Progress 09/01/14 to 08/31/16
Outputs
Target Audience:Our original goal was to recruit from three, rural Indiana counties and deliver trauma-informed parenting classes to 120 kinship parents. During the project period, we followed our submitted protocol faithfully. Recruitment proved to be extremely challenging,despite our efforts to expand to additional counties. Through communications with the program officer, we extended the outreach of the trauma-informed parenting classes to a total of 11 rural counties:Clay, Owen, Fulton, Fountain, White, Montgomery, Tipton, Cass, Clinton, Parke or Pulaski county. Approval was sought and received from the Department of Child Services in Indiana to offer these classes as foster parent training hours as an incentive for kinship parents to attend. Our second target audience was Extension Educators in the rural counties. Extension Educators were trained by the project consultant, a master's prepared social worker, Elizabeth Sharda,who was involved in the pilot of the curriculum through the National Child Traumatic Stress Network (NCTSN) or in the second year in the project, by the project director, Karen Foli. Recruitment occurred across 11 rural counties in Indiana with parenting classes ultimately offered in four rural counties (Clay, Owen, Clinton, and Montgomery)from 2014 to 2016. In total, five classes were held. Approximately 12 classes that were planned and advertized had to be canceled. Forty-three parents were registered for classes; however, 8 did not attend classes; 13 attended classes, but did not meet inclusion criteria/were not kinship parents or did not attend >75% of the classes; and 6 individuals registered incounties where classes were not offered due to low enrollment. The remaining 16 parents' data will be used in the final analysis.The average age of participants was 58.7 years; the majority were married (n=12), White/Caucasian (n=16); female (n=12), in very good or excellent health (n=10), with a high school diploma (n=6) or a high school diploma with technical/vocational training (n=4), and holding guardianship of the child(ren) (n=11). Kinship parents reported in half the cases that a birth parent was incarcerated or in the legal system (n=8). Twelve kinship parents reported that a birth parent had an "alcohol or drug addiction," with 7 participants reporting that the child had (possibly) suffered abuse and/or neglect. A third target audience, area youth workers, was added as a recruitment effort.The project director, Karen Foli, presented at the Indiana Youth Institute, Youth Workers' Cafeprogram in Clay County, Indiana, in April 2016: "Kinship Care: What It Is and What It Looks Like for Youth Workers." In attendance were approximately 45 individuals from various government agencies, including the Department of Child Services, Court Appointed Special Advocates (CASA), and private citizens (parents). The NIFA sponsored project was described for these individuals during this presentation with upcoming classes announced. Recruitment flyers were also distributed. Changes/Problems:The original protocol/grant application's approach was sound. Our rationale was that by utilizing embedded "insiders" (Extension Educators) to assist in recruitment, implementation of the classes would follow our plannedtimeline. Each project change surrounded efforts to increase enrollment of parents as this proved to be unexpectedly challenging. The following list summarizes changes in response to the significantly lower than anticiapted enrollment: 1. Overall Strategies to Increase Enrollment: Strategies included a) new counties added to the original three (total of 11); b) revision of the recruitment materials, including the press release, the newspaper advertisement, the recruitment brochures, and the business letters; and c) increased recruitment activities. Multiple Instituational Review Board amendments were filed that reflected these changes. Hundreds of brochures were printed and disseminated in various ways. Extension Educators began to target additional organizations and requesting booth space at youth fairs. Communications between the project director and Extension Educators increased in frequency and duration. Additional teleconferences were conducted with fall and spring classes scheduled. Registration of classes were closely monitored via a spreadsheet on a secured, password protected server. 2. Addition of Clay and Owen Counites: A total of 11 counties were included in the project, and all but two met the NIFA definition of "rural." These two counties did not meet the criteria set forth by NIFA and therefore, were not originally included in the grant application. In January 2016, Karen Foli, Project Director, entered into a dialogue with the program officer, Aida Balsano, who upon reviewing the supporting data for therequest,agreed to addthese counties to the project. Supporting data includedstatistics from both the U.S. Census Bureau and the National Center for Health Statistics.In addition, the Extension partner in these counties was very interested in supporting kinship parents. This individual had hosted an information night in 2015 with attorneysand social workers discussing resources for these parents. However, the Extention Educator assessed that the participants wanted to know more about how to parent these children and saw a significant need for this program. 3. Approval for Foster Parent Training: With the approval of Fay Russell, MS, Assistant Deputy Director, Staff Development, Department of Child Services, State of Indiana, we were authorized to add the following wording to our recruitment materials: "These classes are approved by the Indiana Department of Child Services for up to 15 hours of foster parent training." With this statement on our recruitment brochure, we hopedthat kinship parents, who were also foster parents, would be motivated to enroll and attend the classes for this free training. We sent certificates of completion to the kinship parents after they had attended the classes. 4. Extending the Project for an Additional Year. At the end of the first project year, it became evident that our efforts to increase enrollment were limited in effectiveness. The project director, Karen Foli, sought and obtained permission from Dr. Balsano for a 1-year extension to the project in the hope of achieving our target number. What opportunities for training and professional development has the project provided?This project provided training to threeExtension Educators and one Extension Specialiston trauma-informed parenting. This was conducted over approximately 8 hours of teleconference meetingsby the consultant for the project, Elizabeth Sharda, LMSW, Trainer and Consultant, Individual Affiliate, National Child Traumatic Stress Network. The fourth Extension Educator was trained by the project director, Karen Foli, who implemented the classes in Owen and Clay Counties. As mentioned previously, Dr. Foli also presented to the Youth Worker Cafe sponsored by the Indiana Youth Institute. During this presentation, Dr. Foli descibed the project, the positive reception of the course content by kinship parents, and the preliminary evidence of impact obtained from post-project interviews. This project's major goal was to positively impact kinship parenting behaviors based on increased knowledge and understanding of child trauma. It was also a project in which two organizations came to understand each other's mission, values and aims (School of Nursing and Extension). For example, faculty spend much of their time teaching and conducting research with an appreciation of institutional review boards, consenting individuals, and integrity of data. Incontrast, Extension Educators focus on disseminating educational activities, coordinating county fairs, and tracking constituencies served. As publications move forward, Extension Educators will have the opportunity to disseminate findings in both presentation and manuscript formats. Dr. Foli, who has extensive peer-reviewed publications, will be the lead author and mentor in these activities. How have the results been disseminated to communities of interest?Planned dissemination activities: Planned Poster Presentation: Planned submission to Sigma Theta Tau International Honor Society in Nursing: 44th Biennial Convention, Indianapolis, Indiana, November 2017. Foli, K. J., Kersey, S., Zhang, L., &Wilkinson, B. (poster presentation). Trauma-Informed Parenting: Reaching Rural Kinship Families through a Nursing and Extension Education Partnership Planned Publications: 1. Submission to the Journal of the American Psychiatric Nurses Association (special issue on trauma-informed care). This manuscript will be data-driven and include the quantitative and qualitative findings of the project. Foli, K. J., Kersey, S., Zhang, L., Woodcox, S., Wilkinson, B., Nagele, M., & Newcom, T. (in preparation).Trauma-Informed Parenting: Reaching Rural Kinship Families through a Nursing and Extension Education Partnership 2. Journal to be determined. This manuscript will describe the partnership between nursing faculty and Extension Educators and how the project was planned and implemented. Foli, K. J., Kersey, S., Zhang, L., Woodcox, S., Wilkinson, B., Nagele, M., & Newcom, T. (in preparation).Reaching Vulnerable Families through a Nursing and Extension Educator Parnership: A Transdisciplinary Project (working title) What do you plan to do during the next reporting period to accomplish the goals?
Nothing Reported
Impacts
What was accomplished under these goals?
Major Goal: We have preliminary findings that support the major goal of the project/study. Our data are rich in that we have both qualitative and quantitative findings. In particular, our qualitative content analysis indicates that specific, positive parenting changes occured in relation to the trauma-informed parenting class. For example, our themes include: Clarification of caregiving role; increased support for the child; and specific parentng changes based on increased understanding of the child's past trauma. Participant quotes include: "I think before I yell": "It lit up a light bulb in me" and (child behaviors) "are easier for me to understand." The project director and statistician have been working on the quantitative data analysis. For continuous variables, such as the Parenting Stress Index, paired t-tests will be performed to find whether before and after reports were significantly different. For categorical variables, such as Child Rearing Practices Report, Fisher's exact test will be used for the analysis. All analysis will be conducted by using statistical software, R (R Development Core Team, 2008). Quanitative data are less conclusive; however, indivdual items in the certain questionnaires appear to be significant. The exception to this is the Parenting Stress Index, with pre-and post-intervention scores that did not produce significant results. We believe that the small sample size (n=16) negatively affected our ability to assess changes based on self-report surveys. With our publication plan, we will disseminate these results (see below). Objective #1: This objective was met. Extension Educators located in the originally planned three counties and the Extension Specialist were trained by the project consultant, Elizabeth Sharda. Subsequently, an additional Extension Educator was trained in the curriculum; this Educator was embedded in new counties (Clay and Owen)that had been added to increase enrollment. The project director, Karen Foli, trained the fourth Educator. Objective #2: This goal was partially met; while 43 individuals registered for the classes, due to factors such as not attending the entire curriculumand not meeting inclusion criteria,16 parents completed the course and submitted data that will be analyzed. The project director, Karen Foli, attests to thesignfiicant hours that were spent to strengthen recruitment and meet the target number of participants. In addition to direct recruitmentefforts such as face-to-face communicationand telephone calls, we sentletters to churches, local businesses andcontacted volunteers in each ruralcommunity. We strategicallyutilized social media (Facebook, Extension web pages, and the Purdue Today [daily electronic newsletter] section: "Research Participants Needed"). We used traditional media, such as radio spots withinterviews, and newspapers. Extension Educators worked diligently to communicate the project to local residents and peer organizations. A nursing faculty member on the team, Susan Kersey, who is a clincial nurse specialist in child and adolescent psychatric mental heatlh, was employed at aregional community mental health centers' satellite offices in two of the target counties. She distributed dozens of brochures to these organizations so that therapists who worked with kinship families would relay the project to interested parents. Hundreds of project brochures were distributed across the project time line. These were updated continuously as the project expanded to different counties or redesigned in more consumer-friendly formats. Another strategy to facilitate enrollment was seeking and obtaining approval from the State of Indiana Department of Child Services (DCS) to issue certificates of attendance/approved foster parent training hours. For those parents who were working with DCS, this was effective. We also contacted several organizations to assist us in "spreading the word" about the project. Extension Educators and when appropriate, Dr. Foli, contacted county DCS offices to explain the project goals. Brochures were sent electronically to multiple parties, including agencies such as Connect2Help 211, an Indiana-based organization that connects individuals with available resources. Objective #3: As described in the Major Goal accomplishment, we are in the process of final data analysis.Several participants believed that the class should be "mandatory" for kinship caregivers. These parents described significant traumatic events for both the children under their care and themselves. They reported receiving much needed support from the other parents in the class, and utlized the information in the manual after the classes were over. Our acceptability, accessibility and overal satisfaction data are strong. For example, 100% of the kinship parents were satisfied or very satisfied with the classes; 100% were satisfied or very satisfied with the location, distance driven, and registration; and 69% strongly agreed or agreed that providing childcare was important to attendance. Objective #4: This objective was met and will continue to be met as dissemination activities increase. Teleconferences were well attended and the as the Extension Educators are embedded within their respective counties, were logistically advantageous. When Extension Educators were on campus, meetings were held face-to-face.
Publications
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Progress 09/01/14 to 08/31/15
Outputs
Target Audience:We have implemented our protocol faithfully, with training of co-faciliators completed, and timely teleconferences with team members. To date, we have offered two classes, reaching 8 kinship parents. This is far short of our anticipated recruitment goals and we have responded by 1) requesting and receiving a one-year extension on the project to August 31, 2016; 2) expanding the geographical area from three to nine counties (rural counties per NIFA codes); 3) requested and received approval for the parenting classes to count as foster parent training, including the statement"These classes are approved by theIndianaDepartment of Child Servicesfor up to 15 hours of foster parent training" in our recruitment materials; and 4) increased recruitment efforts with key stakeholders in the counties, including systems of care, local churches and healthcare providers, as well as contacting local directors of theDepartment of Child Services. Specifically, our rural counties now includeRural (Non-metro) Indiana counties, Montgomery, Tipton, White, Parke, Pulaski, Cass, Clinton, Fountain, and Fulton Counties.These counties are located in west to northcentral Indiana and are surrounded by counties considered metropolitan areas.Criteria for participant inclusion are: kinshipparents who have been full-time caregivers for at least three months, regardless of whether they have formal foster care parentstatus or a more informal parenting arrangement. Recruitment of participants has beenthrough local avenues, and primarily conducted by the Extension Educators. Hundreds of recruitment brochures have been distributed to various agencies and organizations in these counties. As the additional six new counties have just been onboarded, we anticipate increased recruitment activities.Community mental health satellite clinics have also been made aware of this health educational offering and we have received several parents through this. Extension educators have verified that meeting rooms are availableto hold the health education classes with adjacent space for childcare. Nursing students were recruitedthrough the School of Nursing electronic newsletter to provide childcare at the first class that was held and education for the children in attendance (Healthy Eating) was delivered. Changes/Problems:The project as outlined in the proposal was realistic, and the partnership between nursing educators and Extension Educators has worked well. The major problem has beenreaching the kinship parents/participants to enroll in the program. In this progress report, wehave outlined our strategies to try to overcome this challenge. What opportunities for training and professional development has the project provided?The county Extension Educators in Montgomery, White, and Tipton Counties, as well as two nursing faculty and an Extension Health and Wellness specialist were trained in how to implement the program/curriculum by Liz Sharda, the project consultant. Each module's content was reviewed and questions answered. The six individuals gained knowledge and expertise from the training. Feedback after the parentingclasseswas also shared, and included group dynamics and areas for growth. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals?As previously outlined, we have expanded from 3 to 9 counties and continue aggressive recruitment activities. We have printed hundreds of new brochures, designing them to be more colorful. We have created a project chart that outlines the classes in each countywith those responsible for facilitating, as well as recruitment/advertisement ideas, and are hopeful that our efforts will assist us in reaching our goals. This will be reviewed during the next scheduled conference call (August 26).
Impacts
What was accomplished under these goals?
Major Goal: We have made significant progress toward our major goal. The infrastructure to deliver the project is in place and includes the completion of training to the facilitators and a network of communication. Now, it is an issue of recruiting kinship parents to enroll in the classes. Objective #1: This objective has been met. The three original Extension Educators, the Extension Health and Wellness Specialist,and two nursing faculty members have been trained to deliver the curriculum. Objective #2: We are short of reaching this objective, having held two classes in Montgomery County witha total of 8 kinship parents. Although scheduled, we have been forced to cancel several classes due to the lack of enrolled participants. In response to this, Karen Foli, Project Director, reached out toAida Balsano, Program Officer, for our project to discuss the situation; Ms. Balsanogave verbal authorization in April to expand the geographical reach of our project to additional counties that met the NIFA rural-urban continuum codes. We submitted an amendment to the IRB to recruit from a total of nine counties, which was received. A teleconference with all of the Extension Educators and nursing faculty is scheduled for August 26. During this conference, we will "kick off" our push to increase enrollment in the project. We also requested and received approval from Fay Russell, Assistant Deputy Director Staff Development, Indiana Department of Child Services (DCS), for approval for the kinship classes as foster parent training (up to 15 hours) in all nine counties and include this in our recruitment materials. The team has participated in several teleconferences to discuss strategies to increase our enrollment, and key stakeholders and volunteershave contacted us to learn more about the program. Local DCS directors have also been contacted and the program described to them. A radio spot has been scheduled in September in one of the new counties. Newspaper articles have been written to describe the project to rural dwelling kinship parents.The timing of the classes has also been adjusted to meet the needs of the participants' schedules (evenings and Saturday offerings). We are hopeful that these additional activities will result in higher enrollment in the project. Objective #3: With such a small number of parents who have completed the project, we have not analyzed thedata to date. However, our codebook has been written and approved by our statistician on the project. Data have been collected as outlined in the project proposal. Follow up interviews have been conducted on all 8 participants. The feedback thus far has been overwhelmingly positive. Objective #4: This objective has been met. The team and our consultant havemet via teleconference to discuss the curricular content, how to optimize co-facilitation (nurse faculty pair with Extension Educators), and best practices on leading group discussions within the context of the educational offering. Feedback has been shared by team members and regular conference calls are scheduled and held. Informal feedback from participants has been shared with the team. There is strong team commitment to continue our efforts to recruit to the wider geographic areas.
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