizations in the community over a five month period to assess the needs of the community and begin development of a five year plan. What she heard was that the residents were tired of plans and pilot projects, they wanted action. They also felt that the great degree of diversity in the community would make it impossible to develop a single plan that would be applicable to the whole community.

As a result, the approach was changed from top-down to bottom-up. The focus was shifted to a targeted neighborhood and its immediate needs. The Bowdoin Street neighborhood was selected. It consisted of a single census tract, #918, with 3,649 people, 44% of whom were under 19. It included 570 families with children, nearly 40% of which were poor and over half of which were headed by single women. Many of the residents were recent immigrants from Cape Verde and the Caribbean. English was a second language for over 50% of the residents and 30% spoke no English. The demographic trends from the 1970 to 1990 census showed the white population decreasing from 92% to 15%, the black population increasing from 8% to 63%, and the Latino population increasing from less than 1% to 22%. The data also indicated an increase in extreme poverty in the neighborhood.

Interviews and focus groups were used to collect data on living conditions and the perceived needs of the residents. Twenty percent of the families interviewed had no help with childcare and one third of them expressed a need for some form of social support, e.g., parenting relief, other parents to talk to, and childcare. Concerns about safety were raised and many expressed a need for food and clothing. Residents indicated that food and English classes were more important to them than parenting education and clinical services.

After five months of networking in the community, Dorchester CARES got underway. The initial site was the Log School, one of the Federated Dorchester Neighborhood Houses. The Log School had a twenty year history in the neighborhood of offering an alternative middle school, GED classes, after school programs, daycare, and a somewhat chaotic, weekly food pantry. CARES rehabilitated unused space in the basement and began with a Family Cooperative that initially expanded the food pantry and childcare offerings and added a clothing exchange. Home health visiting for thirty families was undertaken in conjunction with the Bowdoin St. Health Center, another institution with a twenty year history in the neighborhood. English as a Second Language (ESL) classes were added in the fall of 1990.

CARES also established the Prevention Team. Its immediate goal was to coordinate efforts among service providers in the community in responding to families needs. The team of front-line service providers from the involved agencies met monthly, including family members and other involved professionals when appropriate, to discuss specific problems and find solutions. The Prevention Team also identified service gaps, worked to find resources to fill them, and helped organize new services. Its ultimate goal was to prevent child maltreatment and referrals to the child protection system.

The CARES Steering Committee originally consisted of the seven service agency partners and one community resident. CAREs' goal from the start was that the Steering Committee would eventually consist of at least 50% residents. This transition has proven to be more difficult than expected, perhaps in part because CARES has not explicitly focused on developing community leaders of this kind. The Steering Committee is convened monthly by the staff director and has evolved into a policy making Board of Directors. The Board has agreed that the director's role is critical to Cares success as the independent voice that can articulate consensus, provide a neutral voice for balancing, and most importantly keep all parties focused on their collective mission. A formal partnership agreement has been developed to define the benefits and responsibilities of each collaborating partner.

In 1991 the Nurturing Program® for family strengthening and the Family TIES program for substance abuse were added. Facilitators and assistants for the Nurturing Program® were recruited from the community and contribute their time in exchange for 24 hours of upfront training. The lead facilitator serves as the mentor and the facilitators and assistants meet after each session to review and evaluate the session, and to identify family needs. The lead facilitator meets weekly with the CARES staff to coordinate referrals specifically and the Program in general. Facilitators are matched with the ethnicity of the families in the Program. The facilitator makes home visits and phone contact between the weekly meetings and serves as a role model. A graduation ceremony is held and includes fun, food, and recognition including certificates of achievement. Ongoing support is provided through the Family Cooperative and a special parent support group for Program graduates.

The Family Strengthening Task Force was originally convened to conceptualize the initial programs. In 1992, the Task Force became the local "Healthy Boston" coalition, changing its name to the Family and Child Health Action Support Group. It was one of 21 "Healthy Boston" coalitions formed citywide to improve the quality of life by involving merchants, service providers, educators, community organizations, and residents in action groups formed to improve education, economic development, housing, and family health. Its monthly meetings are open to all and community residents are typically half of the 25 - 30 people that attend. The meetings are convened by the CARES staff, are conducted in English and Cape Verdean, provide childcare through the Family Coop, and have lots of food. Their focus is on identifying needs and mobilizing resources.

In 1993 the Parents CAN program for neighborhood parental support began. Parents CAN (Care About Neighbors) volunteers, originally called Family Advocates, are paraprofessionals that were recruited from the neighborhood and therefore are culturally and linguistically representative. Exhibit 3 presents the job posting that was used to recruit Parents CAN volunteers. They manage the Family Cooperatives, building relationships with residents and encouraging neighbors to build relationships with each other. They serve as parent aides, providing social support and mentoring. They make home visits for crises or celebrations and build an informal neighborhood support network and a sense of community. They receive eighteen hours of upfront training and a certificate. On an ongoing basis they meet weekly with the CARES program coordinator for supervision and in-service training and provide their services to anyone free of charge.

The CARES program expanded to five contiguous census tracts (20,000 people and 4,135 families with children) and to three FDNH sites over its five years as a demonstration project. Its six key program components, that make up what it calls its Family Strengthening Service Continuum, are presented in Exhibit 4. At the end of the five year demonstration, it served as the model for, and became one of, the Community Connections Program sites.

The Community Connections Program

The Community Connections (CC) program recognized that replicating the Dorchester CARES model was a matter of replicating a process and not one of replicating a structure. Therefore, after identifying sixteen additional communities based on demographic risk factors and a desire for geographical diversity, a three month capacity assessment process took place in each community. The focus was on assessing the capacity for community level coordination and involvement of residents in planning and decision making. Meetings were held with local service providers, and focus groups of parents and front-line workers were conducted. Based on these assessments, ten communities (including Dorchester CARES) were found to have sufficient community capacity in place to proceed with the development of Action Plans. Seven other communities were found to need a developmental stage where a coalition capable of executing a CC project would be built. These communities spent twelve months in a developmental phase before proceeding to Action Plan development.

Action Plan development was a six month process. It involved a three month fact finding period. This included developing teams of a service provider employee and a community resident to go door to door conducting outreach and surveys of a minimum of fifty families in the community. This fact finding was presented to the community in meetings held over a two month period. Residents were asked to vote at these meetings on the issues they felt were most important. Issues were posted and each resident was given five adhesive-backed dots to affix to the issue or issues they felt were most important. Then a month was taken to prepare the final Action Plan. Organizational development was occurring simultaneously over this six month period, so that program development and implementation could then begin in earnest.

Throughout the developmental and Action Planning stages, CC staff offered technical assistance at the request of the local communities.

Findings

The CARES and Community Connections projects have experienced many of the challenges of community organizing. They have faced challenges in identifying and accessing true leaders in the community. Self-designated leaders and individuals who want to exercise power as gatekeepers to community residents have been encountered. Power struggles among organizations and residents have occurred. Leaders that have emerged from the community have had their credibility become suspect because of their assumption of a leadership role. Situations have occurred where some residents have resented others' leadership roles and therefore have challenged them or attempted to tear them down. Similarly it has been difficult to add new service providers to already existing coalitions. CARES has developed a Partnership Agreement that service providers have to sign to join their coalition. CC has found that service providers are not attracted to the coalitions unless the funding is significant enough to be meaningful to them. In particular, the communities in the development stage were typically funded at $10,000 - $20,000. This level of funding did not attract much attention from service providers. However, for those communities with accepted Action Plans and funding at a $100,000 level, the service providers were anxious to be at the table.

Different communities and service provider coalitions were found to have different attitudes toward the technical assistance offered by CC staff. Some, characterized as like young children, were anxious for any and all help but were not able to identify specific needs. Some were like adolescents, feeling strong and independent and wanting no assistance. And some were like mature adults, recognizing the value of assistance and able to identify their own areas of need. Some communities needed to identify a common enemy as a focal point for their organizing.

Although DSS is the parent agency of the Community Connections program, various other public and private agencies participate. Some of the community level personnel have felt that it was easier to get private service providers in the communities to cooperate than to get the various state agencies to cooperate. Some community personnel have noted that the increased competition in the health care industry has had a negative effect on community health centers. As they become affiliated with large health care organizations, they are pressured to refer clients only within their organization. Community personnel have also commented about the amount of paperwork required by the state to access the Community Connections funding and the contrast to the much simpler paperwork required for foundation funding.

Restructuring how business is done changes the power structure for both service providers and residents and therefore is likely to result in conflicts. Although Dorchester CARES was committed from the beginning to shift control of its Board from service providers to community residents, it has found this transition difficult. Such a power shift is always difficult, and part of the difficulty is because CARES has not focused on resident leadership development as an explicit goal. Participation may bring empowerment at one level, but it does not automatically lead to leadership development and empowerment at higher levels.

Evaluating Community-based Family Support Programs

Evaluating community-based, family support programs is difficult. Each example of a community-based program is going to be unique. Each set of interactions for each family will be unique, as will the characteristics of each family. As a result, traditional program evaluation, with its standard inputs and defined outcomes, does not lend itself to this environment.

An evaluation strategy will need to create a comprehensive picture of the community and its families and children over time. Data at the following four levels of the ecological framework will be required:

• the community,
• the families within the community,
• the internal interactions of the families, and
• the well-being of the children.

A picture of the community and how it is changing can be assembled using four types of data collected over time:

1. Demographic markers and administrative statistics for the community including:
   • health, social service, and criminal justice indicators; and
   • independent social observations of the community.

2. Behavior of residents and their descriptions of the community, assessed by measures of:
   • residents' perceptions of risk factors, protective conditions, and resources for families in the community;
   • the quantity and quality of transactions among neighbors; and
   • the overall social ecology and level of attachment to the neighborhood.

3. Measures of interactions internal to the family with assessments of individuals and families who have been program participants in comparison to matched individuals and families who have not.

4. Measures of the status of children who have, or whose families have, been program participants in comparison to matched children and families who have not.

Dorchester CARES is the only project that has had a long enough life to have had an outcomes evaluation performed. Due to limited funding the evaluation was of limited depth. The results were mixed, however, small but significant increases in the level of social support within and between families was found. Increases in the availability of social support, in neighborhood surveillance, and in community monitoring of children were found, and strengthened caregivers' sense of community.

The bottom line is that it may be too early to tell if Dorchester CARES works, unless one is willing to rely on the personal testimony of CARES participants. Its ambitious and innovative approach presents a challenge to evaluation in the best of circumstances, and with seriously limited funding for evaluation, clear results are unlikely. Determination of definitive cause and effect relationships for successes or failures are probably impossible. The lack of good measures of effects, the lack of an easily identifiable and accessible control group, and the lack of standard interactions to measure (due to program flexibility and a client-directed approach that result in varying components and intensity of services) make family support programs difficult to evaluate (Zigler and Black, 1989).

A process evaluation of CARES has also been done. It documented and analyzed the process and resulting organization of the collaboration, which is important for understanding what worked and would be key to replication efforts. Particularly given the client- and community-driven approach of CARES, replication cannot successfully occur with a cookie cutter methodology. Rather, it will be necessary to copy what was done to create CARES; to recreate the process and reinvent the collaboration (Smale 1994). As a demonstration project, clearly there is interest in being able to replicate what was done. In addition, many of Cares attributes are ones that government and research are supporting, e.g., coordination of services, preventing child maltreatment, and strengthening families and neighborhoods.

Cares process goal is to create a systemic network of formal, ongoing, collaboration among organizations and individuals to jointly deliver comprehensive services to prevent child maltreatment. The methodology of the process evaluation was to: "1) examine the interactive nature of events associated with collaboration, and 2) facilitate the study of process by searching for changes in environmental conditions, then tracing out corresponding changes in administrative action." (Mulroy 1995, page 6) Data collection included review of documents, observation of meetings and conferences, and interviews with Steering Committee members, staff, front-line workers, and community service recipients. Interviews were tape recorded and transcribed. Some meetings and conferences were video taped. Forms were developed to code and analyze data.

"Stress points" that had the potential of destroying the CARES collaboration were found to have occurred repeatedly. The starting point and the glue that held the collaboration together was a shared vision of the "end", preventing child maltreatment, and the "means", family strengthening at the neighborhood level. The motivations of each collaborator can be analyzed in terms of the benefits that accrued to each of them. For example, MCCY got access to a high-risk neighborhood where its demonstration project and advocacy role were most needed. FDNH got increased service capacity with a five year revenue source and expectation of future benefits. These two project initiators "sought agency partners that offered a) compatible, not competitive services, b) similar philosophies and standards of conduct, c) a commitment to the prevention of child abuse." (Mulroy 1995, page 9)

An early stress point was the conflict between the intended top-down planning approach of a broad scope, and the needs and orientation of community members. As a result, a written assessment of the pros and cons of the two approaches was prepared by the project director for the Steering Committee, which decided by consensus, but not without struggle, to dramatically revise the project approach.

The CARES infrastructure is essential to bringing in new partners and building and maintaining relationships and structure as the service continuum grows. The structure is an integrated network as shown in Exhibit 5 [not available online] (Mulroy 1995, Figure 4). A service recipient can enter through any one program and access others as needed. As one nineteen year old mother of two children put it, "When I got one of you, I got all of you!" Comprehensive service integration is infinitely complex and complexity increases exponentially as agencies, neighborhoods, and services expand (Shay 1995). Future stress points can be expected among collaborators and as new partners are added.

Two other stress points of particular significance were noted: competition over scarce funding especially in a competitive, grant awarding system, and operational issues of turf, service standards, and culture. The small size of the Steering Committee, social activities, retreats, a participatory management style, and formal agreements on procedures, reciprocity, and ownership of the products of the collaboration all contributed to the successful resolution of these conflicts. Also important to Cares success was the cross-training of front-line workers from different agencies to build understanding and share knowledge, skills, technology, and values.

Mulroy's evaluation identified as key success factors for the collaboration the eight following items:

1. Flexible leadership that re-focused the project to a small geographic target area and a bottom-up program design that gave consumers legitimacy to define their service needs;
2. Small size of the Steering Committee membership and their clear vision of the long range benefits of the collaboration and belief in the value of the service product;
3. Timely conflict resolution in policy making and organizational planning;
4. Common characteristics of partner agencies that include nonprofit status, compatible services, interest in the same geographic service area, and commitment to a shared vision and to a prevention approach;
5. Lateral, non-hierarchical structure;
6. Agency benefits for both managers and front-line workers;
7. "Chemistry " and trust among participants on both the Steering Committee and the front-line teams; and
8. Full-time project management in a participatory style.

A key function of project management was frequent communication including regular, efficiently run meetings with agendas and minutes. The evaluation report notes, "The most time consuming role was building a dense network of relationships among Steering Committee members, front-line workers, influential others, and then to nurture those relationships into an intricate web of sustainable systems." (Mulroy 1995, pages 22-23) CARES represents a new paradigm in the child welfare arena. It would appear to have great promise in both human terms and in cost-effectiveness terms. It is generally true across a wide range of fields that it is cheaper (in terms of dollars) to prevent problems than to try to correct them later. It is also better to prevent problems because the negative consequences are avoided. In the arena of human services, those negative consequences can be significant human trauma whose costs are not readily quantifiable.

A New, Community-based Paradigm for Child Welfare

A new paradigm for child welfare is needed. The success with current approaches has been limited at best. In addition, a focus on prevention through early intervention in pregnancy and early parenthood, if done successfully, shows promise of dramatically reducing the number, scope, and severity of child welfare problems. It is truly an investment in our families and children, because prevention can produce a return, in cost savings in terms of dollars and human trauma, that is many times greater than the cost of the prevention programs.

The target for such efforts should not be limited to traditionally defined at-risk constituencies. Families and children everywhere will benefit from many of the CARES components, e.g., the Nurturing Program®, Parents CAN, and the building of community. Politically, universal applicability avoids the us versus them dichotomy that is poisoning much of the current discussion of social programs. Efforts to raise the parenting skills of parents and communities, to raise the awareness of the importance, difficulty, and value of good parenting, to increase the social support for families, and to increase the likelihood of optimal environments for child development are critically important to our society as a whole, as one large community.

The child maltreatment prevention programs examined in this paper share many of the same components and principles that have been identified in family support programs elsewhere:

Common attributes of community-based family support program design: Focus on prevention and optimal child development using an ecological model for project design and a collaborative, team approach to integrated service delivery with universal availability and early, less intrusive intervention; Focus on families with a goal of changing patterns of interaction among family members through parent education and support groups that focus on child development and healthy family relationships, and through joint activities for parents and children; Neighborhood or community-based programs that reflect the community, reduce isolation, and build the sense of community, often including a drop-in center that allows informal interaction with other families and with program staff, provides information on and referral to other services, and provides childcare while parents attend service programs; Home visitation for developmental and health screening for children, service referral, parenting education, and social support; and Service recipients and providers that function as partners in planning and delivering an integrated set of services where formal and informal services are interwoven and the focus is on strengths not deficits. (Adams and Krauth 1994, Weissbourd and Kagan 1989)

Key operational characteristics of community-based prevention programs are driven by the ecological model. Comprehensive, universally available services are indicated by the complex etiology and the inability to predict the occurrence of child maltreatment.

Key operational characteristics of community-based prevention programs: Multidisciplinary: Service delivery is comprehensive and coordinated. Community-based: Physically located in the community to encourage service utilization through convenient access and one stop shopping. Community members, organizational and individual, are involved in program design and control. Specific efforts to reduce isolation and build community. Family-centered (not individual): Strengthens family interactions through home visiting for health, parenting skills, and social support, and through other family programs and activities. Client-directed: Meets the client's expressed needs, through universally offered, on-demand services. Clients are partners in defining service delivery and are involved in program design and control. Empowerment: Focus on building on strengths of individuals, families, and the community.

Conclusions

Community-based family support programs (FSP) are focused on families and providing formal and informal services to families and their children to improve the well-being of the children. Although the building of informal supports and social networks does build the community, as may the coordination of services and service providers, community organizing per se its not the focus. This is perhaps most clearly seen in the lack of explicit focus on developing and training community leaders and in the fact that the professionals in FSP's have an on-going role as service providers. In addition, the focus on families does not include all community residents.

"Participation by itself is not necessarily empowering " (Flynn et al. 1994, page 395) and certainly has limits to the empowerment it provides. Some maintain that "for true community empowerment to occur the professionals must leave. " (McFarlane and Fehir 1994, page 389) Given that the professionals in FSP's have no intention of leaving, it seems clear that their goal is not community empowerment in that ultimate high level sense.

In the case of CARES, the various elements of the project can be categorized by their focus on the family, the community, or both. Four of the six elements are focused on the family: Family and Child Health Action, the Nurturing Program, Family TIES, and the Prevention Team. The other two elements focus on both the family and community building: Parents CAN and the Family Cooperative. Only the informal element of social events is focused primarily on the community.

There appear to be three levels at which community activity can occur. First there are community-based programs and services. Second there are community-building activities. Third there is community organizing. Community-based programs and services are ones that are physically based in the community. They use personnel that are focused on the community, and ideally are from it, and that become familiar to it and with it, as opposed to being delivered from a remote site with personnel that deal with a broad cross-section of people. Family support programs should be community-based due to their ecological model that recognizes the importance and impact of the community. FSP's can be community-building if they work to link community residents together, building interdependency and identity. Coordinating services and building a coalition of service providers can also build community. The strength of the coalition (however that might be measured) or the creation of a true collaboration, rather than just a coalition, may further contribute to community-building. There is reason to believe that community-building, as opposed to simply being community-based, might have a positive impact on the effectiveness of FSP's.

Family support programs rarely appear to be full-blown community organizing efforts, due to the narrowness of their focus and the lack of explicit focus on developing resident leadership and empowering the community to the extent that it takes total control into its own hands.

The level of resident empowerment corresponds to the level of community activity. Community-based activities are more empowering than centralized ones. However, the level of empowerment is limited. If, as is the case in the Community Connections programs, residents have power only because service providers, with some financial incentive, are willingly sharing power primarily based on their good intentions, their empowerment is limited. If residents have input into decision making but not decision making power, and if staff of the local coalitions are facilitators for resident participation but not working to develop indigenous leaders to take their place, empowerment is limited. Indications of this limited empowerment at CARES are the difficulty of recruiting residents to serve on its Board and the lack of expansion of the agenda by residents or broader political involvement by them.

Another measure of empowerment is the control of funding. If the FSP's are dependent on government, and perhaps service providers and foundations, for funding, the empowerment is limited. FSP's are unlikely to achieve their full potential unless funding for the services incorporated under their umbrellas are under their control. The funds as they are paid to service providers need to be from a single stream, under the FSP's control, rather than from a variety of categorical funding sources that requires work, cajoling, and coalition building on the part of the FSP to coordinate. In summary, community-based strategies are appropriate to family support programs. Community-building strategies have the capacity to make FSP's even more effective. Community organizing strategies are inappropriate in that they go beyond the scope of FSP's and involve a broader audience and agenda. This is not to say that community organizing efforts could not be stimulated by and spun-off from a community-building FSP. And it certainly is not to say that community organizing efforts should not support or look to build FSP's. It also does not mean that community organizing efforts, beyond specific support of FSP's, cannot have positive effects on child well-being.

Good family support programs will work at building community. However, they will recognize that the goals and strategies of community organizing go beyond the scope of their mission.

Exhibits

1, 2, and 5: Not available online.

Exhibit 3

Click here to return to text.

Exhibit 4

Program Name/Target Population	Services
Family Cooperative for neighborhood residents	Advocacy and outreach Food pantry Clothes closet Craft circle Social and recreational events ESL, GED, job development Child care for participants Outreach and service linkage Site for Nurturing Programs other education Parent support groups
Family and Child Support for pregnant women, their families, & infants (to 2 yrs)	Home health visiting Primary health care Developmental assessment Parent education Linkage to co-op and other support services
Nurturing Programs for families who want support and skill-building	Nurturing skills curriculum for all family members through structured series of weekly sessions Training and interagency team preparation Transportation, meals
Parents CAN (Care About Neighbors) parent aides for families who need extra support and help	Training and ongoing support to program participants who are ready to help others Linkage of volunteers to parents who need support and placement in group leadership roles
Family TIES therapeutic care for families with substance abuse problems	Intensive, home based team intervention Risk assessment Linkage with treatment services & support Monitoring progress Parent aide support services
Prevention Team for families at risk, in need of multiple services	Case coordination and planning for families served through any of the above services Identification of service gaps Cross-agency support and training

Click here to return to text.

Bibliography

Adams, Paul, and Krauth, Karin (1994)
Community-Centered Practice to Strengthen Families and Neighborhoods: The Patch Approach
The Prevention Report, Fall 1994, 2-5
Iowa City, Iowa: The National Resource Center for Family Centered Practice

Bernier, Jetta, and Shay, Sharon. (1989)
Dorchester CARES: Coordination, Advocacy, Resources, Education, and Services to Prevent Child Maltreatment in the Dorchester Area of Inner-City Boston (Program Narrative of Grant Application to the National Center on Child Abuse and Neglect)
Massachusetts Committee on Children and Youth: Boston, MA; July 1989

Bronfenbrenner, Urie (1986)
Ecology of the Family as a Context for Human Development: Research Perspectives
Developmental Psychology, 22(6), 723-742.

Carlisle, Linda K., Commissioner (1995)
Family Preservation and Support Services: 5-Year State Plan, Title IV-B, Subpart 2
Boston, MA: Massachusetts Department of Social Services

Carnegie Corporation of New York (1994)
Starting Points: Meeting the Needs of Our Youngest Children
N.Y.; April 1994

Community Connections (1996)
Working Together to Support Massachusetts Families: Coalition Needs Assessment and Action Planning Guidelines and Procedures.

Daro, Deborah, and McCurdy, Karen (1973)
Preventing Child Abuse and Neglect: Programmatic Interventions
Child Welfare 73, Sept./Oct. 1994, 405-430

Dorchester CARES (1995)
Statement of Capacity and Commitment
Boston, MA: Dorchester CARES

Dorchester CARES Governance Task Force (1995)
Partnership Agreement
Boston, MA: Dorchester CARES

Earls, Fenton (1992)
An Epidemiological Study on the Risks of Child Abuse in an Urban Neighborhood. Final Report to the W.T. Grant Foundations
Cambridge, MA: Harvard School of Public Health and the Judge Baker Children's Center.

Flynn, Beverly C., Ray, Dixie W., and Rider, Melinda S. (1994)
Empowering Communities: Action Research through Healthy Cities
Health Education Quarterly, Fall 1994

Garbarino, James., and Kostelny, K. (1992)
Child Maltreatment as a Community Problem
Child Abuse and Neglect, 16, 455-464.

Garbarino, J., and Sherman, D. (1980)
High-risk Neighborhoods and High-risk Families: The Human Ecology of Child Maltreatment
Child Development, 51, 188-198.

McFarlane, Judith, and Fehir, John (1994)
De Madres a Madres: A Community, Primary Health Care Program Based on Empowerment
Health Education Quarterly, Fall 1994

McGuire, J.B., and Shay, Sharon (1995)
Evaluation of Changes in the Community: A Methodology for Assessing the Impact of Dorchester CARES. A Supplement to the Final Report to the National Center on Child Abuse and Neglect: Dorchester CARES (Grant no. 90-CA-1417)
Boston, MA: Massachusetts Committee for Children and Youth

McKnight, John (1995)
The Careless Society: Community ans Its Counterfeits
New York: Basic Books

Miller, Roberta, Morris, Marsha, and Skelton, Mary (1996)
Healthy Boston Evaluation: Executive Summary
Watertown, MA: Roberta Miller & Associates

Mulroy, E.A. (1995).
Shared Power: How Nonprofit Organizations Collaborate to Reduce Child Abuse and Neglect in Poverty Neighborhoods. A Supplement to the Final Report to the National Center on Child Abuse and Neglect: (Grant no. 90-CA-1417),
Boston, MA: Dorchester CARES

Price, R.H., Cowen, E.L., Lorion, R.P., and Ramos-McKay, J. (1989).
The Search for Effective Prevention Programs: What We Learned.
American Journal of Orthopsychiatry, 59(1), 49-58.

Senge, Peter M. (1990)
The Fifth Discipline
Doubleday: N.Y.; 1990

Shay, Sharon W. (1995)
Building the 21st Century Ark: The CARES Model for Comprehensive Family Support (FinalReport to the National Center on Child Abuse and Neglect: Dorchester CARES Grant no. 90-CA- 1417)
Boston, MA:Massachusetts Committee on Children and Youth.

Shay, Sharon (1990)
Dorchester CARES: Continuation Application Program Narrative (Grant Number 90-CA-1417)
Boston, MA: Dorchester CARES

Smale, G. (1994).
Innovations Transfer and Community-Centered Practice.
The Prevention Report, Fall 1994, 6-12.
Iowa City, Iowa: The National Resource Center for Family Centered Practice.

Weissbourd, Bernice, and Kagan, S. (1989).
Family Support Programs: Catalysts for Change.
American Journal of Orthopsychiatry, 59(1), 20-31.

Willis, Diane J., Holden, E. Wayne, and Rosenberg, Mindy, editors (1992)
Prevention of Child Maltreatment: Developmental and Ecological Perspectives
New York: John Wiley & Sons

Zigler, Edward, and Black, K. (1989)
America's Family Support Movement: Strengths and Limitations
American Journal of Orthopsychiatry, 59(1), 6-19.

Back to Family, Gender & Children Index