Outcomes from a randomized controlled trial of the Relief Nursery program

Study Aim/Purpose:
This study examined the impacts of the Relief Nursery program, established in the mid-1970s in the Eugene-Springfield community of Oregon. The program is designed to provide a comprehensive array of family support services to low-income families at risk of child abuse and neglect, including home visiting, parent education and a therapeutic early childhood education classroom, respite services, and additional services tailored to each family’s needs.

Summary of Methods:
Families with children between the ages of 18 months and four years who contacted the program for the first time were randomly assigned to the “full program” condition or “respite care only” condition. Respite care provided to the two groups was of equal quality but provided in a different physical location. A total of 180 primary caregivers (95% women) and 180 children initially participated in the study, which lasted two years with a very high retention rate. Eighty-three percent of the participants were White, 15 percent were multiracial, and in terms of ethnicity 42% were Latinx. Thirty-six percent of caregivers had been homeless, 28 percent had been diagnosed with a mental health condition, 23 percent had serious drug or alcohol problems, and 25 percent had been arrested.

Interviews with caregivers were conducted at baseline and every 6 months for two years to measure the following outcomes: family strengths and resources (assessed using the Family Functioning Style Scale); availability of social supports (measured using the Social Support Questionnaire); potential for child abuse (measured using the Child Abuse Potential Inventory); parenting quality (assessed using the Alabama Parenting Questionnaire; caregivers’ parenting self-efficacy (assessed using a total score from the Being a Parent question items); parental depression (measured using the Center for Epidemiologic Studies Depression Scale); family stress (measured using the Parental Stress Index); and child behavior problems (assessed using the 113 item Child Behavior Checklist-Parent). Beginning with the first followup interview, families were also asked about their satisfaction with the services received. Receipt of respite care, requests for referrals, and characteristics of the components of the full program attended were also documented.

Summary of Results:
At the six-month interview (wave 2), after controlling for baseline differences between the two groups, no significant differences in outcome effects were found. However, at the twoyear (wave 4) interview and the end of the 2-year study period (wave 5) there were significantly higher levels of social support reported by caregivers in the Full Program than by caregivers assigned to the Respite Care only condition. Outcome differences were not found on any measures of family functioning or child behaviors. While participants in both study groups expressed satisfaction with the services received, those in the “full program” expressed higher levels of program helpfulness and satisfaction.

Limitations of Study:
The authors noted several limitations in the study design, including the small sample size and the use of only one tool for measurement of outcomes. They also indicated that the study results were impacted by unexpected decreases in program funding, which had negative effects 34 ARCH National Respite Network and Resource Center on program staffing and their ability to refer to other services, and thus also potentially limited participants’ participation over time in the program’s core components. They also explained that, while enrollment in the Respite Nursery program is based on self-referral, the resulting selection bias may result in different population characteristics among the study population than the larger population of families who are at risk for child abuse and neglect, and thus the results would not be generalizable.

Authors’ Discussion/Conclusions:
The authors conclude that their findings of the program’s limited impact may have been in part due to the relatively low levels of program staffing and its effect on their ability to engage families and thus to ensure provision of all of the services. They recommend that, in order to assure adequate dosage of the intervention to study participants, the protocols should incorporate a variety of purposeful strategies to so that all components reach over 90 percent of families for a significant period of time. They also suggest that it may be more useful to evaluate program impacts on a homogeneous group of families, e.g., those with similar parent, child, and family needs, and who are identified as “high risk” specifically for child abuse and neglect.