Battling neglect by building better families

Kids thrive in strong families. So, what makes a family strong? And can we teach it?
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As difficult as family members can sometimes be, they are our first and often longest and most important relationships.

Kids thrive in strong families. So, what makes a family strong? And can we teach it?

After nearly two decades of helping families in crisis, Shawn Sivly has seen hundreds of parents and children in conflict: the kids who run away and the parents who kick them out, the parents who can no longer control their headstrong kids and the kids who are no longer safe from their angry parents, the families so at odds, overwhelmed or unhealthy that the best option is placing a child in short-term emergency housing at Kirkland-based Friends of Youth, where Sivly is manager of shelters.

Each family whose child comes to the Youth Haven shelter for 7-to-17-year-olds is different, each crisis unique, says Sivly (below). But one thing remains constant: Unless kids are being abused, and sometimes even then, they “always just want to go home.”

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Shawn Sivly. Credit: Alex Garland

For most of us, it’s hard to imagine life without family. As difficult as family can sometimes be, the relationships we form with the people who care for us at the beginning of life are our first and often our longest-running and most intimate connections. Family members are the people we depend on and who depend on us, the ones we love and sometimes hate, but rarely feel indifferent about. And for many of us, they’re the ones — for better or worse — who exert the most influence on the person we grow up to be.

Decades of research has studied the importance of family on children’s development and well-being, and for the most part this work points to a simple conclusion: Children do best when they grow up in strong families.

Over the years, child welfare agencies, including Washington State’s, have adjusted their practices based on those findings, moving away from separating families and towards providing the kinds of support that helps keep families from shattering in the first place. One indication of this shift in thinking is that the number of children in foster care in the United States has been declining over the last decade, from a high of 511,420 in 2004 to a low of 396,892 in 2012. (It trended up again to 402,378 in 2013). In Washington, the population of foster children has bounced around the 10,000 mark for the last 10 years, from a high of 11,167 in 2008 to a low of 9,533 in 2011. Figures released this fall put the 2013 number at 10,208.

Defining who is family can be a challenging exercise. Is it the people bound to a child by blood? The ones who, regardless of DNA, are legally responsible for a child’s well-being? The “fictive kin” tied by strong feelings of affection or concern? Is it all three? Or more?

“The family is the place where the child has a home, a haven and one or more adult caregivers who are taking care of them, protecting them, navigating for them, loving them,” says Liliana Lengua (below), professor of psychology and director of the Center for Child and Family Well-Being at the University of Washington, where she studies parenting. “Traditionally those adults have been the biological parents, but it doesn't have to be that way.”

Crosscut archive image.It could be adoptive parents or step-parents or foster parents. It might be grandparents, aunts or uncles, trusted community members or some combination. The definition of family today, says Lengua, “can be pretty idiosyncratic.”

Bottom line, says Lengua: “It's the people close to the kids who help care for them and raise them.”

Whatever its makeup, your family will exert a profound influence on you. Recent neurobiological research has steadily uncovered the critical importance of our first attachments in life. These primal relationships influence the ability to regulate emotions, feel empathy and curiosity, achieve developmental milestones, show resilience in the face of challenging situations. The list continues to grow along with the studies.

“Very young brains are very malleable,” explains Nilofer Ahsan of the Center for the Study of Social Policy, a national nonprofit organization that counts among its programs a curriculum for helping families grow stronger. “When you're a baby, everything impacts the brain, and probably what impacts it most is interaction between the child and the primary caregiver.”

Long before imaging technologies made the latest brain studies possible, researchers looking for insight into mental illness were studying children growing up in stressful circumstances — in poverty, for example, or in dangerous neighborhoods or in families splintered by divorce. Over time, says Ann S. Masten, professor of child psychology at the University of Minnesota’s Institute of Child Development, that work evolved into the study of resilience, the capacity to withstand or adapt to stressful or challenging events.

Masten began her study of resilience in children nearly four decades ago, not long after some pioneering researchers first started to shift their focus away from the causes of mental illness and toward an understanding of what makes children and families resilient. As she points out in her new book, “Ordinary Magic: Resilience in Development” (Guilford Press, 2014), researchers began taking note of the common strengths of resilient children, certain “protective factors” that seemed to help them make it through stressful times.

Masten’s short list of protective factors includes close relationships, intelligence, self-control, motivation to succeed, self-confidence, effective schools, communities and cultural practices and the belief that life has meaning. Capable parenting tops the list.

Masten stresses that human development is dependent on an interplay of factors that goes beyond who your parents are and what kind of care you receive as a young child. “It’s not just genes, and it’s not just family,” she says. The broader culture, community, friends — they’re all important and connected and should all be considered when devising interventions to help children. “But,” she adds, “how families are handling adversity has a profound impact on how children will handle it.”

Numerous studies have pointed to the moderating effects of family on the adjustment and behavior of children, including children at risk. Research suggests that supportive families make a difference in levels of problem behavior, such as aggression. Even when kids come from similar circumstances, high quality parenting can make the difference between children who have problems adjusting to circumstances and those who don’t. And in a finding that likely won’t surprise many parents, one study found that adolescents who have good relationships with their parents were four times less likely to engage in delinquent behavior than those who didn’t.

To put it simply, well-adjusted families, often described as close or cohesive, with high levels of emotional support and low levels of conflict, produce well-adjusted children.

So what makes a family well-adjusted, and how do we create more of them?

Crosscut archive image.“Nobody,” says Nilofer Ahsan (left), “chooses to be a bad parent. They face circumstances in their lives that make it difficult to be the present, responsive parents that they want to be, and that we want them to be.”

Ahsan is the national leader of Strengthening Families, an approach that’s used in more than 30 states, including Washington. The initiative focuses on five factors that protect kids from abuse and neglect. The creators of Strengthening Families selected these protective factors after a close analysis of research literature and interviews with professionals who manage successful family support programs. Strengthen these five protective factors, the thinking goes, and you strengthen families:

  • Parental resilience — the ability to manage stress when faced with challenges;
  • Social connections — the network of friends and family that caregivers can rely on;
  • Knowledge of parenting and child development — the grasp of the basics about how children grow and develop and how to successfully guide and care for them;
  • Concrete support in times of need and the availability of services (medical, financial, educational, spiritual, etc.).
  • Social and emotional competence of children — the ability of children to form relationships and regulate and express their emotions.

One of the principles of Strengthening Families, Ahsan explains, is to meet parents where they are. For example, parents spend about six minutes a day, on average, dropping off and picking up their kids. What can a child care worker do in those six minutes to help parents build and nurture the five protective factors? A program in Arkansas developed short lessons on how to combat the most common stressors for parents. The lessons, on topics ranging from parental substance abuse to child toileting mishaps, are ready for program staff to share whenever a harried parent pauses long enough to listen.

This kind of “just in time parenting support” can encourage small but significant changes, Ahsan says. And the bite-sized approach may be a more realistic way to reach overwhelmed families than the traditional parenting classes. “I come from a family support background, and the mantra used to be 'a family resource center on every corner,’” she says. “We used to have a ‘If you build it, they will come’ attitude."

She pauses a moment and chuckles softly. “I don't know about you,” she continues, “but I have a fulltime job. I have two children. I'm probably not going to come.”

Reaching parents in six-minute bites is one way to try to build stronger families. But no one would argue it’s the only way. Across Washington State and the rest of the country, an array of agencies is trying to help. The sheer number and variety of these service groups can make a person yearn for a guide.

In a way, Susana Contreras-Mendez (below) is that guide. She is the family and community partnership coordinator for the Denise Louie Education Center, a Seattle nonprofit whose services include home visiting. Part of her job is to build strong relationships with families who are caring for children 3 years old and younger in order to help them navigate life successfully.

Crosscut archive image.Home visiting has been on a roll since 2010 when, as part of the Affordable Care Act, Congress dedicated $1.5 billion over five years for states to establish home visiting programs for at-risk women and children. That same year, the Washington State Legislature created the Home Visiting Services Account to help fund and evaluate home visiting programs.

In 2014 the Account, funded by federal, state and private money, and administered by the nonprofit Thrive by Five, awarded about $8.5 million in grants to more than 50 programs serving 1,800 Washington families.

Built into the federal legislation is the stipulation that 75 percent of funds go to home visiting programs that can demonstrate effectiveness. The US Department of Health and Human Services commissioned a review of home visiting research in an effort to determine which approaches moved the needle on the eight desired outcomes listed in the federal legislation, things like improved child and maternal health, school readiness, economic self-sufficiency, positive parenting practices and reductions in child maltreatment.

So far, good quality studies on home visiting effectiveness are in short supply, which makes it hard to draw sweeping conclusions about the efficacy of the approach. But of the 14 home visiting models scrutinized in DHHS’s 2013 review all showed “favorable impacts” on at least some of the desired outcomes — and some of those results have been lasting.

Home visiting programs require a commitment for the families who sign up for them. Families must invite a visitor — often a nurse, social worker or trained parent educator — into their home every week for an hour or more. These home visiting relationships can go on for years, beginning during a woman’s pregnancy and not formally ending until her child is 3-5 years old, depending on the program.

On a sunny fall afternoon in Rainier Valley, Susana Contreras-Mendez enters one family’s apartment and cheerfully gets to work. She helps arrange for an evaluation of the toddler’s development, recommends an organization that helps low-income residents find housing, offers to connect the young boy’s mom with counseling services so she can deal with the anxiety she’s feeling after would-be thieves tried to break into her apartment.

Contreras-Mendez asks about everything, from whether the family has health insurance to whether the 14-month-old has shoes yet. He doesn’t. So Contreras-Mendez holds her thumb and forefinger against the boy’s foot to take a rough measurement and promises to look for some shoes to bring next week.

This kind of intensive, specific approach — connecting parents and children with a customized mix of services that addresses their specific needs — holds promise, says Suzanne Kerns, an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Kerns’ work includes teaching primary care physicians how to recognize and reach out to families in distress. When it comes to helping families function, she says, “One size does not fit all. And one intervention won’t do it all.”

At the Youth Haven emergency shelter run by Friends of Youth, Shawn Sivly and her colleagues often get just 21 days to help families develop the skills and connect with the services they need to bring their kids back home. It’s not much time, Sivly says, and sometimes, it’s not possible. During the first part of the year, about 70 percent of the kids at Youth Haven — the shelter serves 7-17 year olds — went home to their families. In the last six months, about 50 percent have.

No matter the outcome, Sivly has noticed that her young clients make their own connections, their own families. They may know each other from school, from juvenile detention, from Facebook, and they form their own bonds. She recalls two young shelter residents stopping her as she introduced them. They’d already lived together three times.

Family is “extraordinarily important,” says the UW’s Suzanne Kerns. But if you don’t have one readymade at birth, it doesn’t mean you’re destined for an unfulfilling life. “In those cases, you really are looking for other connections and supports,” she says. “And you can definitely find them.”

Depending on the circumstances, family can be a blessing and a curse. But, says Kerns, “I don't think there's a single person out there who doesn't have a family who doesn't wish they did.”

Listen to Steve Scher's podcast on how home visits can help make families stronger.

Photo of Nilofer Ahsan courtesy of the Center for the Study of Social Policy. Photo of Susana Contreras-Mendez courtesy of Susana Contreras-Mendez.


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About the Authors & Contributors

Kathleen Donnelly

Kathleen Donnelly

Kathleen Donnelly is a Seattle-based writer specializing in health and global development.