Discussion 2: Pretests/Posttests and Attrition
This week's video introduces you to the Hernandez family. Juan and Elena Hernandez are mandated to attend parenting classes. As part of the parenting classes, they are required to participate in both a pretest (taken before classes begin) and a posttest (taken after classes end). Pretests and posttests can yield very useful information. They can measure the learning that has or has not taken place as a result of the education being provided. For this Discussion, imagine what kinds of questions would be on a pretest and posttest for this particular study sample (the parents who are taking parenting classes).
By Day 5
Post your explanation of what you think the social workers wanted to know when they designed the pre/posttest for evaluating the parenting classes. Be sure to address the concept of attrition and whether or not you believe they took that into account. Be sure to explain why. Then, analyze potential lessons learned from attrition. Finally, explain how you might design a study to gather data about the effectiveness of these parenting classes. Use the following questions to focus your thinking:
- Would you recommend a pre-experimental, experimental, or quasi-experimental design?
- Would the study involve measurement over time?
- Would there be a control group?
- In this group research design you imagine, what or who will be compared?
- What limitations in terms of generalizability and internal validity can you anticipate based on the research plan you envision?
- What can you tell the social worker about the issue of client drop out (also called attrition or experimental mortality)?
- If there is no control group, what type of research design could answer the question: Is this parent training class effective in reducing abusive parenting practices?
Please use the resources to support your answer.
Juan Hernandez (27) and Elena Hernandez (25) are a married Latino couple who were referred to the New York City Administration for Children Services (ACS) for abuse allegations. They have an 8-year-old son, Juan Jr., and a 6-year-old son, Alberto. They were married 7 years ago, soon after Juan Jr. was born. Juan and Elena were both born in Puerto Rico and raised in Queens, New York. They rent a two-bedroom apartment in an apartment complex where they have lived for 7 years. Elena works as babysitter for a family that lives nearby, and Juan works at the airport in the baggage department. Overall, their physical health is good, although Elena was diagnosed with diabetes this past year and Juan has some lower back issues from loading and unloading bags. Both drink socially with friends and family. Juan goes out with friends on the weekends sometimes to “blow off steam,” having six to eight beers, and Elena drinks sparingly, only one or two drinks a month. Both deny any drug use at all. While they do not attend church regularly, both identify as being Catholic and observe all religious holidays. Juan was arrested once as a juvenile for petty theft, but that has been expunged from his file. Elena has no criminal history. They have a large support network of friends and family who live nearby, and both Elena’s and Juan’s parents live within blocks of their apartment and visit frequently. Juan and Elena both enjoy playing cards with family and friends on the weekends and taking the boys out to the park and beach near their home.
ACS was contacted by the school social worker from Juan Jr.’s school after he described a punishment his parents used when he talked back to them. He told her that his parents made him kneel for hours while holding two encyclopedias (one in each hand) and that this was a punishment used on multiple occasions. The ACS worker deemed this a credible concern and made a visit to the home. During the visit, the parents admitted to using this particular form of punishment with their children when they misbehaved. In turn, the social worker from ACS mandated the family to attend weekly family sessions and complete a parenting group at their local community mental health agency. In her report sent to the mental health agency, the ACS social worker indicated that the form of punishment used by the parents was deemed abusive and that the parents needed to learn new and appropriate parenting skills. She also suggested they receive education about child development because she believed they had unrealistic expectations of how children at their developmental stage should behave. This was a particular concern with Juan Sr., who repeatedly stated that if the boys listened, stayed quiet, and followed all of their rules they would not be punished. There was a sense from the ACS worker that Juan Sr. treated his sons, especially Juan Jr., as adults and not as children. This was exhibited, she believed, by a clear lack of patience and understanding on his part when the boys did not follow all of his directions perfectly or when they played in the home. She mandated family sessions along with the parenting classes to address these issues.
During the intake session, when I met the family for the first time, both Juan and Elena were clearly angry that they had been referred to parenting classes and family sessions. They both felt they had done nothing wrong, and they stated that they were only punishing their children as they were punished as children in Puerto Rico. They said that their parents made them hold heavy books or other objects as they kneeled and they both stressed that at times the consequences for not behaving had been much worse. Both Juan and Elena were “beaten” (their term) by their parents. Elena’s parents used a switch, and Juan’s parents used a belt. As a result, they feel they are actually quite lenient with their children, and they said they never hit them and they never would. Both stated that they love their children very much and struggle to give them a good life. They both stated that the boys are very active and don’t always follow the rules and the kneeling punishment is the only thing that works when they “don’t want to listen.”
They both admitted that they made the boys hold two large encyclopedias for up to two hours while kneeling when they did something wrong. They stated the boys are “hyperactive” and “need a lot of attention.” They said they punish Juan Jr. more often because he is particularly defiant and does not listen and also because he is older and should know better. They see him as a role model for his younger brother and feel he should take that responsibility to heart. His misbehavior indicates to them that he is not taking that duty seriously and therefore he should be punished, both to learn his lesson and to show his younger brother what could happen if he does not behave.
During the intake meeting, Juan Sr. stated several times that he puts in overtime any time he can because money is “tight.” He expressed great concern about having to attend the parenting classes and family sessions, as it would interfere with that overtime. Elena appeared anxious during the initial meeting and repeatedly asked if they were going to lose the boys. I told her I could not assure her that they would not, but I could assist her and her husband through this process by making sure we had a plan that satisfied the ACS worker’s requirements. I told them it would be up to them to complete those plans successfully. I offered my support through this process and conveyed empathy around their response to the situation.
The Hernandez Family
Juan Hernandez: father, 27
Elena Hernandez: mother, 25
Juan Hernandez Jr.: son, 8
Alberto Hernandez: son, 6
Together we discussed the plan for treatment, following the requirements of ACS; they would attend a 12-week Positive Parenting Program (PPP) along with weekly family sessions. In an effort to reduce some of the financial burden of attending multiple meetings at the agency, I offered to meet with the family either just before or immediately after the PPP so that they did not have to come to the agency more than once a week. They agreed that this would be helpful because they did not have money for multiple trips to the agency, although Juan Sr. stated that this would still affect his ability to work overtime on that day. I asked if they had any goals they wanted to work toward during our sessions. Initially they were reluctant to share anything, and then Elena suggested that a discussion on money management would be helpful. I told them I would be their primary contact at the agency—meeting with them for the family sessions and co-facilitating the PPP group with an intern. I explained my limitations around confidentiality, and they signed a form acknowledging that I was required to share information about our sessions with the ACS worker. I informed them that the PPP is an evidenced-based program and explained its meaning. I informed them that there is a pre- and post-test administered along with the program and specific guidelines about missed classes. They were informed that if they missed more than three classes, their participation would be deemed incomplete and they would not get their PPP certification.
Initially, when the couple attended parenting sessions and family sessions, Juan Sr. expressed feelings of anger and resentment for being mandated to attend services at the agency. Several times he either refused to participate by remaining quiet or spoke to the social worker and intern in a demeaning manner. He did this by questioning our ability to teach the PPP and the effectiveness of the program itself, wanting to know how this was going to make him a better parent. He also reiterated his belief that his form of discipline worked and that it was exactly what his family members used for years on him and his relatives. He asked, “If it worked for them, why can’t that form of punishment work for me and my children?” He emphasized that these were his children. He maintained throughout the sessions that he never hit his children and never would. Both he and Elena often talked about their love for their children and the devastation they would feel if they were ever taken away from them.
Treatment consisted of weekly parenting classes with the goal of teaching them effective and safe discipline skills (such as setting limits through the use of time-out and taking away privileges). Further, the classes emphasized the importance of recognizing age-appropriate behavior. We spent sessions reviewing child development techniques to help boost their children’s self-esteem and sense of confidence. We also talked about managing one’s frustration (such as when to take a break when angry) and helping their children to do the same.
Family sessions were built around helping the family members express themselves in a safe environment. The parents and the children were asked to talk about how they felt about each other and the reason they were mandated to treatment. They were asked to share how they felt while at home interacting with one another. I thought it was of particular importance to have them talk about their feelings related to the call to ACS, as I was unsure how Juan Sr. felt about Juan Jr.’s report to the social worker. It was necessary to assist them with processing this situation so that there were no residual negative feelings between father and son. I asked them to role-play—having each member act like another member of the household. This was very effective in helping Juan Sr. see how his boys view him and his behavior toward them when he comes home from work. As a result of this exercise, he verbalized his newfound clarity around how the boys have been seeing him as a very angry and negative father.
I also used sessions to explore the parents’ backgrounds. Using a genogram, we identified patterns among their family members that have continued through generations. These patterns included the use of discipline to maintain order in the home and the potentially unrealistic expectations the elders had for their children and grandchildren. Elena stated that she was treated like an adult and had the responsibilities of a person much older than herself while she was still very young. Juan Sr. said he felt responsible for bringing money into the home at an early age. He was forced by his parents to get working papers as soon as he turned 14. His paychecks were then taken by his parents each week and used to pay for groceries and other bills. He expressed anger at his parents for encouraging him to drop out of high school so that he could get more than one job to help out with the finances.
Other sessions focused on the burden they felt related to their finances and how that burden might be felt by the boys, just as Juan Sr. might have felt growing up. In one session, Juan Jr. expressed his fears of being evicted and the lights being turned off, because his father often talked of not having money for bills. Both boys expressed sadness over the amount of time their father spent at work and stressed their desire to do more things with him at night and on the weekends. Both parents stated they did not realize the boys understood their anxieties around paying bills and felt sad that they worried about these issues. We also took a couple of sessions to address money management. We worked together to create a budget and identify unnecessary expenses that might be eliminated.
Key to Acronyms
ACS: Administration for Children Services
PPP: Positive Parenting Program
It was clear that this was a family that loved each other very much. Juan Sr. and Elena were often affectionate with each other and their sons. Once the initial anger subsided, both Juan Sr. and Elena fully engaged in both the family sessions and the PPP. We assessed their progress monthly and highlighted that progress. I also was aware that it was important to learn about the Hernandez family history and culture in order to understand their perspective and emotions around the ACS referral. I asked them many questions about their beliefs, customs, and culture to learn about how they view parenthood, marriage roles, and children’s behaviors. They were always open to these questions and seemed pleased that I asked about these things rather than assumed I knew the answers.
During the course of treatment they missed a total of four PPP classes. I received a call from Elena each time letting me know that Juan Sr. had to work overtime and they would miss the class. She was always apologetic and would tell me she would like to know what they missed in the class so that she could review it on her own. During a call after the fourth missed parenting class, I reminded Elena that in order to obtain the certificate of completion, they were expected to attend a minimum of nine classes. By missing this last class, I explained, they were not going to get the certificate. Elena expressed fear about this and asked if there was any way they could still receive it. She explained that they only had one car and that she had to miss the classes when Juan Sr. could not go because she had no way of getting to the agency on her own. I told her that I did not have the authority to change the rules around the number of classes missed and that I understood how disappointed she was to hear they would not get the certificate. When I told her I had to call the ACS worker and let her know, Elena got very quiet and started to cry. I spoke with her for a while, and we talked about the possible repercussions.
I met with my supervisor and informed her of what had occurred. I knew I had to tell the ACS worker that they would not receive the certificate of completion this round, and I felt bad for the situation Juan Sr. and Elena and their boys were now in. I had been meeting with them for family sessions and parenting classes for almost three months by this point and had built a strong rapport. I feared that once I called the ACS worker, that rapport would be broken and they would no longer want to work with me. I saw them as loving and caring parents who were trying the best they could to provide for their family. They had been making progress, particularly Juan Sr., and I did not want their work to be in vain.
I also questioned whether the parenting and family sessions were really necessary for their situation. I felt there was a lack of cultural competence on the part of the ACS worker—she had made some rather judgmental and insensitive comments on the phone to me during the referral. I wondered if there was a rush to judgment on her part because their form of discipline was not commonly used in the United States. In my own professional opinion, some time-limited education on parenting and child development would have sufficed, as opposed to the 3-month parenting program and family sessions.
My supervisor and I also discussed the cultural competence at the agency and the fact that the class schedule may not fit a working family’s life. We discussed bringing this situation to a staff meeting to strategize and see if we had the resources to offer the PPP multiple times during the week, perhaps allowing clients to make up a class on a day other than their original class day.
I met with Elena and Juan Sr. and let them know I had to contact the ACS worker about the missed classes. I explained that this was something I had to do by law. They told me they understood, although another round of parenting classes would be a financial burden and they had already struggled to attend the current round of classes each week. I validated their concerns and told them we were going to look at offering the program more than once a week. I also told them that when I spoke to the ACS worker, I would also highlight their progress in family and parenting sessions.
I called the ACS worker and told her all the positive progress the parents had made over the previous 3 months before letting her know that they had missed too many classes to obtain the PPP certificate. The ACS worker was pleased with the progress I described but said she would recommend to her supervisor that the parents take the PPP over again until a certificate was obtained. She would wait to hear what her supervisor’s decision was on this matter. She said that family sessions could end at this point. In the end, the supervisor decided the parents needed to come back to the agency and just make up the four classes they missed. Elena and Juan Sr. were able to complete this requirement and received their certificate, and the ACS case was closed. They later returned on their own for a financial literacy class newly offered at the agency free of charge.
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