In this section two papers present the findings of qualitative research:
Life Stories Final Report, four topics are explored: childcare needs and barriers; theeffects of child sexual abuse; high school completion among adolescent mothers; and theunique vulnerabilities of very young mothers. These issues were explored to better understandthe ways that the NFN program can address the needs of this population. What we learn fromthe mothers themselves is that one of the most important roles the home visitor can play is todevelop a strong trusting relationship with the mother.
Revisiting the Cultural Broker Model, data from focus group discussions with Hartford NFN program staff are presented. The focus groups were designed to elucidate the decision processes of the home visitors in identifying family needs and helping families obtain resources and connect to community services. Analyses of these data highlight both the central importance of the home visitor in developing a strong trusting relationship with the mother and the pivotal role of the clinical supervisor for making the paraprofessional model more effective.
Life Stories Final Report
by Mary Patrice Erdmans
Updates on the Life Stories
This study was designed to learn about the Nurturing Family Network program from the perspectiveof the participants. Toward this end, we used a life story interview – an oral autobiography – tolearn about their family background, current living conditions, and involvement in the NFN program.We conducted the life-story interviews with 171mothers and 48 fathers between January 2002 andMarch 2003. See Figure 22 for a categorization of NFN mothers in this study by primary types ofvulnerability. Our 2004 report summarized thefindings of this research, focusing on the types ofvulnerabilities representative of mothers in theNFN program and the ways that mothers engagewith their home visitors.Subsequent to this report, we explored fourother topics: childcare needs and barriers; the effectsof child sexual abuse; high school completionamong adolescent mothers; and the unique vulnerabilitiesof very young mothers.
Childcare: In order to continue their educationor move into the workforce, mothers mustrely on childcare. Who are their formal andinformal child care providers? What are thebarriers to quality child care? How can NFNworkers help mothers access quality childcare?
Child Sexual Abuse: Victims of child sexualabuse are vulnerable to perpetuating cyclesof abuse. What can we learn from the life storiesto better understand the trajectories of sexabuse victims in order to stop the cycle ofabuse?
High school completion: One reason adolescentchildbearing is problematic is thatyoung mothers are at risk of dropping out ofhigh school. What are the differences betweenadolescent mothers who complete high schooland those who do not? How can NFN workershelp mothers return to school or stay inschool?
Children having children: The vulnerabilitiesof first time mothers are intensified byyoung age. Who are the mothers who givebirth before the age of 16, and in what wayscan NFN workers help young young mothersparent?These issues were explored to better understandthe ways that the NFN program can address theneeds of this population and augment the initialreport that categorized the vulnerabilities of mothersin the program and the nature of the relationshipbetween them and their home care providers.
Childcare Needs and Barriers: Almost two-thirds of all children in the UnitedStates between birth and age six (and not yet inkindergarten) are cared for by someone other thana parent on a regular basis. While the primaryfunction for child care is to care for children sothat parents can work, a second purpose is to enhancechild development. Indicators such as improvedcognitive and language skills, fewer behavioralproblems, and better social skills are associatedwith high quality child care. This relationshipis particularly evident with low-income children.
Life Stories Final Report
by Mary Patrice Erdmans
Fig. 22. Connecticut’s Vulnerable Families:for whom high quality child care programs helpoffset disadvantaged home environments(Burchinal 1999; Scarr 1998). Unfortunately, barriersto quality childcare limit these potential benefits,for NFN participants as well as many disadvantagedfamilies in the United States (see Capizzanoand Adams 2003; Mezey et al 2002).Mothers whose children are less than two yearsof age prefer to have their children cared for in thehome or by a family member. This is true for boththe NFN participants as well as most mothers inthe United States regardless of class, race or ethnicity.For our participants, only 15 percent ofmothers whose children were under one year ofage used a child care provider outside of the familynetwork, compared to 41 percent with childrenbetween the ages of one and three, and 52 percentwith children over three years of age.Barriers to daycare for low income families ingeneral included prohibitive costs, availability,convenience (transportation), and negative perceptionsof childcare. These barriers were also mentionedby many of the participants in the life stories.
- In general, low-income mothers cannot affordquality childcare and despite being eligible forfederal funding many do not receive assistance(Mezey et al 2002). Between 2002 and 2007,funding for Care4Kids in Connecticut was cutby 41 percent; and in 2001 only 8 percent ofthe estimated 170,000 children eligible forChild Care and Development Fund (CCDF)received funding (see Care4Kids, 2007; Dinanand Cauthen, 2004). In 2004, there were17,000 eligible children on the waiting list forCare4Kids funds (Jacklin 2004). Roughly 20percent of the mothers participating in ourstudy mentioned cost as a barrier. Only fivemothers in the study had ever received stateassistance for child care.
- Mothers who work non-conventional hours(evenings, nights, or weekends), part-timehours, and shifts have a harder time enrollingtheir children in formal child care centers. Ahalf a dozen mothers mentioned this in theirinterviews. Availability is also limited for infantsand toddlers as well as children with disabilities.Mothers with infants had to rely onfriends and family for care.
- Because there are not enough centers in poorneighborhoods, they are inconvenient and difficultto access, particularly for householdswithout reliable transportation. Mothers detailedthe difficulties of using public transportationto get their children to daycare, to getthemselves to work and then to reverse it all atthe end of the day.
- Mothers in the study expressed reluctanceabout having their child cared for by“strangers” as opposed to family members. Infact, 81 percent of the mothers expressing anegative attitude toward daycare mentionedmistrusting strangers. In comparison, only 26percent mentioned practical issues of costs,availability and convenience (the numbers donot sum to 100 because some mothers mentionedboth practical issues and trust issues).More often mothers feared benign neglectrather than deliberate abuse, worrying that inadequatesupervision or unclean facilitieswould be harmful to their children.
Employed mothers in our study were mostlikely to use daycare – 20 percent of employedmothers used center-based or home-based formalcare. Another one-third used informal care (familyand friends, paid and unpaid), and almost one-halfof the children were cared for solely by the parents– the mother or mother and father (see Table 70).This is one reason why home visitation programsare important for this population. The parents areoften the sole caregivers even when they work –therefore it is important that the parents be as informedas possible about child development.
When mothers have to work and they cannotafford daycare, they often resort to less thanideal arrangements. For example, one motherworked the night shift and left her children alone inthe apartment sleeping while she worked. Sheused a baby monitor set up at the neighbor’s house:“I can leave the door unlocked for her. All she hasto do is have the monitor at her house.’ So far thishas worked but she said, “My biggest problem is ifI have to get a day job. I can’t afford the daycare.Even with the state help, I can’t afford the daycare.”
When mothers can’t afford or are reluctant touse daycare providers, they rely instead on familyand friends. Forty-two percent of our participants68used family and close friends as child care providers.In fact, of the five mothers who received stateassistance, four of the providers were either maternalgrandmothers or friends of the family. Whilefamily and friends certainly have a closer bondwith the child than a stranger working at a day carecenter, this does not always mean that the familyor friend is a qualified provider. Relatives are exemptfrom the requirement that daycare providersbe licensed by the Connecticut Department of PublicHealth.
In a very small number of cases, mothers reliedon parents or partners who had a history of substanceabuse or violence. While 27 women whowere victims of child abuse allow their child tohave contact with the abuser, only 10 rely on themto provide childcare. And of these, only three are“red flag’ situations. These mothers use theselesser qualified providers because of necessity(they are either working or in school), and theysaid they could not afford to pay for childcare, andthey did not trust strangers.
Some of their general mistrust was related totheir violent family backgrounds andneighborhoodswhere mistrust is an appropriate response ina world of uncertain conditions. Some of the mistrustof formal childcare is also related to their limitedpower or relative inability to control the conditionsof their existence. Being poor, less educated,unemployed, and members of racial minoritygroups, they are disadvantaged in our society.Their disadvantaged position makes them suspiciousof a system that has not rewarded them. Theyare not only suspicious of daycare providers butwe also found that many of these mothers werefearful and suspicious of law enforcement officers,the court and welfare system officials, teachers andemployers. Given that these gatekeepers can imprisonthem, take their children, or deny them assistance,wages and healthcare, their wariness ofthese outsiders is understandable.
Despite their reluctance, however, mothersshould be encouraged to place their children, especiallyolder toddlers, in quality child care programsthat have the potential to counteract the disadvantagesassociated with low-income neighborhoods.Mothers may feel more confident using formaldaycare if they are informed consumers. Informationabout how to evaluate a child care programcould be provided by the home visitor. For example,their home visitors could have a checklist thatrepresents the criteria needed to evaluate programs,including such things as: staff-to-child ratios andgroup size, director and staff qualifications andtraining, principles and policies regarding discipline,indoor and outdoor playground safety, andhealth standards. In the few cases where mothershad successfully placed their children with qualifiedproviders, it was often their home visitor whohelped them. Several home visitors gave mothersthe Care4Kids form, helped her complete it, andprovided them with a list of all of the childcareproviders in the area. Another home visitor encouragedthe mother to remove her child from a poorquality home-based daycare program. One homevisitor provided the mother with a videotape ondaycare that helped her decide between a home-basedprovider and a formal daycare provider.
Home visitors can help empower parents byteaching them to be vocal advocates for their childrenParents should feel confident that they cancheck on their children at anytime and that theyhave the right to speak with daycare providers andteachers about their concerns. Mothers who havelanguage barriers should have access to translators. Finally, the relationship between the home visitor and the mother provides an opportunity to develop trust. Learning to trust discerningly would be more useful than mistrusting all people all the time.
Status of mother Center-basedcareTable 70. Primary Child Care
Arrangements / Primary arrangements signifies 32 hours or more of care a week.
Status of mother / Center-based care / Home-based care / Family/
Friends paid / Family/
unpaid / None/
Parental care / Total
Working / 6 / 4 / 4 / 12 / 23 / 49
In high school / 7 / 1 / 6 / 10 / 24 / 48
Not working or in high school / 2 / 0 / 0 / 0 / 68 / 70
Totals / 15 / 5 / 10 / 22 / 115 / 167
Table 70. Primary Child CareArrangements:Primary arrangements signifies 32 hours or moreof care a week.
Child Sexual Abuse and Adolescent Mothers:
The path from child sexual abuse to teen pregnancy(and back to child abuse) is not one all victimswalk, but enough do to make the way visible.Victims of child sexual abuse are more likely todevelop behavioral problems, become sexuallyactive at a young age, take greater sexual risks(have more partners and less contraception use), toget pregnant as teenagers, suffer from depression,anxiety, eating disorders and other mental illnesses,abuse alcohol and drugs, have problems inschool, and choose partners who are physically andemotionally abusive (Butler and Burton, 1990;Downs, 1993; Musick, 1993; Finklehor, 1986).Among the mothers participating in the life storiesstudy, the link between child sexual abuse andother problems is striking. Comparing the quarterof the teen mothers who were sexually abused aschildren to those who were not (or did not mentionit), we find that abused girls were more likely:
- to be victims of statutory rape (22% versus5%)
- to have abused alcohol or drugs (52% versus16%)
- to have abusive partners (63% versus 35%)
- to suffer from a mental illness (56% versus23%)
- to have behavioral problems (56% versus31%)
- to drop out of high school before pregnancy(44% versus 33%).
When looking at these comparisons, it is importantto remember that almost all of the mothers in oursample come from low-income families, and manyhave childhoods marked by violence, substanceabuse, and family instability. That is, when comparingapples to apples, we see that child sexualabuse significantly exacerbates the problems ofpoverty.
As depressing as it is that a quarter of these teenmoms were sexually abused as children, even moredepressing is that they usually did not tell anyoneabout the abuse. More than one-half of the girls didnot report the abuse or they told someone long afterthe fact. Only twelve of them told someone immediatelyor shortly after the abuse, five were believedand seven victims were not believed orworse, they were accused of being responsible forwhat had happened. Victims are less likely to bebelieved if the parents or guardians feel complicitousor responsible for not protecting the child or ifthe perpetrator is a part of the family. More thanone-half of the perpetrators in our study had somefamilial connection to the young girl (fathers, stepfathers,grandfathers, uncles, cousins, a fosterbrother) and another quarter were friends of thefamily.
Even when they were believed, often nothingwas done. Rather than prosecute, the most commonresponse was to move the young girl awayfrom the perpetrator.
Only three women received counseling specificallyrelated to the sexual abuse. Another thirteenreceived some counseling in their lives for a varietyof reasons and some discussed the abuse in thatcontext. Hidden, denied, or poorly counseled,many young victims kept the abuse bottled insideuntil it slipped out in destructive ways – self-mutilation,eating disorders, suicide, depressionand acute psychosis. For others, the violence fromthe abuse was directed outward into a pattern ofearly and risky sexual behavior, delinquency, truancy,drug and alcohol abuse, and unhealthy violentrelations with men. This is often the emotionallychaotic and potentially abusive environmentinto which their children are born.
If they do not deal with their own trauma, theycan become preoccupied with the baggage of theirpain and subordinate the needs of the child. Thepotential for child abuse and neglect exists if theydo not mend the damage of the early sexual abuse.One participant was adamant that she would stopthe cycle of abuse, “I am not gonna molest mychild. I don't care if I don’t have sex for 30 years,it would never happen - wouldn’t. I love my sontoo much to see my son’s life get ruined like mineis.” Within three years of this statement, thismother had a second child and two substantiatedcases of child abuse filed against her; in the first case, she was charged with physical neglect becauseher child was sexually molested.
Home visitors should be well-trained to recognizethe symptoms of sexual abuse and work pro70actively to provide support for the victims and tovigorously prosecute the offenders. Speaking outabout the abuse, being believed, taking actionagainst the perpetrator and receiving treatment allhelp the victim recover from and end the cycle ofabuse. We have several mothers who did recoverand have healthy relations with their children andthe men in their lives. In all of these cases, themother had a long-term relationship with a therapist;and this relationship was often strongly encouragedby someone close to her whom shetrusted. By developing a close, trusting relationwith the mother, the home visitor puts herself in aposition to encourage the abuse victim to accesscounseling.