The task of the focus group participants was to discuss problems they saw (in their practice, in the neighborhoods, or with their own children) as early warning signs of later preschool difficulty. They were asked to restrict their discussion to problems evinced within the first three years of life. The locus of the problems could be the child (e.g., speech delay), the parent (e.g., an overprotective parent), or the environment (e.g., no opportunity for peer play). The outcome "school difficulty" was intentionally vague to maximize the range of responses and open discussion among group members.
Each focus group generated an extensive list of "early warning signs." Table 3 presents several themes that were common across groups and across sites. The most striking finding is the similarity in the concerns of parents and providers. Interestingly, no one mentioned the lack of traditional pre- academic skills such as children's knowledge of numbers, letters, colors as a concern. Instead, participants in both Fremont County and Lawndale discussed more basic issues such as the development of self-control, respect for others, a sense of confidence and competence. Their concerns were broad, ranging from aspects of parenting, the child, and the child-parent relationship to the family as a socializing agent, and the larger context of the neighborhood. Parents and professionals were passionate and sincere, and readily voiced their concerns for the children of their communities. The observations of providers and parents alike were astute and their illustrations were often poignant and alarming.
Despite demographic differences (viz., urban vs. rural, race and ethnic composition), Lawndale and Fremont County participants were similar in terms of their concerns. Where differences did arise, they tended to reflect a greater range of troublesome circumstances or more severe forms of the risk conditions in Lawndale. Drug abuse and gang involvement is more widespread in Lawndale and appears to be taking a particularly heavy toll on family routines and the safety of young children. A social worker in Lawndale described just how extensively drug use can interfere with parenting -- for instance, one mother routinely sold WIC foods to buy drugs and fed her infant table scraps instead. She was proud her infant never ate "baby" food and kept her in the oven of their tiny one-room apartment because she couldn't tolerate the sound of her crying. As an aside, equally alarming is that the court did not find cause to remove this baby from her mother's home. The problems of drugs and alcohol are not confined to Lawndale, however. Fremont County parents and professionals also spoke of increasing numbers of parents with alcohol problems, and babies affected by parents' alcohol and drug use.
The most unexpected finding from the focus groups was the grave concern of both parents and professionals about increasing numbers of infants and toddlers who are unsupervised and left to raise themselves. Such families were described as lacking routines and schedules. When hungry, toddlers are expected to find themselves something to eat; when sleepy, they nod off wherever they are. When asked how a lack of supervision and routine in the home bode poorly for later school success, the groups were quick to share a well-reasoned developmental sequelae. One Fremont County mother said that lack of supervision leads to lack of respect for adults because children don't feel adults' rules are valuable or relevant. As a result, she offered, children left to raise themselves will have difficulty following rules in school and getting along with others, and are likely to end up as loners.
Statistical tests of differences between the two samples showed that children in Lawndale were at greater socio-economic risk due to proportionately less household income and more teen mothers, single parents, and households with four or more children. Children in Lawndale were also at greater risk due to the accumulation of stressors. That is, a greater proportion of Lawndale parents could be characterized by two or more of the following five characteristics: low income, teen birth, less than high school education, large family size, or one-adult household. Seventy-eight percent of Lawndale families and 20 percent of Fremont County families surveyed had two of more of these five risk factors (Chi-Square = 40.39, p < .001).
Despite the social and demographic differences between Fremont County and Lawndale, parents' reports of their concerns were similar. In both communities, most concerns were about children's health and physical development (e.g., questions about feeding, sleeping, age of sitting, walking, and talking), followed by concerns about cognitive and emotional development (e.g., questions about discipline, how long to leave a baby crying, how to handle tantrums, whether to limit television viewing) and concerns about establishing and maintaining family habits and routines (see Table 5 for summary definitions of each area of concern and Appendix B for individual items).
As Table 6 indicates, parents in both communities were most likely to express concerns about health and physical growth (mentioned by 98 percent of parents in Fremont County and by 85 percent of parents in Lawndale). Next most common were concerns about cognition and emotional development (85% Fremont parents; 82% Lawndale parents), and then questions about family habits and routines (85% Fremont parents; 77% Lawndale parents). On average, parents in Fremont County described ten concerns; parents in Lawndale described nine.
Parents in the two communities were also surprisingly similar in their discussion of problems they experienced in caring for their infants and toddlers. The survey asked about demanding and defiant behaviors such as fussing, attention-seeking, and noncompliance; acting out and aggressive behavior such as biting, kicking, and being overly active; sullen, moody, or shy behavior; and signs of possible developmental problems such as short attention span, delayed speech, or accident proneness (see Table 7 for a summary of category definitions and Appendix B for individual items). Approximately two-thirds of parents in both communities reported problems with aggressive and demanding behaviors (Table 8). Just over half reported moody, dependent behavior. One-third of parents in Lawndale and nearly half of the parents sampled in Fremont County described language, motor lags, or attention difficulties.
When asked for their number-one preferred source of advice, over half the parents surveyed in Fremont and Lawndale mentioned their own and other parents. Health and social service professionals were ranked first by 32 percent of parents in Fremont and 18 percent of parents in Lawndale. Family Center services were ranked first by ten percent of families in Fremont and three percent in Lawndale (Table 11).
Fremont parents' responses to questions regarding specific developmental concerns were somewhat incongruous with their previously stated "top" source of advice. Previously, 53 percent selected "other parents" as their preferred source of advice and only 31 percent selected health and social service professionals. However, specific developmental concerns were referred to these two sources almost equally (175 and 184 concerns respectively, see Table 12). The third most frequently endorsed source of advice was the Family Center's services. Lawndale parents' responses more closely approximated their overall rankings. Of 512 concerns, 222 were referred to other parents and 142 were referred to health and social service professionals. Relatively few concerns were referred to the Family Center and few sought assistance from formal parenting education (e.g., through WIC).
In Fremont, no single concern was the exclusive domain of other parents, health and social service professionals, or the Family Center; yet the data do suggest some degree of "consumer" specificity. Questions regarding feeding, developmental ability, teething, and illness were at least three times more likely to be referred to health and/or social service professionals, whereas more personal decisions regarding feeding mode (breast or bottle), discipline, pacifiers, bedtime routines, and returning to paid employment were preferentially discussed with other parents. In Fremont, questions regarding toilet training and the attainment of other developmental milestones were discussed equally with other parents, health and social services providers, and the Family Center.
The pattern was slightly different among Lawndale parents (see Table 13). With the exception of questions regarding developmental level, parents sought the advice of other parents as often, or more often, than any other source. For example, parents with questions about childhood illnesses were just as likely to turn to other parents as they were to seek advice from health professionals. As in Fremont, parents perceived the Family Center's expertise to include information about toilet- training and choosing child care.
Lawndale parents discussed a total of 230 problems (Table 15). In addition to the three most common problems shared by parents in Fremont County, over 20 percent of Lawndale parents reported problems with children hurting other children, being overly active, being too demanding, constantly seeking attention, and hitting, biting, or kicking adults. Sixty percent of all problems for which a help source was mentioned were referred to other parents. As in Fremont County, even potential signs of developmental delay were typically referred to other parents. For example, parents who noted children's speech problems were just as likely to turn to other parents for help as to health and social service providers.
Pearson correlations between family risk and number of reported concerns and problems suggested only a weak linear relationship with most variables ( r < .30; p > .05), so the family risk index was dichotomized based on fewer (less than 2) vs. more (2 or more) stressors. Chi-square tests were computed to learn whether family hardship was related to perceived sources of advice and support, or to reported developmental concerns and problems. For the most part, parents at relatively different levels of socio-economic stress reported similar help-seeking behavior except that in families with fewer stressors, parents were more likely to include self-help efforts (e.g., reading, and observing others' children) among their resources (Chi-square = 7.08; p < .01). Level of socio-economic stress was not significantly related to parents' report of developmental concerns, or to the total number of concerns they discussed.
Socio-economic stress was related to the number of problems parents discussed, but in an unexpected way. In families with fewer stressors, parents reported significantly more problematic behaviors. On average, parents in the lower-stress group reported five problems; the average of the higher-stress group was three (t > = 2.71; p < .01). Analyses by problem types showed that parents in the lower-stress group reported more problems of all types; differences between the groups were statistically significant (p < .05) for dependent, moody behaviors and for resistant, demanding behaviors.
Results of these analyses raise two comments. First, because the absolute number of problems of each type was small (less than two problems of each type on average), the inverse relation between socio-economic stress and number of behavior problems should be regarded with caution. One possible interpretation is that, in the absence of unrelenting family hardships such as extreme poverty and lack of adult-adult support, parents are more likely to identify and discuss disruptive behavior. Second, it must be acknowledged that Lawndale families are over-represented in the "high" risk group because, in these data, site and risk are confounded. However, the pattern of findings for the combined group is similar to that within each site, thus it seems unlikely that the noted associations with socio-economic stress are related to inherent differences between the two communities such as locality or ethnicity.
A second set of analyses examined potential differences between families whose youngest child was an infant (< 12 months) versus a toddler. The results showed no significant relation between child's age and parents' help-seeking behavior. Similarly, there was little relation between child's age and parents' report of developmental concerns and problems; recall that most parents endorsed concerns of all types (Table 6) and as many as two-thirds described problems of the types probed (Table 8). Where differences were found, they were in the area of physical and intellectual development. More parents of infants expressed concerns about health and physical development and more parents of toddler-age children described potential developmental problems, though few noted they were of "serious" concern. These group differences were not statistically significant (p < .05).
When asked how community members could help parents prepare children to do well in school, responses ranged from parent- focused programs (such as parent education, home-visiting programs, etc.), to the need for better outreach regarding existing programs, to ways of strengthening links between home and school (see Table 17). In addition to increasing parent involvement and knowledge of resources, both groups recommended several child-focused activities. The most popular suggestion was the provision of peer play groups. The common vision was of mixed-age groups facilitated by knowledgeable adults who would take primary responsibility for activities, but attended by parents as well. Nearly half the sample reported that providing assistance with transportation and providing evening and weekend activities would help them take greater advantage of new or existing programs.
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