Evaluating the Use of Bright Futures Educational Materials with Parents of Young Children with Special Needs Janel D. Lauer, OTR/L Health Services MPH Candidate University of Washington

Bright Futures  Initiated by MCHB in 1990  Currently sponsored by a variety of national agencies  Includes parent education component Family Tip Sheets Information on specific areas of child development  Designed to meet the needs of all families Unknown use with parents who have children with special needs

Early Intervention  Services for children ages 0-3 with identified disabilities or delays  Includes supporting families and enhancing the developmental potential of children  Intervention is individualized, and often focused on child’s specific needs

Disability-Related Literature  Shifting focus away from medical model  Concept of “redefinition” Allowing parents to provide typical, rather than specialized, parenting practices  Acknowledging the similarities rather than differences between children with special needs and their “typical” peers

Current Study Context  Boyer Children’s Clinic EI Program  Packet of Bright Futures handouts Infancy Family Tip Sheet Communicating with Children Self-Esteem Stimulating Environments Special Time  Overall goal to improve parenting skills in order to enhance child development

Study Objective  Conduct a process evaluation of the use of Bright Futures materials at Boyer Children’s Clinic  Examine underlying assumptions  Focus on five domains General Use Content Opinions Relevance for Parents of Children with Special Needs Barriers to Use Recommendations

Study Design and Methods  Cross-sectional, mixed-methods study  30-item Questionnaire Likert scale Multiple choice Open-ended  Mailed to families who received packet Initial mailing (105) Reminder postcard Follow-up mailing (77)

Preliminary Results  To date, 43% response rate (n=43)  Demographics of respondents Over 90% mothers Average age 35 About 80% with at least a Bachelor’s degree Average age of child 24 months Special needs of children  Developmental Delay (72%)  Speech-Language Delay (58%)  Physical Disability (26%)  Visual Impairment (19%)  Hearing Impairment (5%)

General Use  75% of respondents read at least one handout  Tended to either read all or none of the handouts  Who read handouts? 73% indicated Mother 21% indicated Father 9% indicated Grandparent 2% indicated Foster Parent

Content Opinions  Overall positive ratings of individual handouts Highest ratings of “Special Time” and “Communicating with Children” Lowest rating of “Family Tip Sheet”  Overall positive opinions about content Generally agreed that handouts were interesting, gave ideas about ways to interact, and had important information about safety, health, and development  Did not feel that information was new

Relevance  Over 80% indicated that the activities mentioned were appropriate for their child  Open-ended responses revealed concerns about relevance “I’m a little annoyed to be reminded about when typical kids start to.....” “Does a family with an older child with delays need to be reminded that typically developing children are ahead?”

Barriers  Common reasons for not reading handouts Not having time Already having enough developmental information Misplacing packet  Other barriers noted in answers to open-ended questions WA State DOH mailings Not age-appropriate for children over 1 year Sense that this was for parents of “typical” children

Recommendations  Majority of parents would recommend (64%)  Even parents who personally did not like or did not read the handouts felt that they would recommend for others  Open-ended answers described feeling that the use of handouts should depend on the individual child and family

Limitations  Small sample size Low statistical power  Homogenous, selective sample Limited generalizability  Possibility for measurement error Non-validated survey

Conclusions  Handouts with information that is less specific to developmental stages may be more appropriate Focus on handouts that pertain to all children  Special Time  Communication Information on specific developmental skills more appropriately addressed individually  Selective use of handouts versus universal

Implications  Further research on use of Bright Futures materials with parents of children with special needs  Determination of whether written handouts are an effective way to promote redefinition, or if other methods may be more appropriate

Acknowledgements  Thesis Committee Members Marcia Williams, PhD, MPH, PT (Chair) David Grembowski, PhD  This work was funded in part by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (Title V, Social Security Act), grant #T76MC

Special Thanks  Jean Myers, MPH, PT Bright Futures, University of Washington CHDD  Cheryl Buettemeier, MS, CCC-SLP Program Director, Boyer Children’s Clinic  Staff and Families at Boyer Children’s Clinic  MCH ’06 Cohort  Family and Friends

Questions?