Projec ject t Co Conectar ar Bobbie J. Vaughn, PhD Linda M. - - PowerPoint PPT Presentation

Projec ject t Co Conectar ar

Bobbie J. Vaughn, PhD Linda M. Callejas, PhD Myrna Veguilla, MS Florida Center for Inclusive Communities University of South Florida

Pr Proje

• ject

ct Conec nectar tar

• Project Conectar proposes that using natural

helpers or promotoras will assist Latino (Hispanic) families in Little Havana Miami to identify developmental delays and access services for their children at an earlier age

• Project Conectar will evaluate CDC LTSAE

materials, family needs for information, and access to services to impact through the intervention efforts of the promotoras, project staff, and collaborators-Myriam Monsalve-Serna

• f Connect Familias and Betty Alonso of The

Miami Foundation

Wh What t Are e Pr Promotoras? motoras?

• Promotor/a is the Spanish word for Community

Educator

• Used through Latin America, Asia, Mexico, and

Africa where health care is limited as well as in the U.S. (especially along the border with Mexico)

• Began US with Federal Migrant Health Act of

1962 and Economic Opportunity Act of 1964, mandated outreach efforts in migrant labor camps and poor communities

How w Do Do Pr Promotoras

• motoras Hel

elp? p?

• Provide culturally competent responsiveness to

services

• Decrease barriers by acting as a conduit from

families to providers

• Improve retention in services (help problem-

solve barriers)

• Provide health education
• Increase positive outcomes, especially for

Latino clients

Set etting ting

• Established in 1995 to develop a comprehensive,

neighborhood-based and family-focused system of care designed to promote family and community safety

• Works to decrease barriers to services and increase

family/community safety by addressing child and family needs via its three major components:

• 1. A Service Provider Network
• 2. Community Health Workers (CHW) and Natural Helpers

(NH)

• 3. A community resident alliance, La Alianza Hispana de la

Pequeña Havana, where residents meet to discuss identified needs and issues of concern

Nat atural ural Hel elpers pers

• Connect children and families to services and

conduct outreach to the community

• Serve about 500 children and youth and 300

parents annually, as well as approximately 1500 community residents through community events

• Keeping families safe
• Improving family communication
• Finding a job
• Basic household needs
• Accessing medical and/or legal services

Qualitative litative Data ta

Focu cus s Gr Groups ups

• Conducted 4 focus groups between January

2010 and April 2010 in the community

• Families with children with disabilities that were

part of ConnectFamilias (CF)

• Families with children with disabilities (not with

CF)

• CFs’ Natural Helpers/Community healthcare

workers (NHs/CHWs) (i.e., promotoras)

• Advisory board (Community providers,

collaborators CF trainer/coordinator/The Miami Foundation, university professionals)

Focu cus s Gr Groups ups

• Questions for the focus group were developed by

project staff and advisory board members

• Questions about “Learn the Signs. Act Early.”

material

• Aesthetics: format, colors, font, use of

pictures

• Translation and grammar
• Family perceptions about use of materials
• Family’s experiences as they relate to seeking

services or getting information about their child’s disability

Wh What at We We hav ave e Learned…

• Preliminary Family Focus Group Findings
• Ease of Use
• Felt printed materials ineffective method to

create awareness, rather have an expert

• Too much information, difficult to navigate,

put important information first

• Mediator/guide/someone to help explain

why this information, is important for you/your child.

What We have Learned…

Families Way of Knowing

• Families know there are issues

even when doctors tell them differently

• Families persist and seek

information for sake of child…“I move the heavens and earth to get them (providers) to help him because it is not possible that in this country where they have everything, there is nothing.”

• “Knowledge is power”– If I know
• r understand, I can take action.

Families are up against a wall

• Inconsistent insurance

coverage, Medicaid dropped

• “….And that is the problem with

the healthcare system, because if you don’t qualify for anything – Medicaid or any of the other resources [that exist] – you don’t qualify, and you cannot move the mountain, you cannot move it.”

• Perceived discrimination
• Lack of bilingual/multicultural

staff at provider

What We have Learned…

• Professionals
• Professionals completely miss the boat (i.e.,

misdiagnose or don’t diagnose)

• Physicians and other professionals stop short (i.e.,

give them some information not enough)

• Cultural
• Lack of education/knowledge about the disability

by family and friends

• Difference in how children/peers respond to

disabilities in the home country vs. the U.S.

• Children with disabilities were considered a part of

kids activities there, but information better here

Qua uantitat ntitative ive Da Data ta

Who are t e the e Pr Projec ect t Conect nectar ar Partic icip ipants? ants?

Study sample: 70 cases

Country of Origin Mother Father Guatemala 6% 2% Colombia 5% 2% Honduras 33% 44% Nicaragua 19% 18% Domincan Republican 2% 2% Peru 10% 6% Venezuela 6% 6% Mexico 6% 5% Argentina 3% 3% USA 2% 3% El Salvador 5% 3% Costa Rica 2% 0% Cuba 2% 5% Ecuador 0% 2%

Fami amily y Char aracteristics acteristics

• Age
• Mother’s age range: 17-44 years old
• Average age: 31 years (M: 30.65, SD: 6.62)
• Father’s age range: 15-44 years old
• Average age: 33 years (M: 33.16, SD: 7.02)
• Education
• Mothers: 52% did not have a HS diploma
• Fathers: 55% did not have a HS diploma
• Income
• Majority of families (83%) had an annual

income below $20,000

Pa Paren ent t Edu duca catio tion

Househol usehold d Inc ncome me

De Descr cripti iption

• n of

f Childr ldren en

• Age range:
• 5 months - 5 yrs, 9 mos (65 months)
• Average age:
• 3 years old
• On the average, the child was almost 5 years
• ld when the parents noticed a problem

Ye Year ar 1 Pr 1 Procedur cedures es

• Natural Helpers/Community Healthcare Workers

enroll families in the project when home visiting, if family expresses concern about their children

• Business as usual no recruitment no special

activities Data collection forms:

• Family Service Assessment Survey (FSAS)
• Assesses family demographics and access to

services

• Ages and Stages Questionnaire: Social

Emotional (Squires, Bricker, & Twombly, 2002)

Wh What at Di Did W d We Co e Consi nsider: der: Child ld ch characteris cteristi tics cs

a) a child’s demographic characteristics (i.e., age at the time of the study and gender b) a child’s total ASQ score c) presence of a problem above the ASQ cut off score d) child’s age when the problem was noticed

Fami amily y ch char aracter acteristics istics

a) mother’s age at the time of the study b) father’s age at the time of the study c) mother’s educational level d) father’s educational level e) family annual income f) number of years family had lived in the US g) number of children in the family h) number of extended family members

What t Di Did We d We Consi nsider der

• Three outcomes examined: (a) whether the

problem was noticed by parents, (b) whether parents seek help, and (c) whether assessment

• f the child’s problems was performed (N=70).
• Number of years in the U.S. and help seeking

approached statistical significance indicating that the longer the family lived in the U.S. the more likely they were to seek help

• No statistically significant associations were
• bserved between parents’ socio-

demographic characteristics (i.e., age, educational level, etc) and noticing a problem with the child

Wh What at We We Kn Know w

• Child age, gender, or severity of the problem as

indicated by the ASQ, was not associated with whether the child’s parent noticed a problem

• When parents noticed a problem with the child

along with the number of years the family lived in the U.S. paired with a.) number of children in the family, or b,) extended family members, no statistically significant associations.

60% of children scored at a level that indicated a concern

Wh What at We We Con

• nsi

sidered dered

ASQ Questionnaire

• No. of Questionnaires
• No. of Children < Cut Off

6 8 2 12 1 18 24 7 3 30 8 5 36 11 9 48 21 12 60 14 11

Pr Process cess Eva valuation luation wi with th CHWs/NHs /NHs

• Early perceptions about Project Conectar and accomplishments

with families during Year 1 of the project were unclear. Conducting “business as usual” (i.e. not providing additional information or intervention than is typically the case) was challenging for Natural Helpers/Community Health Workers (NH/CHWs), who were eager to help families of children with suspected delays or disabilities. Many of these children had not been seen or evaluated for concerns. “In the beginning I didn’t understand what I was supposed to do, what my role was, how I was going to reach out to families, I thought it would be difficult. At first I thought we were going to get data and help families right away but I later understood that it wasn’t that way.” “I thought it was getting data and we would talk about the themes and experiences. So data collection was with us not with the families.”

Pr Process cess Eva valuation luation

Pr Project

• ject Conectar

nectar

Pr Process cess Eva valuation luation

Pr Process cess Eva valuation luation

Pr Process cess Eva valuation luation

Pr Proces cess s Evaluation luation

Pr Process cess Eva valuation luation

Pr Process cess Eva valuation luation

• When asked about additional training that they would

like to receive, NH/CHWs identified a number of areas related to parent education and behavioral difficulties in local children. Specific areas for training requested include:

• Parent education on how to manage problem

behaviors, especially for children with developmental disabilities

• Parent education on how to identify developmental

milestones

• Providing parents with support to help them with

the process of accepting a potential developmental disability or delay

• Training on hyperactivity disorder – what constitutes

normal/healthy behavior in an active child and what can be considered atypical.

• NH/CHWs also advocated for the development of parent

support groups to help parents with acceptance.

Ye Year 2 Pl 2 Plans ns

• Continue enrolling families and gathering data
• Participate in Neighborhood event to conduct

developmental screenings

• Train NHs/CHWs on developmental disabilities
• Train NHs/CHWs to run brief parent groups to

help families understand about milestones

• Schedule screenings in different location such as

preschools, Connect Familias office, and reserve space at a local park

• Work with advisory group to develop other

recruitment strategies (PSAs, Video, etc.).

Cont ntact act Inf nform rmatio ation

Bobbie Vaughn bvaughn@usf.edu 813.974.6104 Linda Callejas callejas@usf.edu 813.974.4615