The Evidence Base for Social Network Interventions as a Way of Helping Children and Families in Need

1
The Evidence Base for Social Network
Interventions as a Way of Helping Children and
Families in Need

• Carolyn E. Cutrona, Ph.D.
• Institute for Social and Behavioral Research and
  Department of Psycholgoy
• Iowa State University

2
Goals

• Describe three approaches to increasing support
  for parents and children
• Summarize empirical evidence on the effectiveness
  of each approach
• For whom, under what circumstances are these
  interventions effective?

3
Social Support Intervention Types

• Support Groups
• One-to-One Programs (Home Visitor Mentoring)
• Optimizing Support in the Natural Network

4
Support Groups

• Participants share a common life stressor,
  transition, or affliction
• Receive expert information and/or training
• Engage in mutual aid to foster improved coping
  and adjustment
• Gottlieb, 1998

5
Support Groups

• Support groups provide a temporary personal
  community that supplements or compensates for
  deficiencies in the individuals natural social
  network.

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Support Groups

• Sharing experiences with others is expected to
  lead to
• Validation
• Normalization of the experience
• Reduction in social isolation
• Feeling of belonging
• Rewards of helping others

7
Effectiveness of Peer Support Groups

• Literature reviews of controlled support group
  interventions for
• Cancer patients
• Helgeson Cohen, 1996
• Family caregivers for dementia patients
• Bougeois Schulz, 1996
• First-time parents
• Cowan Cowan, 1986
• Recently divorced adults
• Hughes, 1988
• Abuse victims
• Coates Winston, 1983

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Findings

• Groups that consist only of discussion among
  participants are not as effective as those that
  include an educational component
• Helgeson Cohen, 1996

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Findings

• Support groups that meet over a longer period of
  time are more effective than brief interventions

10
Findings

• Evidence supports effectiveness among cancer
  patients
• One study showed significantly lower mortality
  among women with metastatic breast cancer in the
  intervention group relative to the control group.
• Spiegel et al., 1989
• Less effective for
• Caregivers for dementia patients
• New parents
• Recently divorced
• Rape victims

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Potential problems

• Participants may not be supportive
• Expression of primarily negative emotions may be
  demoralizing
• Comparisons with others may be demoralizing
• May interfere with relationships with family and
  friends

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Optimizing the Effectiveness of Support Groups

• Match type of support to needs of the specific
  stressed population
• Include an educational component
• Maximize similarity among group members

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Optimizing the Effectiveness of Support Groups

• Balance expression of negative emotions with
  expression of positives
• Refer extremely distressed to individual therapy
• Integrate natural network into the group
• Couples groups
• Concurrent parent and child groups

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One-to-One Support Interventions

• Home Visitor Programs
• Mentoring

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Characteristics

• Designed to address a social loss or deficit
• Supporter usually has experience with issues
  faced by client
• Interactions are outside of the formal service
  delivery system

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Characteristics

• Forming a relationship is part of the
  intervention
• The relationship is long-term, but time-limited
• Independence, coping skills, ties to community
  resources, better relationships with natural
  network among the goals

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Type and Method of Support

• Information support
• Direct instruction
• Modeling new skills
• Referrals to community resources
• Emotional support
• Companionship
• Shared activities

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Effectiveness of Home Visitor Programs

• Review of 31 rigorously evaluated programs for
  parents and young children
• Programs targeted a range of outcomes
• Low birth-weight, health behaviors, economic
  self-sufficiency, parenting quality, and
  childrens physical and mental development
• Program content varied
• Health education, parenting education, teaching
  parent to provide cognitive stimulation to child,
  emotional support to mothers and family, linkage
  to community service, maternal educational and
  career development counseling
• Olds Kitzman, 1993

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Findings

• Comprehensive programs, that meet multiple family
  needs are most effective
• Parenting PLUS health, education, employment,
  center-based preschool

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Findings

• Positive outcomes were more likely for
  multi-problem parents and children who were at
  highest risk
• Family must perceive a need for the program for a
  meaningful relationship to develop with the home
  visitor

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Findings

• Programs that used professionals (e.g., nurses)
  were more successful than those that used
  paraprofessionals

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Findings

• Families that received more visits benefited most
• Weekly visits over the first 2 years of the
  childs life resulted in child gains in cognitive
  development relative to a control group
• Similar program with monthly visits showed no
  effect
• Powell et. al., 1989 Olds et al., 1998

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Cost Effectiveness

• Successful programs are expensive
• However, the costs are more than recovered in
  future years in terms of
• Reduced costs in health care
• Child welfare services
• Public assistance benefits
• Criminal justice costs
• Karoly et al., 1998 Rand Corporation report

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Mentoring Adolescents

• Older, more experienced adult provides
  information and advice in the context of a close
  and enduring relationship to a young person whose
  social network does not provide adequate
  supportive relationships with adults.

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Empirical Justification for Mentoring Programs

• In studies of high risk youth from multi-problem
  families, one of the best predictors of
  successful outcomes is the presence of a strong
  parent or nonparental adult who gives guidance
  and encouragement
• Garmezy, 1987 Lefkowitz, 1987 Rutter, 1987
  Werner Smith, 1982

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Effectiveness of Mentoring Programs

• Random controlled evaluation of the Big
  Brothers/Big Sisters program
• Tierney Grossman, 1995
• Randomly assigned over 1,100 youth to treatment
  or wait-list control
• Assessed pre-intervention and 18-months later
• Self-concept, peer and family relations, academic
  performance, anti-social behavior

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Findings

• After 18 months the treatment group, relative to
  the control group showed
• Better relations with peers and family
• Better school behavior and attitudes
• Skipped school 52 less than controls
• Less drug and alcohol use
• 46 less likely to have begun drug use than
  controls
• Less fighting

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Findings

• Many mentors do not meet regularly and
  consistently with the youth
• Mentors who succeeded in meeting regularly with
  young teens began with an instrumental focus, not
  just companionship
• Hamilton Hamilton, 1992

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Findings

• Demographic match between mentor and youth is
  less important than screening potential mentors
  and providing them with orientation, training,
  and continuing supervision and support.
• Sipe, 1996

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Findings

• Compared to professional services and residential
  treatment, mentoring is quite inexpensive
• However, requires professional staffing to be
  successful
• Big Brothers/Big Sisters makes approximately
  75,000 matches a year in the U.S. at a cost of
  about 1,000 per youth
• Tierney et al., 1995

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Optimizing Support in the Natural Network

• The goal is to improve and enrich the quality of
  support provided by friends, relatives,
  coworkers, and neighbors.
• Based on the assumption that needed support
  resources exist in the natural network, but can
  be improved to the benefit of the stressed
  individual.
• Cutrona Cole, 2000

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Characteristics

• Focus on facilitating optimal functioning of
  current relationships
• Professionals role is to educate and motivate
  family, friends, and neighbors to maximize the
  quality of care they provide to one another
• Often in the context of a family member with a
  severe disability or making a behavior change
  (e.g., smoking cessation)

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Effectiveness of Natural Network Optimization
Interventions

• Literature review of controlled support group
  interventions that
• Trained support recipient to elicit and utilize
  support
• Trained one key network member to provide support
• Mobilized the social network
• Cutrona Cole, 2000

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Findings

• Training support recipient to elicit and utilize
  support
• Successful with diverse populations when
• Systematically analyze network needs
• Coach and rehearse communication skills
• Address underlying beliefs and attitudes that
  interfere with elicitation and utilization of
  support

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Findings

• Training one key network member to provide
  support
• Mixed results
• Spouses of lung cancer patients showed no
  benefits from 12 sessions of individual social
  support counseling
• Goldberg Wool, 1985

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Findings

• Training one key network member to provide
  support
• Sometimes effective as an add-on to a behavior
  change program for the support recipient
• Among smoking cessation programs, one in five
  showed significantly better results when a spouse
  or friend was also trained in how to support
  positive behavior change.
• Cohen et al., 1988 Gruder et al., 1993
• Results somewhat more positive for weight loss
  programs that involve the spouse
• Brownell et al., 1978

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Findings

• Mobilizing the social network
• Mixed results
• Stroke survivors showed no benefits from 3
  individual sessions of social support
  counseling followed by joint sessions with
  family members
• Friedland McColl, 1992

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Findings

• Mobilizing the social network
• A family intervention to delay nursing home
  placement of patients with Alzheimers disease
  was significantly more successful than standard
  case management.
• Included four family and two individual social
  support counseling sessions for the primary
  caregiver followed by unlimited access follow-up
  to counseling and support
• Institutionalization delayed by more than 12
  months in support condition.
• Mittelman et al., 1996

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General Conclusions

• For some interventions, trained professionals
  produce better results than paraprofessionals.
  Match providers to needs.
• For all interventions, careful selection,
  training, and supervision of support providers is
  critically important.

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General Conclusions

• Genuine change in peoples lives takes time
  longer-lasting interventions are more effective
  than brief interventions.
• To bring about real change in an individuals
  social network, must change both the networks
  behavior and the individuals ability to
  recognize and utilize social support.

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Overall Conclusions

• A warm relationship is necessary, but not
  sufficient, to bring about significant change in
  families lives.
• Relationship quality plays a vital role in
  increasing peoples receptiveness to education,
  advice, and the mastery of new skills but in
  itself, does not bring about magical changes in
  peoples functioning.