October 2009

Grant Results

SUMMARY

From June 2000 to November 2003, researchers at the University of Notre Dame, in collaboration with the University of Alabama-Birmingham, the University of Kansas and Georgetown University, conducted two pilot studies on the use of cell phones to gather detailed information about predictors of early child neglect among adolescent and adult mothers.

Date from these studies helped secure funding for a much larger study and intervention project aimed at preventing child neglect among teenage mothers.

Key Findings
The pilot studies yielded preliminary data indicating that:

  • High-risk mothers are willing and able to use cell phones to report on their parenting behaviors.
  • Respondents found the cell phone interviews fun, interesting and non-intrusive as long as they did not occur too frequently.
  • A strong correlation between data gathered through the cell phone interviews and through standard survey instruments is evidence that the use of cell phones is feasible for collecting reliable and valid information on parenting.
  • Compared to adult mothers, teens are significantly less likely to practice essential parenting behaviors, such as protecting, comforting and mentoring, on a daily basis.
  • Teen mothers reported high levels of social support from family, but three-quarters of them wished that their babies' fathers would spend more time with their babies.

Key Results
Data from these studies helped advance, and secure funding for, a much larger study and an intervention project aimed at preventing child neglect among teenage mothers. Researchers at the University of Notre Dame and others received grants for this subsequent study totaling approximately $15 million from the National Institute of Child Health and Human Development at the National Institutes of Health (NIH).

Funding
A grant of $749,640 from the Robert Wood Johnson Foundation (RWJF) supported the pilot studies. The Cingular Corporation and Centennial Wireless supported the pilot studies by providing cell phones and call minutes for participating mothers.

 See Grant Detail & Contact Information
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THE PROBLEM

Although researchers do not concur on a common definition of parental neglect of children, they agree that it is a significant, but understudied, threat to the normal development of young children, particularly those born to teenage mothers. According to the U.S. Department of Health and Human Services, child neglect constitutes over half of the more than 2 million cases of child maltreatment reported each year. Teen mothers are at particular risk of neglecting their children.

In a 13-year study funded by the NIH, less than 30 percent of the children of adolescent mothers showed normal development at age three, and even fewer showed average achievement in the second grade. The study, led by John Borkowski, Ph.D., Andrew J. McKenna Family chair and professor of psychology at the University of Notre Dame (project director of the grant reported here), also found that approximately 60 percent of mothers believed that they should physically punish their infants in order to correct "discipline problems," a parenting style that had adverse consequences for the child's physical and emotional development as early as three years of age.

The study also revealed that less than 10 percent of the mothers found themselves in stable relationships or in meaningful jobs five years after the birth of their first child; the majority had another infant within three years; and teenage mothers never breast-fed their infants and rarely used consistent sleeping arrangements. According to Borkowski, "their children typically experienced irregular, chaotic living patterns with respect to location, types of contacts and daily activities."

Because of the same irregularity in adolescent mothers' lives, the use of new technologies, such as cell phones, offers many advantages for collecting data from them. Cell phones permit natural, frequent and non-intrusive contact because they are not time- or place-dependent. They are incentives for study participation because adolescents find them fun to use. Before such methodologies can be applied, however, researchers needed to test their feasibility with samples of a target population of adolescent mothers.

This project builds on Borkowski's previous work with the NIH cited above, and on a conference he organized in 1999 (see Grant Results on ID# 036862) examining new methodological, conceptual and analytic approaches to understanding parental influences on child development.

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RWJF STRATEGY

This project relates to RWJF's strategic goal of improving the health status of society's most vulnerable people by supporting projects that explore the intersection between health and health care problems and social factors—poverty, race, education and housing. On the topic of parenting influences on child development, including child abuse and neglect, RWJF has supported the following projects, among others:

  • Research on Parenting Influences on Child development (by Borkowski; see Grant Results on ID# 036862).
  • Healthy StepsSM: A Program to Improve Early Childhood Development (see Grant Results on ID#s 031255 and 040304.
  • Conference on Prevention of Child Abuse and Neglect in the 21st Century (ID# 012289).
  • Support for Center for Prevention and Treatment of Child Abuse and Neglect (ID# 002251).

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THE PROJECT

Borkowski joined with faculty and staff of Georgetown University, the University of Alabama-Birmingham and the University of Kansas in two pilot studies assessing the feasibility of using cell phone interviews to collect reliable and valid parenting information from adolescent and adult mothers of infants, and to collect detailed profiles of the patterns of care, stimulation and stability in their children's daily lives.

The Cingular Corporation and Centennial Wireless also supported the pilot projects by providing cell phones and call minutes for participating mothers.

Key research questions raised in the pilot studies included:

  • How can researchers define and use "neglect" in this and future studies in ways that will facilitate targeted prevention and accurate early detection?
  • How can researchers obtain information on day-to-day patterns of care?
  • Can study respondents use cell phones and will they answer calls from the researchers?
  • Will respondents provide detailed, sensitive data?
  • Will the frequency of contact be intrusive?
  • Will the study's frequent probes alter maternal reports and/or behavior?

Researchers did not pursue a community dimension of this study that was proposed to RWJF: a picture of the scope of existing teen parenting programs and an investigation of teen mothers' use of community-based services. Project Director Borkowski points out that data gathered in the grant period focused on mothers of infants who typically do not yet use many community-based services. That use typically comes when their children are older.

Data from these pilots helped researchers to secure approximately $15 million from the NIH's National Institute of Child Health and Human Development to support both a three-year study of the emergence of child neglect in a sample of 700 teenage mothers, low-risk adult mothers and high-risk adult mothers, and an intervention project aimed at preventing child neglect among teenage mothers.

Methodology

Forty mothers (20 teens and 20 adults) participated in the first pilot study; 61 mothers, all teenagers between ages 15 and 18, participated in the second pilot. All participants had infants between four and eight months old. In both studies, the research team recruited mothers through child development centers, public schools and well-child clinics in four cities (South Bend, Ind.; Birmingham, Ala.; Kansas City, Kan.; and Washington).

In both pilot studies, the researchers used a parent child activities interview to obtain detailed parenting information. This 20-minute semi-structured interview collected quantitative and qualitative data on the daily routines of mother and child in the previous 24 hours, including time in alternative care, time with father, bed and bath time and outings.

The interviews focused on eight "daily essentials" of good parenting identified by Sharon Landesman Ramey and Craig Ramey (published in their book Right from Birth: Building Your Child's Foundation for Life—Birth to 18 Months, 1999). The eight essentials include:

  1. encouraging exploration
  2. mentoring/rehearsing
  3. celebrating developmental advances
  4. comforting
  5. protecting from inappropriate teasing or harsh punishment
  6. stimulating language development
  7. guiding towards appropriate behavior
  8. recognizing and reacting to a child's cues.

In the first pilot, researchers conducted daily or every other day phone interviews over a two-week period. In the second more formal pilot study, the researchers randomly assigned mothers to two groups: one received up to seven cell phone interviews and the other received two phone interviews over a three-week period. Based on their responses to the interviews, the researchers assigned each mother a Parenting Essentials score on a five-point scale that captured negative, neutral and positive parenting styles.

The researchers then examined relationships between the Parenting Essential scores and mothers' scores on standard surveys of parenting knowledge and styles gathered through face-to-face interviews with them prior to and after the cell phone interviews.

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FINDINGS

In a report to RWJF, the researchers noted the following preliminary findings from the two pilot studies:

  • High-risk mothers are willing and able to use cell phones for reporting on their parenting behaviors. The large majority (94 percent) of mothers answered on the first call attempt and completed the parent child activity interviews. Mothers found the interviews fun, interesting and non-intrusive as long as they did not occur too frequently. In the first pilot study, mothers who were contacted every other day were 20 percent more satisfied than those who received daily calls. This observation led the researchers to reduce the maximum number of interviews in the second pilot study to seven over a three-week period. At that rate, 91 percent of mothers reported that the interviews were not intrusive. In fact, the use of cell phones appeared to be a strong incentive for study participation as judged by the high retention rates (98 percent in the first pilot study).
  • There is a strong correlation between the information gathered through the cell phone interviews and other standard measures of parenting styles and knowledge. Mothers with higher Parenting Essential scores (gathered via cell phones) also had higher scores on standard measures of knowledge about infant development. Mothers with lower reports of Parenting Essentials also tended to have a more punitive and less responsive parenting style, according to standard measures. This positive association with standard measures of parenting is evidence of the cell phone methodology's feasibility for gathering valid and reliable information on child neglect. Researchers also found that frequent contact over a cell phone does not induce positive change in parenting behavior, but it may lead to disclosures of information less favorable to the mothers than would occur in more traditional surveys.
  • Mothers' responses to the parent child activity interviews provided some critical indicators for defining early neglect. Possible indicators of early low-level neglect include mothers' descriptions of routines that show a severely limited amount of responsivity and monitoring of their child, routines that appear to have none or very few of the parenting essentials, as well as the appearance of specific salient events that might reveal patterns of negligence on the part of the mother. Although not in themselves full-blown neglect, inappropriate parenting patterns or events, when occurring in combinations over time, may predict later developmental delays in the child and more serious neglect.
  • Compared to adult mothers, teen mothers are significantly less likely to practice the daily essentials of parenting. Teenage mothers were significantly less likely to mentor and rehearse, celebrate advances, protect, comfort and communicate verbally with their child than were adult mothers. Although the two groups did not differ significantly in the consistency of their feeding, sleeping and bedtime routines, adult mothers otherwise provided a more consistent daily routine. Teen mothers spent more time watching television with their child and less time in child-centered activities than adult mothers, who tended to go on twice as many outings with their child during a 24-hour period. The percentage of adult mothers who reported that their infant did something to bother them dropped from 10 percent to 6 percent between infants' fourth and eighth months; in contrast, teen reports of annoyance increased over the same period from 6 percent to 22 percent. This indicates that adolescents become increasingly irritated over time with their children's behaviors, suggesting possible linkages with later neglectful and/or abusive parenting.
  • Teenage mothers reported high levels of social support. In the second pilot study, 91 percent of the 65 teen mothers had someone to help them take care of their babies. Some 68 percent of the biological fathers were involved in the care of their babies; nonetheless, 75 percent of the mothers wished that the baby's father would spend more time with the baby.

Communications

Although publishing preliminary data from the pilot studies was not an objective of this project, the project director and his colleagues have prepared two articles describing the project's feasibility testing of a cell phone methodology. They will submit "The Feasibility of Cellular Phone Interviews for Assessment of At-Risk Parenting" to the American Journal of Public Health and "Cell Phones as a Window to Parenting Practices" to Child Abuse and Neglect. The researchers will publish their major findings on early child neglect—based in part on project data and methodology—over the next several years.

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SIGNIFICANCE TO THE FIELD

Legal definitions of parental neglect currently dominate the field. These definitions are of necessity highly conservative, emphasizing extreme parental omission and serious potential consequences for the child. Such definitions, limited to gross physical neglect, ignore more subtle patterns of social and interpersonal neglect, which, when prolonged and consistent, may have devastating consequences for an infant and child's development.

According to the project director, an explicit goal of this project is to "lower the bar" by contributing to a definition of neglect within the field that is below the legal threshold required in most states to report and document neglect. Producing a broader definition of early neglect that researchers can agree upon and use in their investigations is an important step toward the design of interventions to predict and prevent the problem.

In this and prospective studies, researchers viewed child neglect as a parent's failure to provide the child with appropriate and adequate nurturance, including support for social-emotional development and intellectual and language stimulation, as well as attention to physical needs and health care.

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LESSONS LEARNED

  1. Cell phones should be an effective incentive to reduce attrition in other research studies with high-risk, mobile populations. Cell phones' high cost, however, appear to prevent their widespread use in large intervention programs. (Project Director)
  2. Cell phones should be an effective way for physicians as well as researchers to follow up on individuals within high-risk mobile populations or those with special needs. In both research and patient care, getting follow-up information can be an intractable problem that cell phones might address. (Project Director)
  3. It is possible to use a foundation grant to achieve much larger support from federal agencies, as well as to gain support from corporations. In this study, researchers successfully reapplied for funding from the National Institute of Child Health and Human Development by including data obtained under this RWJF grant in their proposal pilot study. RWJF's involvement in the pilots also convinced two cell phone providers to contribute cell phones and call minutes to the project. (Project Director)

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AFTER THE GRANT

Researchers are using data from the pilot studies in a much larger study of child neglect through two grants totaling approximately $15 million from the National Institute for Child Health and Human Development.

The first grant, a research study of child neglect among 396 adolescent mothers (18 years or younger) and 286 adult mothers (22 years or older), began in June 2001. Over a period of several months, mothers participated in three interviews at home and nine interviews by cell phone. The researchers rated the mothers using the same Parenting Essentials measurements as they used in the pilot study. Results will be published in an article in Child Maltreatment in press as of June 2008. Among the findings:

  • Adult mothers were significantly more likely to have higher Parenting Essentials scores than adolescent mothers.
  • For both adult and adolescent mothers, the likelihood of receiving lower Parenting Essentials scores increased over time, suggesting that the mothers' tolerance for minor misbehavior decreased over time, according to the researchers.

Under the second grant, researchers sought to determine the efficacy of cell phone use in a parenting skills enhancement program. The researchers studied a program in which participating parents were visited once a week and taught ways to improve parent-child relationships. Between sessions, the 19 participating parents received daily, personalized text messages offering supportive advice or asking a question relating to involvement in the program.

In a second article in Child Maltreatment in press as of June 2008, the researchers noted that some 77 percent of participants in the second study stated that they would recommend the use of cell phones in future projects. Furthermore, though analysis of the efficacy of cell phone use within an intervention program was ongoing as of June 2008, the researchers anticipated that cell phones would positively affect session attendance and retention among participants.

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GRANT DETAILS & CONTACT INFORMATION

Project

Predicting and Preventing Child Neglect

Grantee

University of Notre Dame (Notre Dame,  IN)

  • Amount: $ 749,640
    Dates: June 2000 to November 2003
    ID#:  037224

Contact

John G. Borkowski , Ph.D.
(574) 631-6549
souders.1@nd.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Bigelow KM, Carta JJ and Lefever JB. "Txt u ltr: Using Cellular Phone Technology to Enhance a Parenting Intervention for Families at Risk for Neglect." Child Maltreatment, 13(4): 362–367. Epub 2008 Sep 15. Abstract available online.

Lanzi RG, Hughes KP, Ramey S, Lefever JB and the Centers for the Prevention of Child Neglect (in preparation). "The Feasibility of Cellular Phone Interviews for Assessment of At-Risk Parenting." Unpublished.

Lefever JB, Howard KS, Lanzi RG, Borkowski JG, Atwater J, Guest KC, Ramey SL, Hughes K and the Centers for Prevention of Child Neglect. "Cell Phones and the Measurement of Child Neglect: The Validity of the Parent-Child Activities Interview." Child Maltreatment, 13(4): 320–333, 2008. Epub 2008 Jul 8. Abstract available online.

Lefever JB, Lanzi RG, Ramey S, Guest KC, White KJ and the Centers for the Prevention of Child Neglect (in preparation). "Cell Phones as a Window to Parenting Practices." Unpublished.

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Report prepared by: Jayme Hannay
Reviewed by: James Wood
Reviewed by: Molly McKaughan
Program Officer: Katherine Kraft