Projec ject t Co Conectar ar Bobbie J. Vaughn, PhD Linda M. Callejas, PhD Myrna Veguilla, MS Florida Center for Inclusive Communities University of South Florida
Pr Proje oject ct Conec nectar tar Project Conectar proposes that using natural helpers or promotoras will assist Latino (Hispanic) families in Little Havana Miami to identify developmental delays and access services for their children at an earlier age Project Conectar will evaluate CDC LTSAE materials, family needs for information, and access to services to impact through the intervention efforts of the promotoras , project staff, and collaborators-Myriam Monsalve-Serna of Connect Familias and Betty Alonso of The Miami Foundation
Wh What t Are e Pr Promotoras? motoras? Promotor/a is the Spanish word for Community Educator Used through Latin America, Asia, Mexico, and Africa where health care is limited as well as in the U.S. (especially along the border with Mexico) Began US with Federal Migrant Health Act of 1962 and Economic Opportunity Act of 1964, mandated outreach efforts in migrant labor camps and poor communities
How w Do Do Pr Promotoras omotoras Hel elp? p? Provide culturally competent responsiveness to services Decrease barriers by acting as a conduit from families to providers Improve retention in services (help problem- solve barriers) Provide health education Increase positive outcomes, especially for Latino clients
Set etting ting Established in 1995 to develop a comprehensive, neighborhood-based and family-focused system of care designed to promote family and community safety Works to decrease barriers to services and increase family/community safety by addressing child and family needs via its three major components: 1. A Service Provider Network 2. Community Health Workers (CHW) and Natural Helpers (NH) 3. A community resident alliance, La Alianza Hispana de la Pequeña Havana , where residents meet to discuss identified needs and issues of concern
Nat atural ural Hel elpers pers Connect children and families to services and conduct outreach to the community Serve about 500 children and youth and 300 parents annually, as well as approximately 1500 community residents through community events Keeping families safe • Improving family communication • Finding a job • Basic household needs • Accessing medical and/or legal services •
Qualitative litative Data ta
Focu cus s Gr Groups ups Conducted 4 focus groups between January 2010 and April 2010 in the community Families with children with disabilities that were part of ConnectFamilias (CF) Families with children with disabilities (not with CF) CFs’ Natural Helpers/Community healthcare workers (NHs/CHWs) (i.e., promotoras) Advisory board (Community providers, collaborators CF trainer/coordinator/The Miami Foundation, university professionals)
Focu cus s Gr Groups ups Questions for the focus group were developed by project staff and advisory board members • Questions about “Learn the Signs. Act Early.” material • Aesthetics: format, colors, font, use of pictures • Translation and grammar • Family perceptions about use of materials • Family’s experiences as they relate to seeking services or getting information about their child’s disability
Wh What at We We hav ave e Learned… Preliminary Family Focus Group Findings Ease of Use • Felt printed materials ineffective method to create awareness, rather have an expert • Too much information, difficult to navigate, put important information first • Mediator/guide/someone to help explain why this information, is important for you/your child.
What We have Learned… Families Way of Knowing Families are up against a wall Families know there are issues Inconsistent insurance even when doctors tell them coverage, Medicaid dropped differently “….And that is the problem with Families persist and seek the healthcare system, because information for sake of child…“I if you don’t qualify for anything move the heavens and earth to – Medicaid or any of the other get them (providers) to help him resources [that exist] – you because it is not possible that in don’t qualify, and you cannot this country where they have move the mountain, you cannot everything, there is nothing.” move it.” “Knowledge is power”– If I know Perceived discrimination or understand, I can take action. Lack of bilingual/multicultural staff at provider
What We have Learned… Professionals • Professionals completely miss the boat (i.e., misdiagnose or don’t diagnose) • Physicians and other professionals stop short (i.e., give them some information not enough) Cultural • Lack of education/knowledge about the disability by family and friends • Difference in how children/peers respond to disabilities in the home country vs. the U.S. • Children with disabilities were considered a part of kids activities there, but information better here
Qua uantitat ntitative ive Da Data ta
Who are t e the e Pr Projec ect t Conect nectar ar Partic icip ipants? ants? Country of Origin Mother Father Study sample: Guatemala 6% 2% 70 cases Colombia 5% 2% Honduras 33% 44% Nicaragua 19% 18% Domincan Republican 2% 2% Peru 10% 6% Venezuela 6% 6% Mexico 6% 5% Argentina 3% 3% USA 2% 3% El Salvador 5% 3% Costa Rica 2% 0% Cuba 2% 5% Ecuador 0% 2%
Fami amily y Char aracteristics acteristics Age • Mother’s age range: 17 -44 years old • Average age: 31 years (M: 30.65, SD: 6.62) • Father’s age range: 15 -44 years old • Average age: 33 years (M: 33.16, SD: 7.02) Education • Mothers: 52% did not have a HS diploma • Fathers: 55% did not have a HS diploma Income • Majority of families (83%) had an annual income below $20,000
Pa Paren ent t Edu duca catio tion
Househol usehold d Inc ncome me
De Descr cripti iption on of f Childr ldren en Age range: • 5 months - 5 yrs, 9 mos (65 months) Average age: • 3 years old On the average, the child was almost 5 years old when the parents noticed a problem
Ye Year ar 1 Pr 1 Procedur cedures es Natural Helpers/Community Healthcare Workers enroll families in the project when home visiting, if family expresses concern about their children Business as usual no recruitment no special activities Data collection forms: Family Service Assessment Survey (FSAS) • Assesses family demographics and access to services Ages and Stages Questionnaire: Social Emotional (Squires, Bricker, & Twombly, 2002)
Wh What at Di Did W d We Co e Consi nsider: der: Child ld ch characteris cteristi tics cs a) a child’s demographic characteristics (i.e., age at the time of the study and gender b) a child’s total ASQ score c) presence of a problem above the ASQ cut off score d) child’s age when the problem was noticed
Fami amily y ch char aracter acteristics istics a) mother’s age at the time of the study b) father’s age at the time of the study c) mother’s educational level d) father’s educational level e) family annual income f) number of years family had lived in the US g) number of children in the family h) number of extended family members
What t Di Did We d We Consi nsider der Three outcomes examined: (a) whether the problem was noticed by parents, (b) whether parents seek help, and (c) whether assessment of the child’s problems was performed (N=70). • Number of years in the U.S. and help seeking approached statistical significance indicating that the longer the family lived in the U.S. the more likely they were to seek help • No statistically significant associations were observed between parents’ socio - demographic characteristics (i.e., age, educational level, etc) and noticing a problem with the child
Wh What at We We Kn Know w Child age, gender, or severity of the problem as indicated by the ASQ, was not associated with whether the child’s parent noticed a problem When parents noticed a problem with the child along with the number of years the family lived in the U.S. paired with a.) number of children in the family, or b,) extended family members, no statistically significant associations.
Wh What at We We Con onsi sidered dered ASQ Questionnaire No. of Questionnaires No. of Children < Cut Off 6 8 2 1 0 12 18 0 0 24 7 3 8 5 30 36 11 9 48 21 12 14 11 60 60% of children scored at a level that indicated a concern
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