Families and Gender
CARES uses community-based and community organizing approaches
to promote the well-being of young children. This paper reviews
the applicability of community-based and community organizing
approaches to the policy goal of preventing child abuse and neglect
and enhancing the well-being of young children up to age three.
It includes an in-depth case study of Dorchester CARES, which
stands for key components of the model, namely Collaboration,
Advocacy, Resource development, Education, and Services, and offers
family strengthening programs and services. Case
Study Plus: Dorchester CARES
Lippitt, Heller School for Advanced Studies in Social Welfare
Brandeis University, 1996
reviews the applicability of community-based and community organizing
approaches to the policy goal of preventing child abuse and neglect
and enhancing the well-being of young children up to age three.
and neglect has documented, potentially long-term, adverse effects
on the physical, cognitive, social, and emotional development
of children. After the fact treatment cannot reverse and eliminate
all of the impacts of such maltreatment. Preventive approaches
may well be the only real solution. Successful prevention programs
can cost less than treatment programs. "Not only do preventive
approaches spare the child the pain, which would be ample reason
enough to pursue them, but they can also save money "; (Willis,
body of evidence indicates that subtle deprivation can also have
long-term, sometimes irreversible impacts on children, particularly
when the deprivation occurs during the early years. Under-nourishment,
lack of appropriate cognitive and physical stimuli, inappropriate
levels or types of social interaction, and insufficient emotional
support and feedback in the first two or three years of life can
have permanent impacts. (Newsweek 1996) Early, preventive interventions
are the only way of addressing these issues that are critical
to child well-being. They may well also represent a true investment
that produces a return many times its cost.
the issues of children, especially young children, an ecological
approach is clearly necessary. The ecological model recognizes
that individuals are inseparable from the context in which they
live and that this context has significant influences on them.
For children, this context includes their family, community, and
culture. The individuals, institutions, and organizations that
are part of these entities are also part of the child's ecological
environment. (Shay 1995, Bronfenbrenner 1986)
are dependent, ecological factors are critically relevant. The
most immediate and powerful influence is, of course, the family.
The family, however, is embedded within interdependent social
and institutional systems. The neighborhood or community that
the family lives in has effects on the family and on the children
in it. Therefore it is only logical that the community can be,
and perhaps must be, an important element in strategies to prevent
child maltreatment and enhance child well-being.
and Omer's schematic representation of ecological factors affecting
the child is presented in Exhibit 1[not available online] (Hendrickson
and Omer in Adams and Nelson 1995, page 150). The broad ecological
bands of institutions and geography are presented on the top half
of the diagram. The bottom half of the diagram presents specific
ecological factors including societal, institutional, organizational,
community, family, and personal attributes.
level factors include the parents' social relationships, economic
position, and living situation. Key community level risk factors
for child maltreatment are lack of support networks for parents,
isolation from extended family and neighbors, lack of accessible
social services, and low socioeconomic status. Social and community
support for the family can reduce stress and provide other assistance
that can enhance child well-being. It can be received from extended
family, friends, and informal and formal systems in the community.
Such support can take the form of emotional support, reinforcement
of decision making, sharing of difficulties and other experiences,
and problem solving assistance. It encompasses social expectations
and encouragement of appropriate parenting and sanctions for inappropriate
is mounting that comprehensive services for parents, with a goal
of modifying parental behavior, can positively affect poor children
at least in the short-term, and some evidence exists for long-term
benefits as well (Weissbourd and Kagan 1989). Although socioeconomic
and demographic factors have been correlated with child abuse
rates, significant variations across neighborhoods from what these
factors would predict have been observed (Garbarino and Kostelny
1992, Garbarino and Sherman 1980). Apparently characteristics
of communities, even beyond socioeconomic and demographic characteristics,
have an impact on child abuse, and presumably other indicators
of child well-being. There is evidence that social impoverishment
has a significant impact on child abuse rates (Garbarino and Kostelny
1992, Bronfenbrenner 1986, Garbarino and Sherman 1980).
manifestations include social isolation and the lack of support
from and contact with other adults in the community. Family stress
is associated with child maltreatment, and a lack of formal and
informal social support is a key element of stress. "Without support,
stress becomes unmanageable, and without social sanctions precluding
the use of force, unmanageable stress can erupt into violence
against children. "; (Shay 1995, page 6) Increasingly parents
are raising children without supportive adult family members or
others nearby and without supportive communities. Many of these
parents are single parents which exacerbates the situation. Young
or single parents, who are poor and in situations where social
support and guidance from other adults is lacking, are at high
risk for child maltreatment. Extreme symptoms of social impoverishment
can include mental health problems, especially depression, and
alcohol or drug abuse - all of which are associated with abusive
model postulates that isolation contributes to harsh parenting
and to low monitoring of children. These can in turn lead to abuse
or neglect. It recognizes the protective potential of social networks
to reduce stress, provide role models, break feelings of isolation,
and provide social support.
model dictates an operational model that is multi-disciplinary,
community-based, family-centered, and client-directed. The operational
goals of strengthening families and family functioning are inextricably
tied to the goal of reducing social isolation by building community.
The operational model dictates providing a comprehensive continuum
of formal and informal prevention services focused on increasing
nurturing values and skills, and empowering parents in their caregiving
and community roles. The model also dictates that services be
universally available, on-demand. Shay's schematic presentation
of such a model as operationalized in the Dorchester CARES project
is presented as Exhibit 2 [not available online] (Shay 1995, page
Such a model
focuses on building on the strengths of individuals, families,
organizations, and the community. It targets the maximization
of the impact of available resources through better coordination
of existing resources and development of new ones to fill gaps
identified by the residents of the neighborhood. A key synergy
of these concepts can occur if service recipients are also asked
to contribute by volunteering time and skills. This provides needed
resources and simultaneously builds on strengths, building individuals'
self-esteem and the sense of community. Residents' participation
can include roles as volunteers, as paid and volunteer paraprofessionals,
as paid staff, and as decision makers and leaders. This contributes
to community residents by developing expertise through experience
and training. This also results in culturally and linguistically
appropriate service delivery and the building of employment opportunities
and skills of community members.
level strategies can include building formal and informal supportive
networks for families, building a sense of community responsibility
for children, encouraging community sanctions on inappropriate
parenting, and increased awareness, accessibility, and coordination
of services within the community.
model implies the need to maximize the nurturing capacity of the
community, while minimizing the dependency on outside resources
and services. This model shares many attributes with the model
John McKnight presents in The Careless Society. The core
of his model, "increasing interdependence in community life through
a focus on the gifts and capacities of people", is certainly applicable.
(McKnight 1995, page 122) Reducing dependency on formal, government
provided social services may also be applicable although the primary
focus is on increasing the well-being of children. This may require,
possibly temporarily, increased services. The last component of
his policy statement, that people "have been excluded from community
life because of their labels", is least applicable. (McKnight
1995, page 122) These families are more likely not to have been
involved in community life because of geographic mobility, language
and cultural barriers, fear due to neighborhood violence, and
other factors of their lives and living condition. His concept
of "community guides" is applicable but seems limited in that
he presents these guides in many ways as another, different type
of service, albeit a temporary and informal one. He seems to fail
to recognize that community guiding can be a two way relationship,
with the parties "guiding" each other simultaneously or perhaps
in different ways or at different times. This "guiding" can be
and perhaps should be a long term relationship. McKnight identifies
trust as a key component of these guiding relationships, but seems
to fail to recognize that trust only develops over time.
ecological, family support models are being tried. Patch-based
community social work in Britain and the Decategorization Project
in Iowa share the following attributes (Adams and Krauth 1994):
Family Support Program Attributes
- program staff and methods reflect the community;
- build community by changing interactions among community
members and with service providers;
- collaborative, team approach;
- recipients and the network of service providers function
as partners in planning and delivering services;
- formal and informal services are interwoven;
- community members deliver services as volunteers, para-professionals,
- focused on families with a goal of changing patterns
of interaction among family members;
- focused on individual, family, and community strengths
not deficits; and
- intervention sooner, less aggressively, and often on
a voluntary basis.
programs are typically provided by community centers that hark
back to the settlement houses of the early 1900's, and to the
multi-dimensional, neighborhood-based programs of the War on Poverty.
The Head Start and Parent-Child Development Centers of the 1960's
and their focus on parent involvement and education brought family
support programs into the public policy arena (Weissbourd and
Corporation's report "Starting Points: Meeting the Needs of Our
Youngest Children" was issued in April 1994. It notes that although
we know how important the first three years of life are, and although
we know much about the requirements for optimal development in
this period, the care and nurturing of these young children are
deteriorating badly. The report calls for a comprehensive strategy
and effort to address the urgent problems jeopardizing the healthy
development of millions of children under age three. It calls
for integrated action in four areas: promoting responsible parenting,
guaranteeing the availability of quality child care, ensuring
basic health and safety, and mobilizing community support for
families and their young children. The report calls for home visiting
services on a voluntary basis for all first time parents and the
availability of more intensive home visiting services for at-risk
families that request them.
to the patch-based community social work in Britain and the Decategorization
Project in Iowa mentioned above, nine National Center on Child
Abuse and Neglect (NCCAN) projects in communities from Chicago
to Puerto Rico, and including Dorchester CARES in Boston, were
examples of family support programs that share key attributes.
These nine demonstration projects were run from 1990 - 1994. They
were focused on the prevention of child abuse and neglect, and
they all adopted a community-based, family support approach.
Family Preservation and Support Act was passed in August 1993
and provides ongoing funding to family support programs as an
innovative approach to child maltreatment through prevention.
Roughly $1 million was provided to Massachusetts under this Act
in 1995 to begin the process. The Department of Social Services
(DSS) is implementing community-based, family support programs
under an initiative entitled "Community Connections ". Dorchester
CARES is being used as the model for these programs and has become
one of the seventeen sites.
CARES was initiated by the Massachusetts Committee for Children
and Youth, a child advocacy organization. It partnered with the
Federated Dorchester Neighborhood Houses (FDNH), a group of community
centers reminiscent of the settlement house tradition. CARES is
an acronym for key components of the model, namely Collaboration,
Advocacy, Resource development, Education, and Services.
plan had been to develop a five year plan for all of Dorchester
(90,000 people) and to begin operation in a targeted neighborhood.
The CARES Director met with hundreds of people and organizations
in the community over a five month period to assess the needs
of the community and begin development of a five year plan. What
she heard was that the residents were tired of plans and pilot
projects, they wanted action. They also felt that the great degree
of diversity in the community would make it impossible to develop
a single plan that would be applicable to the whole community.
As a result,
the approach was changed from top-down to bottom-up. The focus
was shifted to a targeted neighborhood and its immediate needs.
The Bowdoin Street neighborhood was selected. It consisted of
a single census tract, #918, with 3,649 people, 44% of whom were
under 19. It included 570 families with children, nearly 40% of
which were poor and over half of which were headed by single women.
Many of the residents were recent immigrants from Cape Verde and
the Caribbean. English was a second language for over 50% of the
residents and 30% spoke no English. The demographic trends from
the 1970 to 1990 census showed the white population decreasing
from 92% to 15%, the black population increasing from 8% to 63%,
and the Latino population increasing from less than 1% to 22%.
The data also indicated an increase in extreme poverty in the
and focus groups were used to collect data on living conditions
and the perceived needs of the residents. Twenty percent of the
families interviewed had no help with childcare and one third
of them expressed a need for some form of social support, e.g.,
parenting relief, other parents to talk to, and childcare. Concerns
about safety were raised and many expressed a need for food and
clothing. Residents indicated that food and English classes were
more important to them than parenting education and clinical services.
months of networking in the community, Dorchester CARES got underway.
The initial site was the Log School, one of the Federated Dorchester
Neighborhood Houses. The Log School had a twenty year history
in the neighborhood of offering an alternative middle school,
GED classes, after school programs, daycare, and a somewhat chaotic,
weekly food pantry. CARES rehabilitated unused space in the basement
and began with a Family Cooperative that initially expanded the
food pantry and childcare offerings and added a clothing exchange.
Home health visiting for thirty families was undertaken in conjunction
with the Bowdoin St. Health Center, another institution with a
twenty year history in the neighborhood. English as a Second Language
(ESL) classes were added in the fall of 1990.
established the Prevention Team. Its immediate goal was to coordinate
efforts among service providers in the community in responding
to families needs. The team of front-line service providers from
the involved agencies met monthly, including family members and
other involved professionals when appropriate, to discuss specific
problems and find solutions. The Prevention Team also identified
service gaps, worked to find resources to fill them, and helped
organize new services. Its ultimate goal was to prevent child
maltreatment and referrals to the child protection system.
Steering Committee originally consisted of the seven service agency
partners and one community resident. CAREs' goal from the start
was that the Steering Committee would eventually consist of at
least 50% residents. This transition has proven to be more difficult
than expected, perhaps in part because CARES has not explicitly
focused on developing community leaders of this kind. The Steering
Committee is convened monthly by the staff director and has evolved
into a policy making Board of Directors. The Board has agreed
that the director's role is critical to Cares success as the independent
voice that can articulate consensus, provide a neutral voice for
balancing, and most importantly keep all parties focused on their
collective mission. A formal partnership agreement has been developed
to define the benefits and responsibilities of each collaborating
the Nurturing Program® for family strengthening and the Family
TIES program for substance abuse were added. Facilitators and
assistants for the Nurturing Program® were recruited from
the community and contribute their time in exchange for 24 hours
of upfront training. The lead facilitator serves as the mentor
and the facilitators and assistants meet after each session to
review and evaluate the session, and to identify family needs.
The lead facilitator meets weekly with the CARES staff to coordinate
referrals specifically and the Program in general. Facilitators
are matched with the ethnicity of the families in the Program.
The facilitator makes home visits and phone contact between the
weekly meetings and serves as a role model. A graduation ceremony
is held and includes fun, food, and recognition including certificates
of achievement. Ongoing support is provided through the Family
Cooperative and a special parent support group for Program graduates.
Strengthening Task Force was originally convened to conceptualize
the initial programs. In 1992, the Task Force became the local
"Healthy Boston" coalition, changing its name to the Family and
Child Health Action Support Group. It was one of 21 "Healthy Boston"
coalitions formed citywide to improve the quality of life by involving
merchants, service providers, educators, community organizations,
and residents in action groups formed to improve education, economic
development, housing, and family health. Its monthly meetings
are open to all and community residents are typically half of
the 25 - 30 people that attend. The meetings are convened by the
CARES staff, are conducted in English and Cape Verdean, provide
childcare through the Family Coop, and have lots of food. Their
focus is on identifying needs and mobilizing resources.
1993 the Parents CAN program for neighborhood parental support
began. Parents CAN (Care About Neighbors) volunteers, originally
called Family Advocates, are paraprofessionals that were recruited
from the neighborhood and therefore are culturally and linguistically
representative. Exhibit 3 presents the job posting
that was used to recruit Parents CAN volunteers. They manage the
Family Cooperatives, building relationships with residents and
encouraging neighbors to build relationships with each other.
They serve as parent aides, providing social support and mentoring.
They make home visits for crises or celebrations and build an
informal neighborhood support network and a sense of community.
They receive eighteen hours of upfront training and a certificate.
On an ongoing basis they meet weekly with the CARES program coordinator
for supervision and in-service training and provide their services
to anyone free of charge.
CARES program expanded to five contiguous census tracts (20,000
people and 4,135 families with children) and to three FDNH sites
over its five years as a demonstration project. Its six key program
components, that make up what it calls its Family Strengthening
Service Continuum, are presented in Exhibit 4.
At the end of the five year demonstration, it served as the model
for, and became one of, the Community Connections Program sites.
Community Connections Program
Connections (CC) program recognized that replicating the Dorchester
CARES model was a matter of replicating a process and not one
of replicating a structure. Therefore, after identifying sixteen
additional communities based on demographic risk factors and a
desire for geographical diversity, a three month capacity assessment
process took place in each community. The focus was on assessing
the capacity for community level coordination and involvement
of residents in planning and decision making. Meetings were held
with local service providers, and focus groups of parents and
front-line workers were conducted. Based on these assessments,
ten communities (including Dorchester CARES) were found to have
sufficient community capacity in place to proceed with the development
of Action Plans. Seven other communities were found to need a
developmental stage where a coalition capable of executing a CC
project would be built. These communities spent twelve months
in a developmental phase before proceeding to Action Plan development.
development was a six month process. It involved a three month
fact finding period. This included developing teams of a service
provider employee and a community resident to go door to door
conducting outreach and surveys of a minimum of fifty families
in the community. This fact finding was presented to the community
in meetings held over a two month period. Residents were asked
to vote at these meetings on the issues they felt were most important.
Issues were posted and each resident was given five adhesive-backed
dots to affix to the issue or issues they felt were most important.
Then a month was taken to prepare the final Action Plan. Organizational
development was occurring simultaneously over this six month period,
so that program development and implementation could then begin
the developmental and Action Planning stages, CC staff offered
technical assistance at the request of the local communities.
and Community Connections projects have experienced many of the
challenges of community organizing. They have faced challenges
in identifying and accessing true leaders in the community. Self-designated
leaders and individuals who want to exercise power as gatekeepers
to community residents have been encountered. Power struggles
among organizations and residents have occurred. Leaders that
have emerged from the community have had their credibility become
suspect because of their assumption of a leadership role. Situations
have occurred where some residents have resented others' leadership
roles and therefore have challenged them or attempted to tear
them down. Similarly it has been difficult to add new service
providers to already existing coalitions. CARES has developed
a Partnership Agreement that service providers have to sign to
join their coalition. CC has found that service providers are
not attracted to the coalitions unless the funding is significant
enough to be meaningful to them. In particular, the communities
in the development stage were typically funded at $10,000 - $20,000.
This level of funding did not attract much attention from service
providers. However, for those communities with accepted Action
Plans and funding at a $100,000 level, the service providers were
anxious to be at the table.
communities and service provider coalitions were found to have
different attitudes toward the technical assistance offered by
CC staff. Some, characterized as like young children, were anxious
for any and all help but were not able to identify specific needs.
Some were like adolescents, feeling strong and independent and
wanting no assistance. And some were like mature adults, recognizing
the value of assistance and able to identify their own areas of
need. Some communities needed to identify a common enemy as a
focal point for their organizing.
DSS is the parent agency of the Community Connections program,
various other public and private agencies participate. Some of
the community level personnel have felt that it was easier to
get private service providers in the communities to cooperate
than to get the various state agencies to cooperate. Some community
personnel have noted that the increased competition in the health
care industry has had a negative effect on community health centers.
As they become affiliated with large health care organizations,
they are pressured to refer clients only within their organization.
Community personnel have also commented about the amount of paperwork
required by the state to access the Community Connections funding
and the contrast to the much simpler paperwork required for foundation
how business is done changes the power structure for both service
providers and residents and therefore is likely to result in conflicts.
Although Dorchester CARES was committed from the beginning to
shift control of its Board from service providers to community
residents, it has found this transition difficult. Such a power
shift is always difficult, and part of the difficulty is because
CARES has not focused on resident leadership development as an
explicit goal. Participation may bring empowerment at one level,
but it does not automatically lead to leadership development and
empowerment at higher levels.
Community-based Family Support Programs
community-based, family support programs is difficult. Each example
of a community-based program is going to be unique. Each set of
interactions for each family will be unique, as will the characteristics
of each family. As a result, traditional program evaluation, with
its standard inputs and defined outcomes, does not lend itself
to this environment.
strategy will need to create a comprehensive picture of the community
and its families and children over time. Data at the following
four levels of the ecological framework will be required:
- the community,
- the families
within the community,
- the internal
interactions of the families, and
- the well-being
of the children.
of the community and how it is changing can be assembled using
four types of data collected over time:
markers and administrative statistics for the community including:
social service, and criminal justice indicators; and
social observations of the community.
of residents and their descriptions of the community, assessed
by measures of:
perceptions of risk factors, protective conditions, and
resources for families in the community;
quantity and quality of transactions among neighbors; and
overall social ecology and level of attachment to the neighborhood.
of interactions internal to the family with assessments of individuals
and families who have been program participants in comparison
to matched individuals and families who have not.
of the status of children who have, or whose families have,
been program participants in comparison to matched children
and families who have not.
CARES is the only project that has had a long enough life to have
had an outcomes evaluation performed. Due to limited funding the
evaluation was of limited depth. The results were mixed, however,
small but significant increases in the level of social support
within and between families was found. Increases in the availability
of social support, in neighborhood surveillance, and in community
monitoring of children were found, and strengthened caregivers'
sense of community.
line is that it may be too early to tell if Dorchester CARES works,
unless one is willing to rely on the personal testimony of CARES
participants. Its ambitious and innovative approach presents a
challenge to evaluation in the best of circumstances, and with
seriously limited funding for evaluation, clear results are unlikely.
Determination of definitive cause and effect relationships for
successes or failures are probably impossible. The lack of good
measures of effects, the lack of an easily identifiable and accessible
control group, and the lack of standard interactions to measure
(due to program flexibility and a client-directed approach that
result in varying components and intensity of services) make family
support programs difficult to evaluate (Zigler and Black, 1989).
evaluation of CARES has also been done. It documented and analyzed
the process and resulting organization of the collaboration, which
is important for understanding what worked and would be key to
replication efforts. Particularly given the client- and community-driven
approach of CARES, replication cannot successfully occur with
a cookie cutter methodology. Rather, it will be necessary to copy
what was done to create CARES; to recreate the process and reinvent
the collaboration (Smale 1994). As a demonstration project, clearly
there is interest in being able to replicate what was done. In
addition, many of Cares attributes are ones that government and
research are supporting, e.g., coordination of services, preventing
child maltreatment, and strengthening families and neighborhoods.
goal is to create a systemic network of formal, ongoing, collaboration
among organizations and individuals to jointly deliver comprehensive
services to prevent child maltreatment. The methodology of the
process evaluation was to: "1) examine the interactive nature
of events associated with collaboration, and 2) facilitate the
study of process by searching for changes in environmental conditions,
then tracing out corresponding changes in administrative action."
(Mulroy 1995, page 6) Data collection included review of documents,
observation of meetings and conferences, and interviews with Steering
Committee members, staff, front-line workers, and community service
recipients. Interviews were tape recorded and transcribed. Some
meetings and conferences were video taped. Forms were developed
to code and analyze data.
points" that had the potential of destroying the CARES collaboration
were found to have occurred repeatedly. The starting point and
the glue that held the collaboration together was a shared vision
of the "end", preventing child maltreatment, and the "means",
family strengthening at the neighborhood level. The motivations
of each collaborator can be analyzed in terms of the benefits
that accrued to each of them. For example, MCCY got access to
a high-risk neighborhood where its demonstration project and advocacy
role were most needed. FDNH got increased service capacity with
a five year revenue source and expectation of future benefits.
These two project initiators "sought agency partners that offered
a) compatible, not competitive services, b) similar philosophies
and standards of conduct, c) a commitment to the prevention of
child abuse." (Mulroy 1995, page 9)
stress point was the conflict between the intended top-down planning
approach of a broad scope, and the needs and orientation of community
members. As a result, a written assessment of the pros and cons
of the two approaches was prepared by the project director for
the Steering Committee, which decided by consensus, but not without
struggle, to dramatically revise the project approach.
infrastructure is essential to bringing in new partners and building
and maintaining relationships and structure as the service continuum
grows. The structure is an integrated network as shown in Exhibit
5 [not available online] (Mulroy 1995, Figure 4). A service recipient
can enter through any one program and access others as needed.
As one nineteen year old mother of two children put it, "When
I got one of you, I got all of you!" Comprehensive service integration
is infinitely complex and complexity increases exponentially as
agencies, neighborhoods, and services expand (Shay 1995). Future
stress points can be expected among collaborators and as new partners
stress points of particular significance were noted: competition
over scarce funding especially in a competitive, grant awarding
system, and operational issues of turf, service standards, and
culture. The small size of the Steering Committee, social activities,
retreats, a participatory management style, and formal agreements
on procedures, reciprocity, and ownership of the products of the
collaboration all contributed to the successful resolution of
these conflicts. Also important to Cares success was the cross-training
of front-line workers from different agencies to build understanding
and share knowledge, skills, technology, and values.
evaluation identified as key success factors for the collaboration
the eight following items:
leadership that re-focused the project to a small geographic
target area and a bottom-up program design that gave consumers
legitimacy to define their service needs;
size of the Steering Committee membership and their clear vision
of the long range benefits of the collaboration and belief in
the value of the service product;
conflict resolution in policy making and organizational planning;
characteristics of partner agencies that include nonprofit status,
compatible services, interest in the same geographic service
area, and commitment to a shared vision and to a prevention
benefits for both managers and front-line workers;
" and trust among participants on both the Steering Committee
and the front-line teams; and
project management in a participatory style.
A key function
of project management was frequent communication including regular,
efficiently run meetings with agendas and minutes. The evaluation
report notes, "The most time consuming role was building a dense
network of relationships among Steering Committee members, front-line
workers, influential others, and then to nurture those relationships
into an intricate web of sustainable systems." (Mulroy 1995, pages
22-23) CARES represents a new paradigm in the child welfare arena.
It would appear to have great promise in both human terms and
in cost-effectiveness terms. It is generally true across a wide
range of fields that it is cheaper (in terms of dollars) to prevent
problems than to try to correct them later. It is also better
to prevent problems because the negative consequences are avoided.
In the arena of human services, those negative consequences can
be significant human trauma whose costs are not readily quantifiable.
New, Community-based Paradigm for Child Welfare
A new paradigm
for child welfare is needed. The success with current approaches
has been limited at best. In addition, a focus on prevention through
early intervention in pregnancy and early parenthood, if done
successfully, shows promise of dramatically reducing the number,
scope, and severity of child welfare problems. It is truly an
investment in our families and children, because prevention can
produce a return, in cost savings in terms of dollars and human
trauma, that is many times greater than the cost of the prevention
for such efforts should not be limited to traditionally defined
at-risk constituencies. Families and children everywhere will
benefit from many of the CARES components, e.g., the Nurturing
Program®, Parents CAN, and the building of community. Politically,
universal applicability avoids the us versus them dichotomy that
is poisoning much of the current discussion of social programs.
Efforts to raise the parenting skills of parents and communities,
to raise the awareness of the importance, difficulty, and value
of good parenting, to increase the social support for families,
and to increase the likelihood of optimal environments for child
development are critically important to our society as a whole,
as one large community.
maltreatment prevention programs examined in this paper share
many of the same components and principles that have been identified
in family support programs elsewhere:
Common attributes of community-based family support
- Focus on prevention and optimal child development using
an ecological model for project design and a collaborative,
team approach to integrated service delivery with universal
availability and early, less intrusive intervention;
- Focus on families with a goal of changing patterns of
interaction among family members through parent education
and support groups that focus on child development and
healthy family relationships, and through joint activities
for parents and children;
- Neighborhood or community-based programs that reflect
the community, reduce isolation, and build the sense of
community, often including a drop-in center that allows
informal interaction with other families and with program
staff, provides information on and referral to other services,
and provides childcare while parents attend service programs;
- Home visitation for developmental and health screening
for children, service referral, parenting education, and
social support; and
- Service recipients and providers that function as partners
in planning and delivering an integrated set of services
where formal and informal services are interwoven and
the focus is on strengths not deficits. (Adams and Krauth
1994, Weissbourd and Kagan 1989)
characteristics of community-based prevention programs are driven
by the ecological model. Comprehensive, universally available
services are indicated by the complex etiology and the inability
to predict the occurrence of child maltreatment.
| Key operational characteristics of community-based prevention
- Multidisciplinary: Service delivery is comprehensive
- Community-based: Physically located in the community
to encourage service utilization through convenient access
and one stop shopping. Community members, organizational
and individual, are involved in program design and control.
Specific efforts to reduce isolation and build community.
- Family-centered (not individual): Strengthens family
interactions through home visiting for health, parenting
skills, and social support, and through other family programs
- Client-directed: Meets the client's expressed needs,
through universally offered, on-demand services. Clients
are partners in defining service delivery and are involved
in program design and control.
- Empowerment: Focus on building on strengths of individuals,
families, and the community.
family support programs (FSP) are focused on families and providing
formal and informal services to families and their children to
improve the well-being of the children. Although the building
of informal supports and social networks does build the community,
as may the coordination of services and service providers, community
organizing per se its not the focus. This is perhaps most clearly
seen in the lack of explicit focus on developing and training
community leaders and in the fact that the professionals in FSP's
have an on-going role as service providers. In addition, the focus
on families does not include all community residents.
by itself is not necessarily empowering " (Flynn et al. 1994,
page 395) and certainly has limits to the empowerment it provides.
Some maintain that "for true community empowerment to occur the
professionals must leave. " (McFarlane and Fehir 1994, page 389)
Given that the professionals in FSP's have no intention of leaving,
it seems clear that their goal is not community empowerment in
that ultimate high level sense.
In the case
of CARES, the various elements of the project can be categorized
by their focus on the family, the community, or both. Four of
the six elements are focused on the family: Family and Child Health
Action, the Nurturing Program, Family TIES, and the Prevention
Team. The other two elements focus on both the family and community
building: Parents CAN and the Family Cooperative. Only the informal
element of social events is focused primarily on the community.
to be three levels at which community activity can occur. First
there are community-based programs and services. Second there
are community-building activities. Third there is community organizing.
Community-based programs and services are ones that are physically
based in the community. They use personnel that are focused on
the community, and ideally are from it, and that become familiar
to it and with it, as opposed to being delivered from a remote
site with personnel that deal with a broad cross-section of people.
Family support programs should be community-based due to their
ecological model that recognizes the importance and impact of
the community. FSP's can be community-building if they work to
link community residents together, building interdependency and
identity. Coordinating services and building a coalition of service
providers can also build community. The strength of the coalition
(however that might be measured) or the creation of a true collaboration,
rather than just a coalition, may further contribute to community-building.
There is reason to believe that community-building, as opposed
to simply being community-based, might have a positive impact
on the effectiveness of FSP's.
programs rarely appear to be full-blown community organizing efforts,
due to the narrowness of their focus and the lack of explicit
focus on developing resident leadership and empowering the community
to the extent that it takes total control into its own hands.
of resident empowerment corresponds to the level of community
activity. Community-based activities are more empowering than
centralized ones. However, the level of empowerment is limited.
If, as is the case in the Community Connections programs, residents
have power only because service providers, with some financial
incentive, are willingly sharing power primarily based on their
good intentions, their empowerment is limited. If residents have
input into decision making but not decision making power, and
if staff of the local coalitions are facilitators for resident
participation but not working to develop indigenous leaders to
take their place, empowerment is limited. Indications of this
limited empowerment at CARES are the difficulty of recruiting
residents to serve on its Board and the lack of expansion of the
agenda by residents or broader political involvement by them.
of empowerment is the control of funding. If the FSP's are dependent
on government, and perhaps service providers and foundations,
for funding, the empowerment is limited. FSP's are unlikely to
achieve their full potential unless funding for the services incorporated
under their umbrellas are under their control. The funds as they
are paid to service providers need to be from a single stream,
under the FSP's control, rather than from a variety of categorical
funding sources that requires work, cajoling, and coalition building
on the part of the FSP to coordinate. In summary, community-based
strategies are appropriate to family support programs. Community-building
strategies have the capacity to make FSP's even more effective.
Community organizing strategies are inappropriate in that they
go beyond the scope of FSP's and involve a broader audience and
agenda. This is not to say that community organizing efforts could
not be stimulated by and spun-off from a community-building FSP.
And it certainly is not to say that community organizing efforts
should not support or look to build FSP's. It also does not mean
that community organizing efforts, beyond specific support of
FSP's, cannot have positive effects on child well-being.
support programs will work at building community. However, they
will recognize that the goals and strategies of community organizing
go beyond the scope of their mission.
1, 2, and
5: Not available online.
Care About Neighbors
Are you tired of being stuck at home? Are you searching
for a way to do something to help others in your community?
Are you interested in becoming a VOLUNTEER PARENT AIDE?
"Parents CAN" is a network of community volunteers who
are trained to be parent aides. "Parents CAN" is looking
for responsible, experienced parents to volunteer 5 hours
per week providing neighbor to neighbor support and advocacy
services to others in the Bowdoin Street/Field's Corner
Area. As a parent aide, you need to be friendly and outgoing,
like people, enjoy listening and reaching out to others.
Help yourself as you help others and strengthen your community!
Learn new job skills: leadership abilities, child development,
outreach and advocacy skills. Take advantage of free training
and certification in the above areas. Free child care will
be provided for training and volunteer hours.
After completing training and receiving certification,
volunteer parent aide responsibilities will include:
- Greeting and meeting people who come to the Log School
Family Cooperative, helping create a warm, friendly, inviting
- Helping with clothes distribution, as well as greeting
people who come to the Log School's food pantry.
- Making supportive home visits to family co-op members
and to mothers with new babies who are participating in
the Bowdoin Street Health Center's FACS (Family and Child
- Assisting in leadership of family co-op activities:
a weekly crafts circle, pot-luck socials, picnics, and
- Providing advocacy and help to families regarding welfare
issues, health care access, emergency food deliveries,
translation (if you are bilingual) and other needed services.
- Calling and visiting people in the neighborhood to encourage
their involvement in Log School Family Cooperative activities.
- Attending a weekly one-hour supervision meeting with
other members of the Parents CAN network and participating
in monthly two-hour in-service trainings.
here to return to text.
CARES Prevention Programs
Strengthening Service Continuum
(Piloted in Bowdoin Street Area. Replicating in Field's Corner
and Codman Square.)
|Program Name/Target Population
for neighborhood residents
|Advocacy and outreach
Social and recreational events
ESL, GED, job development
Child care for participants
Outreach and service linkage
Site for Nurturing Programs other education
Parent support groups
|Family and Child Support
for pregnant women, their families, & infants (to 2 yrs)
|Home health visiting
Primary health care
Linkage to co-op and other support services
for families who want support and skill-building
|Nurturing skills curriculum for all family members through
structured series of weekly sessions
Training and interagency team preparation
|Parents CAN (Care About Neighbors)
parent aides for families who need extra support and help
|Training and ongoing support to program participants who
are ready to help others
Linkage of volunteers to parents who need support and placement
in group leadership roles
therapeutic care for families with substance abuse problems
|Intensive, home based team intervention
Linkage with treatment services & support
Parent aide support services
for families at risk, in need of multiple services
|Case coordination and planning for families served through
any of the above services
Identification of service gaps
Cross-agency support and training
here to return to text.
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