GOALS

Exploring United Way for Southeastern 

Michigan’s Program for Supporting 

Children and Families 

from the Bib to the Backpack

i 

GOALS

Exploring United Way for Southeastern Michigan’s Program for 

Supporting Children and Families from the Bib to the Backpack

Final Report

December 31, 2020

United Way for Southeastern Michigan

Melissa Bowman, MPP

Melanie Gill, MPA

Jeffrey D. Miles, MSW

Maya Satterwhite

Philliber Research and Evaluation

Randi Burlew, PhD

Heather Hirsch, MS

Ed Parker, MS

Wayne State University

Ty Partridge, PhD

Christopher Trentacosta, PhD

Here2There, LLC

Alice Audie-Figueroa, PhD

A special thanks goes to the following people for their contributions to this project and report: 

Shauna Aitson, MS; Jennifer Callans, PhD; Amanda Casburn; Cassondra Jones; Delonda 

McCullum, Crystal Sims, and Carmen Thomas

Detroit skyline image by Ryan F from Pixabay 
ii

Acknowledgements 

United Way would like to thank all of the many corporate and individual supporters of this effort 

over the last four years. Your contributions have made a difference not only in the lives of the 

families that we served through GOALS but will continue to help drive positive outcomes in our 

community for years to come. 

A special thank you to: 

Ford Motor Company

General Motors

United Way would also like to thank the amazing partner agencies and team members that 

made this project possible. From day one, their efforts, expertise, and dedication to the families 

in their communities guided this effort and ensured that the children remained at the center of 

the work. Even a global pandemic could not shake their resolve to ensure GOALS families 

received the best care possible. United Way is deeply thankful for your hard work throughout 

this project. 

A final thank you goes out to the amazing team at AmeriCorps for their ongoing support 

throughout this project. Without their funding none of this would have been possible. We 

would like to especially thank our Program Officer Katy Hussey-Sloniker who was always there to 

lend a hand and help keep us moving forward in support of the families we served. 
iii

The layout of the various sections of this report responds to a prompt provided by AmeriCorps. 
iv

Table of Contents

Table of Contents .....................................................................................................................................iv

EXECUTIVE SUMMARY............................................................................................................................ 1 

INTRODUCTION....................................................................................................................................... 6 

Program Background and Problem Definition ................................................................................. 6 

Overview of Prior Research ................................................................................................................. 7 

Overview of Implementation Study.................................................................................................... 7 

Research Questions............................................................................................................................11

Contribution of the Study ..................................................................................................................12

Connection of this Implementation Study to Future Research .....................................................14

STUDY APPROACH AND METHODS...................................................................................................16

Data System.........................................................................................................................................16

Implementation Study Design ..........................................................................................................16

Impact Evaluation Design..................................................................................................................21

GOALS Program Design....................................................................................................................21

Preparing for the GOALS Program...................................................................................................25

Fidelity to GOALS Program Design..................................................................................................27

Program Exposure (Dosage).............................................................................................................29

Program Quality - Agency Level .......................................................................................................30

Program Quality - Specialist Level....................................................................................................33

Program Participant Responsiveness ...............................................................................................33

Program Differentiation .....................................................................................................................34

Participant Satisfaction.......................................................................................................................36

DATA ANALYSIS METHODS.................................................................................................................40

Missing Data........................................................................................................................................41

Baseline Equivalence .........................................................................................................................42

Analytic Samples................................................................................................................................. 43

Analytic Strategy................................................................................................................................. 45

FINDINGS, LESSONS LEARNED, AND NEXT STEPS..........................................................................47

Introduction and Summary................................................................................................................47

Communication ..................................................................................................................................48

Findings By Research Question ........................................................................................................49
v 

Impact Questions................................................................................................................................61

Discussion............................................................................................................................................71

Lessons Learned................................................................................................................................. 72

Next Steps ...........................................................................................................................................77

COVID-19 PANDEMIC EFFECTS ..........................................................................................................80

COVID-19 Timeline ............................................................................................................................80

COVID-19 Impact and Implications..................................................................................................80

COVID-19 Impact on GOALS participants.......................................................................................81

GOALS Mitigation of COVID-19 Effects...........................................................................................82

References...........................................................................................................................................85

APPENDICES...........................................................................................................................................87
vi

List of Figures

Figure 1: Program Logic Model............................................................................................................10

Figure 2: Comparison vs. Intervention Process ..................................................................................20

Figure 3: Assessment Matrix .................................................................................................................28

Figure 4: Little's MCAR Test Results.....................................................................................................42

Figure 5: Consort Diagram ...................................................................................................................44

Figure 6: Count of Types of Communication......................................................................................48

Figure 7: Enrollment in GOALS ............................................................................................................49

Figure 8: Characteristics of GOALS Families ......................................................................................50

Figure 9: Needs of GOALS Families at Baseline.................................................................................51

Figure 10: Number of Programs - 6-Month Follow-Up ......................................................................52

Figure 11: Average Number of Programs - 6-Month Follow-Up ......................................................53

Figure 12: Number of Programs - 12-Month Follow-Up ...................................................................53

Figure 13: Average Number of Programs - 12-Month Follow-Up ....................................................53

Figure 14: Program Completion (GOALS and Comparison) ............................................................54

Figure 15: PICCOLO Pre-post Scale Assessment - 6-Month Follow-Up ..........................................54

Figure 16: PICCOLO Pre-post Scale Assessment - 12-Month Follow-Up ........................................54

Figure 17: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - 6-Month Follow-Up .............................................................................55

Figure 18: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - 12-Month Follow-Up ...........................................................................55

Figure 19: Protective Factors Pre-post Assessment - 6-Month Follow-Up ......................................55

Figure 20: Protective Factors Pre-post Assessment - 12-Month Follow-Up ....................................56

Figure 21: Child Temperament Outcomes - 6-Month Follow-Up ....................................................56

Figure 22: Child Temperament Outcomes - 12-Month Follow-Up ..................................................56

Figure 23: Feeding Your Child Outcomes - 6-Month Follow-Up .....................................................57

Figure 24: Feeding Your Child Outcomes - 12-Month Follow-Up ...................................................57

Figure 25: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 6-Month Follow-Up ..............................................................................................................57

Figure 26: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 12-Month Follow-Up ............................................................................................................57

Figure 27: PICCOLO Pre-post Assessment - 6 and 12 Month ..........................................................59
vii

Figure 28: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - 6 and 12 Month....................................................................................59

Figure 29: Protective Factors - 6 and 12 Month .................................................................................60

Figure 30: Child Temperament Outcomes - 6 and 12 Month ..........................................................60

Figure 31: Feeding Your Child - 6 and 12 Month...............................................................................60

Figure 32: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 6 and 12 Month ....................................................................................................................61

Figure 33: Baseline Equivalence of Individual Characteristics - 6-Month Follow-Up Sample.......61

Figure 34: Baseline Equivalence of Individual Characteristics - 12-Month Follow-Up Sample ....63

Figure 35: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - GOALS and Comparison Families - 6-Month Follow-Up ................64

Figure 36: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - GOALS and Comparison Families - 12-Month Follow-Up ..............64

Figure 37: Protective Factors - 6-Month Follow-Up ...........................................................................65

Figure 38: Protective Factors - 12-Month Follow-Up .........................................................................65

Figure 39: Change in Child's Development - 6-Month Follow-Up ...................................................66

Figure 40: Change in Child's Development - 12-Month Follow-Up ................................................67

Figure 41: Number of Categories of Concern - 6-Month Follow-Up ...............................................68

Figure 42: Percent of Participants with at Least One Category of Concern 6-Month Follow-Up . 68

Figure 43: Number of Categories of Concern - 12-Month Follow-Up .............................................69

Figure 44: Percent of Participants with at Least One Category of Concern - 12-Month Follow-Up

..................................................................................................................................................................69

Figure 45: Child's Temperament Outcomes - 6-Month Follow-Up ..................................................70

Figure 46: Child's Temperament Outcomes - 12-Month Follow-Up ...............................................70

Figure 47: Child's Feeding Practices Outcomes - 6-Month Follow-Up ...........................................70

Figure 48: Child's Feeding Practices Outcomes - 12-Month Follow-Up .........................................71
United Way for Southeastern Michigan 1 

EXECUTIVE SUMMARY 

Families in the Southeastern Michigan counties of Wayne, Oakland and Macomb face social and 

economic challenges that affect the health and developmental readiness of their young 

children. When this study was proposed, a quarter of the children under the age of eighteen 

were living in poverty and a third lived in families receiving public assistance. Eleven percent of 

the labor force was unemployed. In Wayne County, where Detroit is located, the percentages 

were, and are, even higher. More than a third of children were living in poverty, half receiving 

public assistance, and 15% of the labor force was unemployed. All of these percentages were 

higher than the United States as a whole.

In these communities there are few comprehensive 

systems that connect people to the resources they 

need to support themselves as parents and to meet 

their objectives as families. While many resources are 

available, they are often underused and lack

continuity and connectedness to ensure that families 

can easily identify and access supports they need. 

This project was designed to impact the system of 

care, the families they serve, and the children they 

raise. At the system level, the intention of 

programming was to expand the scope of 

interventions offered to families and to strengthen the 

connections between programs and agencies. At the family level, the project meant to grow 

essential skills of parents, to expand their social and resource networks, and to increase their 

self-sufficiency and use of resources. Among children, improvement in developmental 

readiness and health was targeted, intending to increase their probability of lifelong success.

The intervention model was named GOALS, Gain Opportunities to Achieve Lasting Success. 

GOALS utilized an adapted version of the Family Check-Up model. The Family Check-Up model 

is a strengths-based, family-centered intervention that motivates parents to use effective 

parenting practices in support of child competence. It is designed for families with risk factors 

including socioeconomic disadvantage, maternal depression, family and child risk factors for 

child conduct problems, and academic failure. Using principles of strengths-based motivational 

interviewing, the model prompts parents to change problematic behavior in their children by 

modifying their own parenting behavior. By sharing assessment findings, identifying strengths 

and potential problem areas, and providing developmental readiness information and referrals, 

parents are empowered to improve their children’s developmental readiness. 

The project made key adaptations to the Family Check-Up model. GOALS was nested in a 

multi-agency integrated service delivery model which included the 2-1-1 information and 

referral hotline. GOALS included a unique suite of assessments and specially designed 

feedback form to communicate results to families. GOALS placed increased emphasis on goal 

“One of the lessons I learned 

working with residents of Wayne 

County is that I had heard of the 

poverty and food insecurity 

occurring, but going to see and 

hear firsthand, it was worse than I 

had anticipated.” 

- Family Check-Up Model 

Specialist, National Kidney 

Foundation of Michigan
United Way for Southeastern Michigan 2 

setting and referral tracking. Finally, GOALS used multiple service/resource “pathways” to 

support families in key areas of challenge.

The purpose of this study was to evaluate the implementation of this intervention model serving

families from five agencies in the Greater Detroit area. Families from these agencies were given 

the opportunity to participate in the Family Check-Up model if they had a child five years old or 

younger and were living at 200% of the federal poverty level or less. 

The study was designed as a randomized control trial of an intent-to-treat model. Despite 

transitioning to an implementation study due to an unanticipated shortened project period, the 

study continued to use a robust experimental framework to address both the required

implementation questions and the exploratory impact questions. 

A total of 518 families were enrolled into the GOALS intervention and 474 families were 

enrolled into the comparison group. More than three quarters (77%) of these families were 

receiving public assistance at the time of enrollment, most were Families of Color (77%). Nearly 

all (97%) of the parents were female and less than half were living with a spouse (45%). These 

families reported having myriad needs at baseline. Most frequently they identified having 

needs with regards to housing, clothing, and food. Most (73% at six-month follow-up and 71% at 

12-month follow-up) of these families stayed enrolled in the program.

The evaluation used t-tests to determine whether families enrolled in the GOALS program 

showed improvement between pre and post-tests. GOALS families showed significant gains in 

parenting. In particular, their levels of affection, responsiveness, encouragement, and teaching 

as measured by the Parenting Interactions with Children Checklist of Observations Linked to 

Outcomes (PICCOLO) all showed significant improvement at both six- and 12-month follow-up. 

GOALS families also showed significant improvement on four domains of the Arizona Self 

Sufficiency Matrix (ability to meet basic needs, parenting skills, social support, and behavior 

issues) at both six- and 12-month follow-up.

The evaluation also looked at improvement on Protective Factors to prevent child abuse and 

neglect. At six-month follow-up, GOALS families demonstrated significant improvement on two 

of these protective factors: concrete support and child development/ knowledge of parenting. 

At 12-month follow-up, GOALS families demonstrated significant improvement on three 

protective factors: concrete support, child development/ knowledge of parenting, and social 

support.

GOALS families’ scores on the Feeding Your Child survey, which examines the practices parents 

use when feeding their children, also showed significant improvement at both six- and 12-

month follow-up. Similarly, at both six- and 12-month follow-up, GOALS families showed a 

significant decrease in the number of areas of concern identified by the Ages and Stages 

Questionnaires.
United Way for Southeastern Michigan 3 

GOALS families also outperformed the comparison families in some key areas. Regression 

analysis was used to determine whether there were differences between GOALS and 

comparison families at six and twelve months. GOALS families scored significantly higher than 

comparison families on social support as measured by the Protective Factors survey at six-month 

follow-up. In addition, GOALS families had significantly higher scores than the comparison 

group on the Feeding Your Child survey at both six- and 12-month follow-up.

However, comparison families scored significantly higher than GOALS families on the ability to 

meet basic needs and on parenting skills as measured by the Arizona Self-Sufficiency matrix at 

six-month follow-up and on parenting skills at 12-month follow-up. Comparison families also 

demonstrated significantly higher scores than GOALS families on the nurturing and attachment 

protective factor at six-month follow-up setting the stage for further research and analysis. 

The COVID-19 global health pandemic started during the last seven months of the GOALS 

evaluation. In response to the global health pandemic and the state of emergency orders put in 

place by the Governor of Michigan, the GOALS study adapted its implementation protocol to 

protect the health and safety of GOALS staff and participants. In addition, the project added two 

COVID-19 assessments that looked at two time periods, with Phase 1 defined as the period from 

March 13, 2020 (one week before the Michigan Shelter-In-Place Order) to April 30, 2020 (the 

first curve flattening in Michigan), and Phase 2 extended from May 1, 2020 thru August 30, 2020. 

The study found that there was a significant increase in the likelihood of either staying in or 

moving into the high-risk category for both the intervention and control groups during the 

COVID-19 Phase 1 period across multiple ASSM domains: Health Care, Employment, Family 

Social Connections, Community Engagement, Parenting, and Mental Health. 

However, during Phase 2, the families enrolled in the GOALS program were significantly more 

likely to move to a lower-risk category in areas of Mental Health, Parenting, Family Connection, 

and Health Care. The odds ratios for these analyses ranged from 1.8 to 3.5 indicating a nearly 

two-fold decrease in risk across these domains at a minimum. We speculate that this positive 

buffering effect is at least in part related to the GOALS program providing an established and 

trusted support system to help navigate the needs of families in the face of the COVID-19 

pandemic.

GOALS families showed significant improvement in many areas between pre and post-test. 

However, the results indicate that they only outperformed the comparison group in two areas. 

Several factors including recruiting families out of high quality, evidence-based programs at the 

agencies and providing a higher level of care for comparison families than they would have 

received in the absence of this study likely contributed to the fact that the two groups looked 

similar in many ways at follow-up.

Several lessons were learned through the implementation of the GOALS program. Many of 

these lessons involved the assessment measures used. Feedback from agency staff indicated 

that the items on some of the measures were difficult for families to understand, that the Likert 
United Way for Southeastern Michigan 4 

scales used on many of the assessments were confusing for some families, and that the 

assessments did not always detect marginal progress. Further, the assessment package was 

lengthy and could be trimmed in future implementations. Feedback from staff also indicated 

that the ongoing training and support offered by the project was critical. Several challenges 

arose over the course of the project including difficulty managing technology, scoring 

assessments, and providing negative feedback to families, that required additional training for 

agency staff to manage. Finally, while staff turnover was anticipated and the levels of turnover 

were consistent with other similar programs, the challenges in addressing turnover was greater 

than anticipated. Leaders of future implementations should be intentional about planning for 

the impact of turnover on program implementation.

 
United Way for Southeastern Michigan 5 

Introduction 
United Way for Southeastern Michigan 6 

INTRODUCTION

Program Background and Problem Definition

Families in the Southeastern Michigan counties of Wayne, Oakland and Macomb face social and 

economic challenges that affect the health and developmental readiness of their young 

children. When this study was proposed, reports from the Kids Count Data Center 

(https://datacenter.kidscount.org/) showed a quarter of the children under the age of eighteen 

were living in poverty and a third lived in families receiving public assistance. Eleven percent of 

the labor force was unemployed. In Wayne County, where Detroit is located, the percentages 

were, and are, even higher. More than a third of children were living in poverty, half receiving 

public assistance, and 15% of the labor force was unemployed (https://www.bls.gov). All these 

percentages were higher than the United States as a whole. Prior to March 2020, circumstances 

had not meaningfully changed. It is also well documented that COVID-19 has 

disproportionately negatively affected vulnerable communities, which likely exacerbated the 

challenges faced by families in Southeastern Michigan (Michigan.gov, n.d.). 

 

Additionally, in the years preceding this study, United Way for Southeastern Michigan analyzed 

screening data on almost 150,000 children under the age of five to assess their level of 

development using the Ages & Stages Questionnaires. Over a third of the children screened 

were found to be below level on each domain screened: communication skills, gross motor 

skills, fine motor skills, problem solving skills and social skills. These delays were believed to 

have resulted, at least in part, from the conditions in which these children live.

 

In these communities there are few comprehensive systems 

that connect people to the resources they need to support 

themselves as parents and to meet their objectives as families. 

While many resources are available, they are often 

underutilized and there is a lack of continuity and 

connectedness to ensure that families can easily identify and 

access the supports they need. 

 

This project was designed to impact the system of care, the 

families they serve, and the children they raise by creating a 

new integrated service delivery model. At the system level, 

the intention of programming was to expand the scope of 

interventions offered to families and to strengthen the connections between programs and 

agencies through an integrated service delivery model. At the family level, the project meant to 

grow essential skills of parents and other adults who care for young children, to expand their 

social and resource networks, and to increase their self-sufficiency and use of resources. Among 

children, improvement in developmental readiness and health was targeted, intending to 

increase their probability of lifelong success.

"It was painful to hear 

how often these wellintentioned programs 

had appeared to knock 

people down instead of 

lifting them up...The 

system remains utterly 

broken.

- Family Check-Up Model 

Specialist, Oakland 

Family Services
United Way for Southeastern Michigan 7 

A note for our early partners and AmeriCorps reviewers: As the study developed, organizational 

shifts required that the original project title Bib-to-Backpack be changed and the entire initiative 

was renamed GOALS, Gain Opportunities to Achieve Lasting Success. 

Overview of Prior Research

GOALS adapted the Family Check-Up (FCU) model, a strengths-based, family-centered 

intervention that motivates parents to use positive parenting practices in support of child 

competence. It is designed for families with risk factors including socioeconomic disadvantage, 

maternal depression, family and child risk factors for child conduct problems, and academic 

failure. The FCU uses principles of strengths-based motivational interviewing to prompt parents 

to change problematic behavior in their children by modifying their own parenting behavior. By 

sharing assessment findings, identifying strengths and potential problem areas, and providing 

developmental readiness information and referrals, parents are empowered to improve their 

children’s developmental readiness. 

 

Much of the research on the impact of the FCU in families with young children has been done by 

Daniel Shaw, Thomas Dishion and their colleagues. In 2006, they published the results of a 

randomized trial of the 2-year effects of the model. The test of 120 toddler-aged boys found 

reductions in disruptive behavior and greater maternal involvement (Shaw et al., 2006).

 

In 2008, the team published the results of a larger study of 731 low-income families with 2 and 

3-year-old children. Compared to those in the control group, those who received the FCU

model demonstrated decreased behavior problems among children and increased positive 

behavior support among parents (Dishion et al., 2008). 

 

The findings from these two randomized control trials have resulted in dozens of publications in 

peer reviewed clinical and developmental research journals. According to the Social Innovation 

Fund – the original project funder – guidelines, the evidence base for the FCU model meets the 

criteria for strong evidence.

 

However, neither of these prior studies of the FCU model included large numbers of families 

who were recent immigrants to the United States with their own norms and customs, which was 

a key population included in this study. The prior studies also did not offer the scope of support 

services available to families through GOALS. 

Overview of Implementation Study

Introduction

This project began at the now closed Corporation for National and Community Service (CNCS) 

and is now housed with AmeriCorps. It was part of the 2016 Social Innovation Fund (SIF) 

portfolio and was United Way’s second Social Innovation Fund Award. In 2016, United Way was 

awarded $6 million with a required one to one match on every dollar. There was also a majority 
United Way for Southeastern Michigan 8 

pass through stipulation meaning that at least 51% of the federal award had to go to 

subgrantees (referred to in this report as partner agencies) who were also required to match 

their awards dollar for dollar. With the shortened period of performance, United Way’s total 

budget was just over $4 million with a pass-through rate of approximately 76 percent. For more 

information on United Way’s previous SIF project and current 2016 SIF budget see Appendix 

AA.

In addition to the intermediary, United Way for Southeastern Michigan, there were five partner 

agencies. Philliber Research and Evaluation was the lead evaluator. Professors from Wayne 

State University provided technical, statistical and FCU expertise, and financial assistance and 

strategic advice were provided by private consultants. Advarra served as the project’s 

Institutional Review Board (IRB). A Glossary of project terms and partners is provided in 

Appendix A. 

Program Design Approach and Methodology Used

The purpose of this study was to evaluate the implementation of an adapted FCU model - 

GOALS - among families recruited by five partner agencies in the Greater Detroit area. Families 

from these agencies were given the opportunity to participate in the study if they had a child five 

years old or younger and were living at 200% of the federal poverty level or less. A total of 525 

families were expected to participate in the Family Check-Up model between February 2018 

and April 2019. Another 525 families were expected to make up the comparison group. 

The intervention, or GOALS, families were interviewed and received a set of assessments. The 

assessment data was reviewed and synthesized by a specialist working with the family and 

during a feedback session, the family was encouraged to set goals. Referrals were made and 

the family selected pathways - a set of evidence-based, in-network programs - or other services 

meant to help meet those goals. Six- and 12-month assessments and feedback were provided.

The comparison group received the same set of assessments, except for the PICCOLO. These 

families typically had two sessions, compared to the three sessions that the GOALS families 

typically had. Comparison families also had six- and 12- month follow-up assessments. These 

families worked with trained staff called Data Collection Specialists (DCS) who provided brief 

feedback on the assessments, a list of resources, and a level of care consistent with their 

agency’s practices. 

GOALS is based on the theory that by building a parenting continuum/system that will recruit, 

engage, and empower parents to improve their family’s self-sufficiency and parenting skills, 

their children’s developmental readiness will improve. Building this system on a foundation of 

evidence-based parenting strategies - the pathways - and technology-based care-coordination 

supports, parents can be educated and empowered to improve the developmental readiness 

and well-being of their children. The FCU was selected as the foundation of this system because

it was an empirically validated model that had already demonstrated substantial promise as an 
United Way for Southeastern Michigan 9 

effective prevention intervention. The strengths of the FCU include comprehensive assessment, 

family engagement grounded in a motivational 

interviewing approach, and goal setting. These 

strengths, combined with the community 

networking and resourcing capacity of United 

Way, provided a powerful framework for a truly 

community level intervention that could 

significantly impact the Southeast Michigan 

region in a way that would facilitate systemic 

change in the long-term. Specifically, this model 

allowed families to determine goals consistent 

with their own priorities after reviewing their 

assessment data, use pathways providing

resources consistent with their goals, and 

leverage 2-1-1, an established information and 

referral system, that could direct families to 

resources, even if there was not a specific pathway for that goal. 

The first steps of GOALS, relying heavily on the Family Check-Up framework, were to engage in 

a rapport-building “get-to-know-you” session with a trained Family Check-Up Model Specialist 

(FCMS) and complete an assessment of the family’s self-sufficiency and their child’s 

developmental readiness. For each family, the youngest child under the age of five was 

designated as the “target child” and was the focus of the child-specific assessments. There was a 

primary adult identified as well. These individuals had to be the child’s legal guardian and

because of this status the study uses the term “parent” to identify them. Working with their 

FCMS, each family completed an assessment of their family’s ability to meet basic needs, 

parenting skills, social supports, child behaviors and feeding practices. They also completed 

assessments of their child’s communication skills, gross motor skills, fine motor skills, problem 

solving skills, social development, and health. 

The assessments included the Arizona Self-Sufficiency Matrix (by completing a Family Profile 

Form); the age-appropriate Ages & Stages Questionnaires, Third Edition (ASQ-3) and Ages & 

Stages Questionnaires: Social Emotional, Second Edition (ASQ:SE-2); the age-appropriate 

Rothbart Temperament Scale; the PICCOLO; and a Feeding Your Child survey. A description of 

each assessment can be found later in the Program Design section of this report. Several of 

these assessments and screening tools were selected to align with other program evaluations 

being conducted by United Way. Each family also completed a Participant Intake Form that 

captured demographics. 

 

The second step of GOALS was to review the assessments with the FCMS during a feedback 

session in order to identify goals the family wished to work toward and be guided toward 

programs that would help them achieve those goals. The Family Check-Up Model Specialist 

discussed relevant options with the family such as assistance with specific child behavior 

Key FCU Adaptations: 

• GOALS was nested in a multi-agency 

integrated service delivery model, 

including 2-1-1 resource and referral 

hotline.

• GOALS included a unique suite of 

assessments. 

• GOALS used a specially designed 

feedback form. 

• GOALS placed increased emphasis on 

goal setting and referral tracking. 

• GOALS used multiple 

service/resource “pathways.” 
United Way for Southeastern Michigan 10

problems or parent issues; enrollment into an intervention as identified by family goals; and/or 

community referrals. All service referrals were to be accompanied by regular follow-up support, 

either in person or by phone; These families were to continue to meet with the Family Check-Up 

Model Specialist at least every six months to discuss their progress and refine their goals. 

 

The third step was to connect with pathways, programs, and service providers who can help 

families achieve their goals. These services could have been provided by the enrolling agency 

or referrals could be made to other GOALS partner agencies or out-of-network providers. Text 

messaging was to be used by FCMSs to further keep families informed and involved. 

 

The process of assessment, feedback and goal setting, and connection to services was to be 

repeated every six months.

Figure 1: Program Logic Model

Inputs Intervention Outcomes 

Agency partners 

provide:

• Recruitment 

support

• Evidence-based 

programs

• Other services 

in-house

• Referrals for 

outside services

 

United Way provides:

● Funding for 

Family CheckUp Specialists to 

deliver Family 

Check-Up 

model

● Technical 

assistance

● Financial 

assistance

● Evaluation 

support

Families who receive the 

Family Check-Up model 

will receive:

● Assessments of 

strengths and 

potential 

problems

● Motivational 

interviewing to 

identify goals and 

provide coaching

● Services to 

achieve identified 

goals

● Follow-up to 

monitor progress 

and keep on track

Families who receive the Family Check-Up 

model are expected to demonstrate 

greater self-sufficiency as evidenced by:

● Increased ability to meet basic 

needs

● Increased social supports

● Increased parenting skills

● Improved feeding practices

● Decreased behavior problems

 

Children in families who receive the Family 

Check-Up model are expected to 

demonstrate improved development as 

evidenced by: 

● Fine motor skills

● Problem solving skills

● Social development

● Social-emotional health
United Way for Southeastern Michigan 11

Research Questions

Implementation Questions

The primary purpose of this study was to document the implementation of the GOALS model in 

five agencies serving the greater Detroit area. The study was designed to answer the following 

questions about the implementation: 

Confirmatory Questions

The study was to address several confirmatory questions about the implementation of the

GOALS model.

1. How successful is GOALS in enrolling families? i.e., How many families enroll?

2. What are the characteristics of families who enroll? In addition to their demographic 

characteristics, what kinds of needs are identified at the time of enrollment?

3. How well is GOALS implemented? Do families move from assessment to services and 

continue engagement in services?

4. What services do families receive? Do families who receive the GOALS model participate in 

more services than families typically do?

5. How long do families continue to participate in GOALS? Do families who participate in 

GOALS participate longer in services than families typically do?

6. Do families who participate in GOALS improve levels of self-sufficiency as demonstrated by 

improved ability to meet basic needs, parenting skills, social supports, feeding practices and 

reduced risk behaviors?

7. Do children whose families participate in GOALS improve levels of development as 

demonstrated by improved communication skills, problem solving skills, social development, 

social-emotional and health?

Exploratory Questions

The study was to address two exploratory questions about the implementation of GOALS. 

1. Is the amount of improvement a family experiences increased by the number of services 

received?

2. Is the amount of improvement a family experiences increased by the length of time they 

participate in the program?

Impact Questions and Findings to Date

Confirmatory Questions

At the study’s start, we intended to determine moderate level impact, but were limited to 

exploratory impact questions due to changes in CNCS’ funding model, which reduced the 

study’s timeframe. 

Exploratory Questions

An exploratory impact study to determine the effects of participation in the FCU model was 

possible and, despite no longer being required to do so, United Way chose to include an 
United Way for Southeastern Michigan 12

exploratory impact analysis. The study was designed to provide evidence to answer the 

following questions about the impact of GOALS. 

1. Do families who receive the FCU model make significantly greater improvements in selfsufficiency compared to families who only receive standard services as evidenced by 

improved:

a. Parenting skills

b. Ability to meet basic needs

c. Social supports

d. Risk behaviors

e. Feeding practices

2. Do children in families who receive the FCU model make significantly greater 

improvements in development compared to children in families who only receive normal 

services as evidenced by improved:

a. Communication skills

b. Problem solving skills

c. Social development

d. Social-emotional health

Contribution of the Study

Level of Evidence Targeted by the Impact Study

This study documents the ability to implement the Family Check-Up (through our GOALS 

adaptation) among a low-income population, many of whom are first generation Arabic and 

Spanish speaking immigrants, and a quarter of whom identify Arabic or Spanish as the language 

of their home. The study assesses the implementation of the model among such populations 

and seeks a preliminary level of evidence. While the original plan targeted a moderate level of 

evidence, and despite the changes necessary to address the shortened period of performance, 

the exploratory portion of the evaluation had a sample size that is adequate for the study to 

contribute to preliminary evidence as described in the Findings section. 

Strengths and Limitations of the Implementation Study

The shifting landscape stemming from the length of the study being shortened and the onset of 

COVID-19 required nimbleness on the part of United Way and its partners to continue to serve 

families well and created several unique strengths and limitations.

The backend of this model was complex to set up and implement, but the outward relationships 

to the families served were simple and straightforward. United Way, five non-profit agencies, 

Philliber Research and Evaluation, consultants from Wayne State University, and private financial 

and strategy consultants worked closely together to design, implement, monitor, and evaluate 

the model. Jointly, assessments were selected, trainings developed and modified, forms 

designed, data collected and analyzed, case management provided – all as a group. Required 

matching funds were raised and monitored for compliance. The collaborative manner in which 
United Way for Southeastern Michigan 13

the model was managed allowed for synergies to develop and granted agency to the families 

(as they used assessment feedback to help develop their own goals) and to the partner agencies 

(as they offered best practices/programs of their own agencies and directed families to 

resources they did not provide when necessary). 

A pilot phase (October 1, 2017 - February 1, 2018) allowed for creation and modification of the

study’s Family Profile Form and refinement of the randomization protocol and also tested staff’s 

ability to employ the data platform Efforts to Outcomes by Social Solutions (ETO) effectively.

FCMSs received training in the FCU model and worked with a small number of families to learn 

how to implement.

In terms of staff, caseworkers had the opportunity to learn assessments and to earn a 

certification in the Family Check-Up. One of the United Way project team consultants became a 

certified Family Check-Up supervisor and trainer. Data specialists and staff who worked with the 

comparison families learned how to use ETO. Staff met regularly as part of Learning 

Communities to share best practices and collectively problem solve. A challenge in staffing - 

one often seen in this sector and in early childhood education - stemmed from turnover and 

from staff taking parental leave. This sometimes impacted who the families met with, so trust 

and relationships needed to be redeveloped. While there was also turnover at United Way and 

Philliber, there was enough continuity to mitigate most negative effects. 

Not all families were primary-English speakers, which 

required that assessments and forms be translated into 

Arabic and Spanish, and some of the response formats 

were adapted to be more culturally appropriate. These 

translations are now available for the community and 

some, such as the READY4K texting pathway, 

nationwide. Translations, however, did not address 

cultural differences, which had to be handled on a caseby-case basis. The Family Check-Up certification 

requires a caseworker to be videotaped during a family 

session. There was concern at the onset that given the 

political climate and policies toward Arabic immigrants 

following the election in 2016, that large numbers of families might be reticent. This did not 

turn out to be the case. On the other hand, the concept of setting personal goals, rather than 

community goals, was a new idea to some of the families.

When COVID-19 hit and disproportionately affected people in Detroit, communities of color 

and low-income neighborhoods, the project needed to go virtual. The implementation 

transition was almost seamless. One assessment (PICCOLO) had to be dropped because it was 

decided that a virtual assessment of parenting was not feasible, but otherwise the project 

continued virtually. 

“Being that I worked with families 

who primarily did not speak 

English as their first language I was 

able to help simplify documents 

and be an additional support for 

them.”

- Family Check-Up Model 

Specialist,

Leaps & Bounds Family Services
United Way for Southeastern Michigan 14

COVID-19 affected both intervention and comparison families and was a discrete event, so we 

do not believe that it adversely affected the impact part of the evaluation.

Connection of this Implementation Study to Future Research

The evaluation of the GOALS program contributes to the existent literature in a number of 

important ways. The FCU, as noted above, has been well-studied and subjected to two 

relatively large-scale randomized control trials of families with young children. However, in the 

GOALS program the FCU has been extended in several important ways. First, as far as we know 

it will be the first empirical study examining the implementation of an FCU-style intervention on 

a community systems-level scale. This evaluation will allow for a preliminary assessment of the 

impact of having multi-agency coordination and community-wide resource access available to 

FCMSs. This will provide valuable information to the field about the potential scalability of an 

FCU-style intervention as well as broaden the scope of family supports that can be provided, 

which would typically be beyond the capacity of any one agency. Secondly, Dishon, Shaw, and 

colleagues (e.g., Dishion et al., 2008) extended the original FCU from a pre-teen / adolescent 

intervention to an early childhood intervention. The GOALS project takes this extension further 

by including families with newborns to toddlers, as well as early childhood. 

We know from a large body of research that the period between 0-3 is critically important for 

setting the stage for positive development across the lifespan as well as overall family 

functioning (https://www.zerotothree.org/). The potential for promoting positive long-term 

effects through a comprehensive but scalable intervention during this critical developmental 

period for children and families is tremendous. The effects of interventions like GOALS have the 

potential to be more empowering and self-sustaining within the family because it potentially 

puts the entire family on a different developmental trajectory from the beginning. Finally, no 

intervention is one-size fits all, but the GOALS program has separated out universal program 

components and culturally adaptable implementation strategies, and the evaluation includes a 

target population with a unique constellation of cultural, racial, and ethnic diversity. The large 

proportion of MENA (Middle Eastern, North African, Arabic) families in our sample is particularly 

salient here because these families have been largely absent from previous studies. The study 

was also able to add several measures to analyze the impact of COVID-19 on families and future 

research might look at the specific long-term effects of COVID-19 on these families. In summary, 

the GOALS program contributes to the broader literature on early childhood and family 

prevention substantially across multiple domains. 
United Way for Southeastern Michigan 15

Study Approach & Methods 
United Way for Southeastern Michigan 16

STUDY APPROACH AND METHODS

Data System

With an already established financial relationship with Social Solutions through other related 

programs and a well-trained internal staff member, selecting Efforts to Outcomes (ETO) was a 

straightforward process. ETO is a HIPAA compliant case management and customer 

relationship management system with comprehensive security protocols and unique formbuilding tools. 

With experience building two other databases using Social Solutions’ proprietary system, the 

program was able to leverage internal staff capacity to begin the build-out and maintenance 

process in house. As assessments shifted post-pilot and necessary changes were implemented 

throughout the course of the program, having easy access to report building and assessment 

editing facilitated a nimble and responsive build out experience. While using said proprietary 

system did limit some of the staff's ability to code some of the more complex assessments, 

automated scoring was eventually successful for most assessments. Several of the ASSM 

domains in the Family Profile Form remained challenging to automate scoring on and hand 

scoring was required. 

Implementation Study Design

An implementation evaluation was conducted to determine the ability to successfully implement 

an adapted version of the Family Check-Up to improve self-sufficiency and child development 

readiness for families in low-income communities. The study used a series of markers including

recruitment (sampling/eligibility and strategy), enrollment, randomization protocols, retention, 

receipt of services, and fidelity to the model.

Recruitment: Sampling Plan & Eligibility

Participants living in the Southeast 

Michigan counties of Wayne, Oakland, or 

Macomb were eligible to participate in 

GOALS if they met the criteria listed in the 

call-out box here.

Families that did not meet the income 

requirements were still eligible if they 

resided in a zip code determined to be 

automatically eligible. Zip codes preidentified as being automatically eligible 

met at least one of three criteria: high 

concentration of poverty, high 

concentration of children five and under 

living in poverty, or a high concentration of 

GOALS Eligibility Criteria: 

● Earned less than 200% of the Federal 

Poverty Line (based on the year of 

enrollment) or lived in a zip code 

deemed automatically eligible for 

service regardless of income as 

outlined below.

● Were at least 18 years of age.

● Had at least one child aged 5 years or 

younger.

● Were the legal guardian of that child.

● Lived within the tri-county region 

(Wayne, Oakland, and Macomb 

Counties) at the time of recruitment.
United Way for Southeastern Michigan 17

school-aged enrollment in the free/reduced school meal program. Concentrated is defined by 

the United States Census Bureau as a threshold of at or above 40% of the population. 

Recruitment: Strategies 

Agencies were asked at the beginning of the project to outline their recruitment strategies. A 

combination of strategies was recommended including posting flyers, advertising at community 

events, recruiting from the agencies’ existing programs, and word of mouth. Most of the 

agencies used all of these strategies to recruit families at some point over the course of the 

study. For example, each agency created a flyer to post in their buildings and throughout their 

communities that gave information about the study and how to join (See Appendix B for an 

example of the flyers). All recruitment flyers were approved by the Advarra IRB (See Appendix 

AA for a full description of human subjects protections in place during the study) and adjusted 

when the amount of evaluation supports a family could receive increased, and again when 12-

month follow-up sessions were no longer applicable to newly enrolled families. An overview of 

the recruitment strategies used by each agency can be found in Appendix C. 

Taking into account the eligibility criteria and to support efficient enrollment at the network 

level, each partner agency identified recruitment zones that represented target zip codes where 

the agency was already actively serving clients. Recruitment zones were not meant to be 

exclusive; rather, they provided a snapshot of the agency’s service footprint. If a family lived 

outside of an agency’s recruitment zone and sought services from that agency, the agency was 

not precluded from serving them. The family’s existing relationship with the agency, the cost 

and feasibility of transportation for the family and staff members, as well as other factors were 

considered before a decision was made about whether the agency would enroll the family in 

their GOALS study or provide a warm hand-off to another partner agency whose target 

community included the family’s home. Each agency had its own self-selected enrollment 

targets that were determined based on overall agency make-up and capacity, project budget, 

and evaluation needs. Maps of each agency’s recruitment zones can be found in Appendix D. 

It should be noted that there was a significant shift in recruitment strategy at the beginning of 

the project, as United Way had identified a unified recruitment strategy that they were unable to 

implement. The strategy consisted of creating a network of agencies (partners and others) to 

provide families with a Baby Box – a cardboard box filled with materials for families that can also 

be used as safe-sleep space and is based on the Finnish safe-sleep intervention that has been in 

existence since the 1930s – to both promote safe-sleep and the GOALS project. However, local 

concerns around optics, safety, and liability ultimately resulted in United Way not using that 

strategy. 

In response to the Baby Box feedback, United Way adjusted the recruitment strategy by instead 

creating Baby Bundles. These Baby Bundles were a diaper bag give-away filled with caregiving 

essentials and parenting materials aimed at supporting a child’s development. In an effort to 

support parent engagement and recruitment efforts, all partner agencies had access to Baby 

Bundles on an as needed basis. 
United Way for Southeastern Michigan 18

United Way also utilized their connections with other service agencies throughout the GOALS 

service areas to get Baby Bundles out into the community. These agencies distributed the 

bundles through their programs and community events and completed the brief form found in 

Appendix E. Once per month the recipient information from these Baby Bundle Distribution 

Forms was filtered by zip code and sent to the GOALS partner agency serving the area. The 

partner agency would then reach out to the parent to discuss possible participation in the study. 

Over the course of the entire project over 2,000 Baby Bundles were distributed throughout 

Wayne, Oakland, and Macomb Counties.

Parents interested in enrolling into the study were asked to fill out a Recruitment Form 

(Appendix F) which included their name, address, phone number, age, and list of children with 

gender and age. After the form was returned, a GOALS staff member verified that the zip code 

in which the parent resided was included in the list of automatically eligible zip codes. If a 

parent’s zip code was not automatically eligible, the SIF staff member was instructed to verbally 

confirm (either in person or via phone) that the parent met income eligibility requirements. 

These verifications were recorded on the Recruitment Form. 

Additionally, an online platform was developed using Microsoft Forms to track Baby Bundle 

recipient information along with the corresponding paper distribution form. Agencies were 

required to complete the Baby Bundle Distribution Form for each participant receiving a bundle 

within 30 days of receipt. Information could either be collected on the paper form and inputted 

into the online database or could be entered directly into the database via a tablet. 

Enrollment Goals

When GOALS was designed, an objective was set to enroll 1050 families in order to have 

enough participants to provide sufficient power for a valid impact study. Late in the third year, it 

became apparent that the enrollment goal would not be reached by the original deadline of 

April 30, 2019. United Way conferred with Philliber regarding the length of time needed to 

complete a final analysis. As a result of these conversations, the enrollment period was 

extended to December 31, 2019. The final date for data collection was also extended from 

April 30, 2020 to August 31, 2020. This extension would give partner agencies more time to 

recruit and enroll families, but also meant that any family enrolled after June 30, 2019 would not 

receive a 12-month follow-up session. It was also decided at this time that families would not be 

receiving an 18-month follow-up as originally designed so that agencies could focus more 

energy on recruitment. 

Randomization Protocols and Study Retention

Philliber designed randomization protocols for each of the five partner agencies (See Appendix 

G). It is of note that randomization strategies varied based on how agencies were recruiting 

families into the project. All of the agencies were using some combination of the following 

three strategies: recruiting families from existing programs within their agencies, recruiting 

families through flyers and word of mouth, and recruiting families at wide scale community 
United Way for Southeastern Michigan 19

events. Once families were recruited into the study, agencies were instructed to follow the 

randomization protocol to assign them to the intervention or comparison group. 

Initially, the randomization protocols instructed agencies to begin the randomization process for 

families recruited via word of mouth or at large recruitment events as soon as they expressed 

interest in the project. Families who expressed interest in the study were immediately randomly 

assigned to either the intervention or comparison group by the agencies. The agencies would 

then follow up with families to set up the initial assessment appointment. There was often a gap 

of days or weeks between when a family initially expressed interest and when they were 

contacted by the agency to set up an appointment. Agencies found that some families lost 

interest during that time period and never actually enrolled in the study. Other families, 

particularly those recruited at large community events, may have never been interested or may 

not have understood what enrollment in the study entailed. As a result, a large number of 

families who were randomized early in the study never actually enrolled in the study. This led to 

high baseline attrition numbers.

In order to reduce baseline attrition, Philliber and the United Way worked with agencies in 

February of 2019 to revise enrollment and randomization protocols. Under the new protocols, 

agencies did not immediately randomize families that expressed interest in the study. Instead, 

the agencies recorded contact information from these families and let the families know that 

they would receive a call from the agency when there was room to immediately enroll new 

families into the study. Whenever Family Check-Up Model Specialists and Data Collection 

Specialists had appointment times available, families were contacted to determine if they were 

still interested in enrolling in the study. Families were also given more information about what 

was involved in the study and asked whether they were ready to set up an initial appointment 

right away. If the families expressed both that they remained interested in enrolling and that 

they were prepared to set up an appointment immediately, they were offered a spot in the 

study. After the phone call, the agency would randomly assign the family to the intervention or 

comparison group using the updated randomization protocol. If a family was randomly 

assigned to the intervention group, a Family Check-Up Model Specialist immediately contacted 

them to set up the first appointment. If a family was randomly assigned to the comparison 

group, a Data Collection Specialist immediately contacted them to set up a first appointment. 

Additionally, onsite randomization protocols were developed to be used strictly for families that 

presented themselves to the agency and were ready to enroll in the study and complete their 

data collection session with an FCMS or DCS immediately onsite. These protocols can be found 

in Appendix H. These protocols were not to be used if a family and/or FCMS or DCS were not 

readily available.

In addition to the protocol changes, the support provided to families for participating in the 

study increased. Instead of receiving $25 for each set of assessments, families were given $50 

for each set of assessments. After these changes, the baseline attrition rate, which was 

monitored monthly, began to decrease. 
United Way for Southeastern Michigan 20

What do families receive?

GOALS families received the adapted FCU model and worked with a Family Check-Up Model 

Specialist (FCMS) who took them through a process where they completed assessments at 6-

month intervals that identified their strengths and potential domains for improvement as well as 

those of their children. Participants identified areas they wanted to strengthen and set goals 

they wished to attain through comprehensive feedback sessions. The FCMS recommended 

GOALS pathway programs and other non-pathway services (often using the 2-1-1 information

and referral hotline) that could help them achieve those goals. For each timeframe (baseline, 6-

month, and 12-month), the entire process typically took place over the course of three or more 

appointment sessions. 

Depending on the recruitment method, comparison families were provided the services they 

were originally seeking from the agency and/or a standard list of referrals from the agency 

without the additional support of the FCMS. Comparison families were also assessed in 6-

month intervals using the same assessments as GOALS families with the exception of the 

PICCOLO (a description of this assessment is given later in the report). These families also 

received a less intensive feedback session (see Appendix O) by their assigned Data Collection 

Specialist and were given a list of pre-determined resources based on their assessment scores. 

This process typically took place over the course of two appointment sessions.

Figure 2: Comparison vs. Intervention Process
United Way for Southeastern Michigan 21

Fidelity of Implementation

To maintain fidelity to the implementation of the model, monthly reporting between agencies 

and Philliber were used to track randomization protocol adherence, assessment completion, 

and participant enrollment. Eligibility, as determined by the participant’s Recruitment Form, was 

established before the actual enrollment process and validated using the Participant Intake 

Form. Monthly summaries examining follow-up rates, feedback session completion rates, and 

enrollment rates were used to both monitor attrition rates and proximity to enrollment goals.

Impact Evaluation Design

The evaluation was initially designed as a randomized controlled trial. However, in the early 

months of the study there were higher than expected baseline attrition rates and lower than 

expected follow-up rates. This, coupled with a shortened recruitment window, led to a redesign. 

The project worked to address these setbacks and continued to operate within an experimental 

framework. The goal of the evaluation was to determine the effects of participation in this 

adapted version of the FCU model. The study used a series of assessments to determine growth 

in specific areas that may impact families. Parenting skills (determined by both the Family Profile 

Form and PICCOLO for GOALS families), the ability for families to meet basic needs, family 

vulnerabilities, protective factors like community involvement and social supports were markers 

for areas of growth for parents.

The impact of the FCU model on child development was explored using several 

developmentally appropriate assessments and screens, including the ASQ-3, ASQ:SE-2, the 

Rothbart Temperament Scale as well as the Family Profile Form.

GOALS Program Design

One of the adaptations to the standard FCU model made for this study involved changes to the 

assessment package typically used in the FCU model to determine a family’s needs. A number 

of assessments were used to support families and the evaluation. 

Assessments 

The assessments used for GOALS were aimed at one primary child and one primary parent but 

gave a picture of the larger family context as a whole. According to Arizona State University’s 

Research and Education Advancing Children’s Health institute (REACH): 

Ecological assessment allows us to assess and learn about child behavior and 

well-being with each of these different relationships/contexts/perspectives. A 

multi-contextual assessment of the whole of the child’s ecology gives us a 

broader picture and promotes a better understanding about child and family 

well-being as well as providing more opportunities to find strengths and to 

identify issues (2016). 

Following is the description of each assessment/screening tool utilized during the study.
United Way for Southeastern Michigan 22

The Family Profile Form: Beginning in May 2017, a committee comprised of United Way staff, 

Philliber, site managers from four partner agencies, FCU model specialists, and three 

consultants from Wayne State University and Here2There, LLC developed a questionnaire based 

off of the Arizona Self-Sufficiency Matrix (ASSM). A full description of how this was developed 

and tested for reliability and validity can be found in Appendix I. This questionnaire, known as 

the Family Profile Form, was used to assess 17 key family-functioning domains: housing, income, 

food, adult education, employment, transportation, health care access, mental health, substance 

abuse, disability, childcare, child education, parenting skills, family social supports, community 

involvement, safety, life skills, and judicial system involvement (labeled “legal” in the ASSM). 

You can find the full Family Profile Form and Scoring Guide in Appendices J and K. 

The Protective Factors Survey (PFS) was included in the Family Profile Form. The PFS measures 

protective factors in five areas to prevent child abuse and neglect: family functioning/resiliency, 

social support, concrete support, nurturing and attachment, and knowledge of parenting/child 

development. The PFS is validated for use with parents of children of all ages. Scores can range 

from 1 to 7. A higher score reflects a higher level of the protective factors.

Ages & Stages Questionnaires: The Ages & Stages Questionnaires - 3rd Edition (ASQ-3) and the 

Ages & Stages Questionnaires: Social-Emotional - 2nd Edition (ASQ:SE-2) are widely used 

developmental screening tools that assess core domains of development during infancy and 

early childhood. Specifically, the ASQ-3 assesses gross motor functioning, fine motor 

functioning, problem solving, communication, and personal/social development. The ASQ-SE:2 

assesses social-emotional aspects of development as well. These are parent or parent report 

measures that do not require extensive training to administer. Both ASQs use age-graded 

norms to indicate levels of developmental delay or “risk” at a given age. 

Rothbart Temperament Scales: Parents of target children aged three months and older 

completed two scales from an age appropriate Rothbart Temperament Scale for children. 

Parents of target children between the ages of three and 12 months completed the Infant 

Behavior Questionnaire (IBQ-R). Parents of target children between the ages of 13 and 36 

months completed the Early Childhood Behavior Questionnaire (ECBQ). Parents of target 

children ages three years and older completed the Children’s Behavior Questionnaire (CBQ). It 

is of note that there is no Rothbart Temperament Questionnaire specifically designed for 

children between the ages of 13 and 17 months. For the purposes of this study, parents of 

children in that age range were instructed to complete the ECBQ.

 

The IBQ-R and ECBQ are parent report assessments comprised of 7 and 12 items respectively. 

Items are on a 7-point Likert scale. Both the IBQ-R and ECBQ have acceptable psychometric 

properties with Cronbach's alphas ranging from .72 - .75. 

The two Rothbart Temperament sub scales used for this study were the Effortful Control scale 

and the Negative Affect scale. Effortful Control refers to the dimension of temperament that 

relates to a person’s ability to maintain sustained attention and focus and regulate their own 
United Way for Southeastern Michigan 23

behavior (Rothbart, Ellis, Rueda, & Posner, 2003). Negative Affect relates to the part of 

temperament that involves a person’s ability to cope with negative emotions (Putnam, Gartstein, 

& Rothbart, 2015). 

Feeding Your Child: The Feeding Your Child questionnaire is a 15-item questionnaire about the 

practices parents use when feeding their children. The items use a 4-point Likert scale rating 

different practices based on how frequently they used each practice. This survey was included 

as part of the GOALS project because it is a key assessment in the Feeding Eating and 

Succeeding Together (FEAST) pathway which is a GOALS pathway. The Feeding Your Child 

questionnaire can be found in Appendix L. 

PICCOLO: The Parenting Interactions with Children Checklist of Observations Linked to 

Outcomes (PICCOLO) assesses positive parenting based on observations of interactive parentchild play activities. In the study, only intervention families were given the PICCOLO assessment. 

In GOALS, parent-child play occurred during the assessment session for families who were 

randomized to the Family Check-Up condition. Specific toys and other materials for the parentchild play activities were agreed upon by agency managers and Family Check-Up Model

Specialists (FCMS) across sites. Materials were developmentally appropriate, meaning that many 

of the play materials differed for infants, toddlers, and preschool-aged children. FCMSs typically 

scored the PICCOLO from video recordings of the play session, unless families declined to have 

their play sessions recorded. The PICCOLO includes 29 items across 4 domains: Affection, 

Responsivity, Encouragement, and Teaching. Each item is scored as 0 (not at all there), 1 (barely 

there), or 2 (mostly there). Each item focuses on a specific observable parenting behavior (e.g., 

“Speaks in a warm tone of voice.”). Each PICCOLO domain is scored by tabulating the sum of 

the 7 to 8 items in the domain. FCMSs received training in PICCOLO scoring and the PICCOLO 

manual provides detailed explanations to guide scoring decisions for individual items. 

Case Closure Form: Halfway through the study, FCMSs and DCSs expressed that the current 

assessments did not show the incremental growth families experienced while participating. As a 

result, the Evaluation Team created a Case Closure Form for specialists to complete after their 

final feedback sessions with a family. This form was completed by the FCMSs and DCSs and 

allowed them to provide feedback about whether and how much families had shown 

improvement while enrolled in the program. This form was not completed for families that had 

closed out their cases with a specialist that had already left the program by the end of March 

2020. Specialists who worked with a family solely for case closure were also not required to 

complete the form if they were uncomfortable commenting on the growth of the family. The 

Case Closure Form can be found in Appendix M. 

Feedback Sessions

Every family enrolled in the GOALS program received a feedback session that reviewed the 

family’s strengths and areas in need of attention, as reflected in the assessments listed above. 

Families enrolled in the GOALS program received the Family Feedback Form found in 
United Way for Southeastern Michigan 24

Appendix N. On these forms, FCMSs marked where the family fell on the scale from Strength to 

Needs Attention for each area listed. FCMSs used these forms to guide their conversations with 

families and to help parents reflect on how they saw their family. FCMSs were instructed to ask 

parents if the strengths and areas of improvement aligned with how the parent viewed their 

family. 

After reviewing results from the assessments GOALS families worked with their FCMS to set 

SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals that supported the 

family’s growth. Family goals could be small (e.g., cleaning out the garage) to life-changing 

(e.g., obtaining a GED). After goals were set, FCMSs completed the Family Goals Form (see 

Appendix P) with the family that included three goals, steps to reach the goals, and resources 

needed. A copy of this colorful sheet was given to families, who, based on the successful past 

use of a similar tool by one of the partner agencies, were encouraged to display it somewhere in 

the house it would often be seen (e.g., the refrigerator).

The last part of the feedback session included providing 

resources and referrals for the family. Referrals were 

made based on growth areas that needed attention as 

highlighted in the Family Feedback Form, as well as on 

goals that the family had set. FCMSs were instructed to 

enter their Feedback Session prepared with a menu of 

resources to which they could refer the family, but to be 

prepared to only share as much information with the 

family as was appropriate based on their interest in 

resources and their capacity for follow-through. Referrals 

were made to pathway programs as described below, to 

2-1-1 – a United Way managed information and referral hotline, and/or other community and 

agency resources.

Pathways were a portfolio of evidence-based programming offered by each of the GOALS 

partnering agencies. These previously established programs were adapted to support a “no 

wrong door” approach to offering services. This approach allowed families to be referred into a 

pathway when assessment data indicated a need, but also allowed families to be recruited into 

GOALS from a pathway program. 

Prior to the selection of pathways, three need areas were identified as being focal points of the 

GOALS project: Parenting Education, Health Care Access and Support; and Nutrition/Family 

Feeding Practices.

To be considered for the GOALS project, all pathways were required to meet specific criteria:

● Aligned with the key need areas.

● Had measurable outcomes or data to reflect participation success, such as pre-/post-test 

or other measurements.

“Resources can be difficult to 

navigate and take time and 

perseverance that families in 

crisis often must use 

elsewhere.”

- Family Check-Up Model 

Specialist, Oakland Family 

Services
United Way for Southeastern Michigan 25

● Ability to reflect gains in relevant assessment areas of GOALS.

● Were on-going, rather than episodic or one-time.

● Did not address significant or complex crisis situations or offer specialized services. 

FCMSs were trained to address crisis situations immediately and refer to specialized 

supportive services when needed.

After implementation of GOALS began, pathways were occasionally added if there seemed to 

be a large need based on participant assessment data. The final list of pathways and 

descriptions can be found in Appendix Q. 

The process for referring into pathway programs varied depending on the home agency of each 

FCMS. Should a specialist refer to a program within their own agency, the FCMS followed their 

agency’s internal protocols. For pathway programs existing outside their own agency FCMSs 

adhered to the referral protocols that were included in the GOALS Implementation Manual for 

each program. 

Families whose need(s) could not be met through a GOALS pathway were either referred to 

other programs within the partner agency, to the 2-1-1 information and referral hotline, or to 

programs outside the five SIF partner agencies. These referrals often addressed more 

immediate needs like food, utility assistance and housing, as well as hard to find services like 

transportation and material goods. FCMSs who needed to make a referral to a community 

resource for an identified basic need were encouraged to call 2-1-1 together with their family 

during the Feedback Session. Referrals made outside of the partner agencies and 2-1-1 were 

based on the FCMS’s knowledge of local resources. 

Referral Follow-Up 

In the months following the feedback session FCMSs occasionally reached out to families for a 

brief check-in. Families would report on if they had successfully connected with the resources 

provided and received additional resources/referrals if needed. FCMSs also used this time to 

check if parents had made any progress towards the goals they had developed during their last 

feedback session. These check-ins were often arranged around key dates in a family’s goals. 

Preparing for the GOALS Program

The Family Check-Up Training and Certification

All Family Check-Up Model Specialists (FCMS) received structured training in the Family Check 

Up (FCU) model. Initial training consisted of two primary components: E-learning that was 

available via Arizona State University’s Research and Education Advancing Children’s Health 

(REACH) Institute website and in person learning. E-learning was completed before the in 

person learning and included several modules that provided an overview of the three core 

components of the FCU (the Initial Interview, Assessments, and the Feedback Session) as well as 

the FCU’s “COACH” fidelity rating system. E-learning also included quizzes to assess basic 

knowledge of the components. In person learning included approximately one day of didactic 
United Way for Southeastern Michigan 26

learning of FCU components along with several opportunities to perform role plays of specific 

aspects of the FCU.

The first in person FCU training took place in September 2017 at Wayne State University and 

was led by two certified FCU trainers who are affiliated with the REACH Institute. FCMS who 

joined the GOALS project after September 2017 also completed e-learning and in person 

training that was led by either a certified FCU trainer affiliated with the REACH Institute or Dr. 

Christopher Trentacosta, a United Way consultant and Associate Professor of Psychology at 

Wayne State University who became a certified FCU supervisor and trainer in June 2018. The inperson training that was conducted after September 2017 followed the same overall structure, 

but typically included smaller groups of 2 to 3 FCMSs.

FCMSs were also encouraged to pursue certification in the FCU. Certification involved pre- and 

post-feedback consultation with REACH Institute providers or Dr. Trentacosta, project 

consultant, who also rated the FCMS’s video-recorded Feedback Sessions using the COACH 

rating system. FCMSs who received COACH ratings at the “component” level or higher for all 

five COACH domains for two cases became certified. Many FCMSs became certified in the FCU; 

however, several FCMSs did not become certified, either because they chose not to pursue 

certification or because they left their position before completing the certification process. 

Unfortunately, the COVID-19 pandemic interfered with some FCMSs becoming certified since 

sessions with families were no longer being held in person.

Assessment of Program Readiness

United Way provided ongoing comprehensive training and support to partner agencies to help 

them implement The Family Check-Up model. Surveys were conducted during the pilot phase 

to gauge how prepared FCMSs felt for the implementation phase of the project. Appendix R 

shows a summary of the survey responses from 20 of the initial 22 agency staff persons either 

working directly with families (n=11), serving as supervisors (n=5), or serving in some other 

capacity (n=4) after initial program training.

At the conclusion of the four-month pilot phase of the project, evaluators submitted a pilot 

report that provided a comprehensive overview of successes and challenges that arose during 

the pilot. Key findings and actions included the following:

● All agencies developed appropriate plans to recruit the required number of participants. 

This process required a full understanding of the research design and resources available.

● The content of instruments used to describe the study to participants was majorly revised 

to align with the intervention. The wording of some instruments used to capture study 

outcomes was slightly modified to align with the Family Check-Up Model Specialists’ 

(FCMS) perception of how best to ask questions of participants. All instruments were 

translated to Spanish and Arabic.
United Way for Southeastern Michigan 27

● The majority of staff members were prepared for implementation as a result of the training 

provided by United Way, and confidence grew during the pilot.

● Staff were able to learn to use the Efforts to Outcomes (ETO) data management system to 

log information; however, ETO was still undergoing many changes at the end of the pilot 

and had not yet reached full functionality. 

● Agencies used the trainings and pilot period to become familiar with how the intervention 

differed from their normal standards of care, how recruitment and randomization would 

work, and how measurements and protocols were related to the project goals.

Fidelity to GOALS Program Design

GOALS utilized a variety of data points in the Efforts to Outcomes database to monitor fidelity in 

various aspects of the Family Check-Up model implementation. The components that were 

monitored on an on-going basis were the FCMS using light-touch intervention to work with 

families, completing assessments, setting goals, and making referrals to services.

Light-touch Intervention

GOALS was designed to be a light-touch intervention for 

families in need. In an effort to gauge how often FCMSs 

communicated with their families, United Way created a 

Communication Log. Knowing that different communities 

would require different communication strategies, United 

Way established a protocol to determine the volume and 

intensity of efforts to connect in-person and virtually with 

our participants. The process involved identifying the 

type of contact, meeting timeframe and type, time of the 

meeting, and robust note-taking procedures. Each time 

an FCMS contacted a participant, or was contacted by a 

participant, they recorded the communication as a “touchpoint” in the ETO database. 

Partner agencies were responsive to their populations’ communication styles, with unique 

experiences in terms of chosen communication mechanisms. Leveraging technology, FCMSs 

and DCSs were able to be responsive to the ways a participant needed to communicate.

Assessments

The assessment package varied slightly from family to family based on the age of the focus 

child. Specialists were instructed to select assessments based on the focus child age as outlined 

in Figure 3. ETO designation referred to which family member (parent or child) on which the 

assessment was based. 

“It often seemed that 

sometimes what families 

needed most was just a caring 

ear, a warm heart, and the 

validation of their reality.”

- Family Check-Up Model 

Specialist, Oakland Family 

Services
United Way for Southeastern Michigan 28

Figure 3: Assessment Matrix

Assessment Age Range ETO 

Designation

Family Profile Form / Arizona SelfSufficiency MatrixAll ages Parent

Feeding Your Child 2 and up Parent

ASQ-3 All ages, select the 

appropriate questionnaire 

based on child’s birthday

Focus Child

ASQ:SE-2 All ages, select the 

appropriate questionnaire 

based on child’s birthday

Focus Child

Temperament Questionnaires (Select 

One):

• Infant Behavior Questionnaire-R 

• Early Childhood Behavior 

Questionnaire

• Childhood Behavior 

Questionnaire

• IBQ-R: 3 – 12 months

• ECBQ: 13 – 36 months

• CBQ: 3 and up

Focus Child

PICCOLO parent-child interaction script 

and age-appropriate materials

4 months and up Parent

FCMSs were instructed to enter all the assessments described above into the Efforts to 

Outcomes database. Each entry included the date the assessment was taken, the timeframe of 

the assessment (baseline, six-month, or 12-month), as well as responses to each individual 

question. Scores for each assessment were automatically generated to reduce the possibility of 

errors in hand scoring. DCSs were required to use the auto-generated score. Data audits, 

which will be discussed later, were conducted throughout the study to ensure families received 

all applicable assessments and to maintain accurate records.

Goal Tracker

After feedback sessions were complete, FCMSs were required to upload the family’s goals into 

the Efforts to Outcome database. Each goal entry in ETO included the goal set, the 

corresponding ASSM domain, resources given, and goal progress. As a monitoring procedure, 

United Way pulled a Goal Tracker report from ETO to determine how many goals had been set 

by families. 

Referral Log

Regardless of the source, each referral was tracked in the Efforts to Outcomes database using 

the Family Check-Up Referral Log. A copy of this form can be found in Appendix S. This form 

captured the type of referral being made, the corresponding Arizona Self-Sufficiency Matrix 

category, as well as if the referral were made in relation to a set goal. Use of pathways were also 
United Way for Southeastern Michigan 29

captured in this way, including if a family was participating in the pathway program at the time of 

enrollment into the study. Reports were pulled throughout the study to monitor the activity in 

the Referral Log to ensure referrals were properly made and recorded. 

Program Exposure (Dosage)

GOALS families were supported using the study design of light-touch care coordination. This 

meant that families who needed intensive support and services were referred to such services 

instead of enrolled into the study. Families were able to receive check-ins more frequently if 

needed, or as the FCMS saw fit, depending on the families’ goals and needs, but were not 

expected to occur on a frequent (e.g., weekly) basis. As it was designed, GOALS families 

typically received three (or more) total visits with their FCMS: two (or more) for initial interview 

and assessments and one feedback session. Families had baseline, 6-month and possibly 12-

month sessions, depending on date of enrollment. Fidelity to this model was measured in a 

number of ways including communication logs, follow-up rates, and evaluation support reports.

Communication Logs

As mentioned earlier, all communication with participants was recorded in the Efforts to 

Outcomes database. Not only were these records used to ensure fidelity to the light touch 

intervention aspect of the Family Check-Up model, they were also used to measure the amount 

of exposure participants had to the program. 

Follow-Up Rates

Follow-up rates were also used to measure a participant’s exposure. Upon enrollment into the 

study, families were informed they would be participating in assessment sessions every six 

months for the duration of their enrollment. For families enrolled prior to June 30, 2019, this 

meant assessment sessions were conducted at baseline, six-months, and 12-months. Families 

enrolled after that date participated in assessments at baseline and six-months only. 

Families were included in the follow-up counts if they had at least one follow-up session with an 

FCMS or a DCS and had completed at least one of the follow-up assessments. Six-month followup dates were calculated by adding six months to the date of intake, while 12-month follow-up 

dates were calculated by adding 12 months to the date of intake. By September 30, 2020 

follow-up dates for all families had passed. 

Evaluation Support Reports

Evaluation Support Reports were also designed to help measure exposure to the program. 

Families did not receive their evaluation support (initially $25 which was increased to $50) until a 

feedback session had been completed for the assessment time frame (baseline, 6- or 12-

month). On rare occasions, families became unreachable between the assessment session and 

feedback session. As a result, a family missing the feedback would experience less exposure to
United Way for Southeastern Michigan 30

the program than those who completed the full set of sessions. The Evaluation Support Report 

reflected those families that may have lost touch with their agency.

Program Quality - Agency Level

Program quality was measured on two levels: the agency level and the specialist level. At the 

agency level, program quality was monitored using various monthly and quarterly tools. Data 

audits were used on an as-needed basis to monitor data entry quality as well. 

Monthly Summaries

Multiple methods were used throughout the study to maintain a high level of program quality. 

Philliber Research and Evaluation provided a Monthly Summary to United Way documenting 

how many participants had enrolled to date and how many follow-up assessments had been 

completed. The summary also reported on the 

characteristics of families enrolled as well as 

baseline scores for the various assessments 

described in previous sections. Separate 

monthly summaries were created for each 

partner agency as well that included agency-level 

enrollment information and combined 

assessment findings across agencies. These 

agency-level summaries helped agency program 

managers also keep track of their program’s 

performance. United Way and the project 

evaluation team reviewed each monthly 

summary during one of their bi-weekly evaluation calls. During these calls, the evaluation team 

would discuss any ongoing implementation concerns or those that arose over the past few 

weeks. 

Monthly Manager Meetings

United Way, Dr. Trentacosta, and all partner agency program managers met on a monthly basis. 

These meetings were used to provide updates from both agencies and United Way as well as to 

address any portfolio-wide concerns that arose in the last month. The group often worked 

collaboratively to address problems agencies were facing while implementing the study. Some 

of the topics that were addressed were recruitment struggles, attrition, follow-up rates, and staff 

retention. 

Monthly Agency Site-Visits

Once per month the SIF Manager from United Way met with the program manager at each 

agency. These meetings were used to provide updates from both parties as well as to address 

Monthly Monitoring Tools

• Summaries from Philliber

• All-Agencies Manager Meetings

• Agency Site Visits with United Way

Quarterly Monitoring Tools

• Evaluation Site Visits with Philliber

• Agency Monitoring Reports

• Agency Progress Reports
United Way for Southeastern Michigan 31

questions and/or concerns United Way or the agency had regarding implementation. Notes 

were taken and shared with both parties following the conclusion of the meeting. 

Quarterly Evaluation Site Visits

Philliber conducted quarterly site visits with each agency. Most of these site visits occurred in 

person. However, weather conditions and the global health pandemic dictated that some of 

these site visits be conducted virtually. Detailed site visit guides were developed to facilitate a 

structured conversation about project implementation and evaluation. During these site visits, 

agencies were also provided with more detailed demographic and baseline assessment data 

about the families they served. The site visits were summarized in memos for United Way and 

discussed during monthly meetings with United Way.

Quarterly Monitoring Reports

The above Monthly Summaries were used to create individual quarterly monitoring reports for 

each agency. These reports documented compliance to program and study implementation. 

They reported data from the monthly summaries including enrollment, attrition, and follow-up 

rates; monthly meeting attendance; financial match obligations; and timely reporting. The 

Quarterly Monitoring Reports were color coded red, yellow, and green to coordinate with areas 

that needed improvement, were being monitored, or were on track with targets respectively. 

United Way provided a copy of the Quarterly Monitoring Report to partner agencies on a 

quarterly basis. The report was then reviewed and discussed with agency program managers 

during one of the monthly site visits. Strategies were developed to address any area of agency 

performance that needed improvement. 

Quarterly Progress Reports

Partner agencies were required to submit progress reports on a quarterly basis. These reports 

were modeled after the bi-annual report required of United Way by CNCS. In these reports, 

agencies provided detailed descriptions of the progress made toward implementation goals, 

challenges and successes faced during implementation, and other notes related to agency 

performance. Through these reports partner agencies were also able to suggest additional 

trainings and relay success stories from families enrolled in the study. A blank copy of a 

Quarterly Progress Report can be found in Appendix T.

Data Audits

Data audits were performed to ensure all data entered into the Efforts to Outcomes database 

was up-to-date and accurate. Enrollment forms, which collected demographic data about the 

family, were checked for missing data. When items were found to be missing, specialists were 

asked to follow-up with the family when they were reassessed to obtain the information. 

Assessments were also included in the data audits. Each assessment was checked for missing or 

inaccurate data. The most common errors found during data audits included missing question 

responses, missing or duplicate time frames, and assessments reported under the wrong family 
United Way for Southeastern Michigan 32

member (i.e., ECBQ reported under parent instead of focus child). If an error was found, 

agencies were instructed to review their files and make any necessary corrections. Many of the 

assessments used multiple items to measure a single variable; therefore, overall scores for each 

variable were based on questions that were answered. Missing and duplicate assessment time 

frames were often found to be a result of human error selecting the wrong time frame in ETO. 

However, some assessments missed were due to the family opting out or the child aging out of 

the assessment. In these cases, the specialist was instructed to record the reason for the missing 

assessment in ETO. 

Analytic Strategy

Consensus generating methods were used to analyze qualitative implementation data. An 

expert panel from the project team met bi-monthly over the course of the project period to 

review all implementation data. These experts included: Jeffrey D. Miles, MSW, Center for Early 

Childhood Excellence Executive Director; Melanie Gill, MPA, Social Innovation Fund Manager; 

Melissa Bowman, MPP, Data Analytics & Visualization Manager; and Maya Satterwhite, Data 

Specialist, from United Way; Dr. Randi Burlew, Senior Research Associate from Philliber 

Research and Evaluation; Dr. Robert Ty Partridge, Associate Professor of Psychology and Dr. 

Christopher Trentacosta, Associate Professor of Psychology from Wayne State University; and 

Dr. Alice Audie-Figueroa, Early Childhood Strategy Consultant from Here2There, LLC. Standing 

meeting agenda items included reviewing the monthly summary and presenting meeting 

minutes from monthly manager meetings and agency site visits (conducted by United Way), as 

well as summaries of quarterly progress reports, quarterly monitoring reports, and bi-annual 

data audits. At the end of the meetings, the panel worked to come to consensus on challenges 

and next steps.

The expert panel used a modified nominal group technique to collect and analyze quarterly 

evaluation site visit data. The evaluation team drafted the initial questions for each evaluation 

site visit which were then presented to the expert panel for feedback. The draft was then 

discussed during a bi-monthly panel meeting until consensus was reached on the final list of 

questions. The questions were then sent to agencies in advance of site visits so that appropriate 

staff could be invited to the site visit and needed data could be collected for discussion.

Dr. Burlew, the lead evaluator for the project led the site visits at each agency along with 

Heather Hirsch, MS, a data analyst on the project, who took detailed notes. Dr. Burlew and Ms. 

Hirsch were sometimes accompanied by other members of the expert panel during site visits. 

At the conclusion of the site visits, Dr. Burlew and Ms. Hirsch analyzed the site visit notes for 

themes. Themes from the site visits were then presented to the expert panel during a bi-monthly 

meeting. The themes were discussed until consensus was reached about conclusions and next 

steps. These conclusions and next steps were then summarized in a memo by the evaluation 

team and circulated to the expert panel for feedback, after which a final document was 

submitted.
United Way for Southeastern Michigan 33

Evaluators sought to confirm conclusions reached through the site visits through regular surveys 

and close out interviews with agency staff. In cases where conclusions drawn from evaluation 

site visits were in conflict with data collected through surveys and interviews with agency staff, 

discussions were held with agency staff during manager meetings to provide clarity.

Program Quality - Specialist Level

A combination of previously reported measures was used to assure program quality at a 

specialist level. Qualitatively, FCMSs went through extensive training on the Family Check-Up 

model and were highly encouraged to become certified in the model. FCMSs also participated 

in monthly hour-long “Learning Communities” where FCMSs presented challenging cases from 

their GOALS caseload. During Learning Communities, Dr. Trentacosta also provided training 

and support on specific aspects of the FCU such as goal setting. These Learning Communities 

gave United Way and Dr. Trentacosta an opportunity to gauge fidelity to the Family Check-Up 

model and to troubleshoot any problem areas that were observed. 

Additional trainings were also offered throughout the study in response to challenges FCMSs 

reported facing during the Learning Communities. Some of these trainings included 

Motivational Interviewing, Home Visitor Safety, Recognizing and Supporting Human Trafficking 

Victims and Survivors, SMART Goal Setting, Domestic Abuse, and many others. 

To monitor the quality of services provided by the FCMSs in a more quantitative way, a variety of 

reports were pulled from the Efforts to Outcomes database. The Goal Tracker and Referral 

Tracker (both described above) allowed managers to confirm that FCMSs helped families create 

goals and offered referrals to help the family reach them. Additionally, Communication Logs 

and Follow-Up Rates represented the quality of the services and the rapport specialists were 

able to build with the families they served.

 

Program Participant Responsiveness

Program Participant Responsiveness was measured using the Goal Setting Form and the Case 

Closure Form. Midway through the study, it was discovered that many families were not setting 

goals with their FCMS during the feedback sessions. This topic was discussed at a Learning 

Community where FCMSs reported that families were not comfortable setting goals they did not 

feel they could achieve. This issue was addressed through additional training and technical 

assistance and an increase in goals set was reflected in the following data audit. 

As part of the Case Closure Form FCMSs were asked a variety of questions regarding the 

growth a family showed throughout their time in the study. They rated a family’s growth from 
United Way for Southeastern Michigan 34

“Regressed a lot” to “Grew a lot” and also evaluated the 

progress families made towards reaching their goals, from 

“Achieved none of their goals” to “Achieved all of their goals.” 

Both FCMSs and DCSs were also asked to rate the amount of 

growth for each dimension assessed by the Arizona Self 

Sufficiency Matrix. It is of note that the study protocol did not 

require FCMSs and DCSs to provide support or resources in 

every area covered by the ASSM. Support provided to the 

GOALS families by FCMSs was driven by assessment results, 

goals set, and the needs expressed by the families. DCSs 

provided general resources to families in the comparison group based on their agency’s referral 

protocols. Thus, FCMSs and DCSs were asked to rate families only in the areas in which they felt 

they had adequate information to make a clinical assessment. 

Program Differentiation

The following partner agency descriptions are based on each organization’s completed Request 

for Qualifications at the beginning of the study. 

ACCESS 

Arab Community Center for Economic and Social Services (ACCESS) is the largest Arab 

American community nonprofit in the United States, with their 11 locations and more than 120 

programs offering social, economic, health and educational services to more than 70,000 

people per year in metropolitan Detroit. Since 1971, ACCESS has worked to meet the needs of 

families and communities with a comprehensive system of programs and services that translate 

to a stronger society. Their programs include Even Start Family Literacy and Early On Program, 

Parents as Teachers, Great Parents/Great Start, 21st Century Community Learning Centers, and 

Early Learning Communities. 

Having provided services to some of Metro Detroit’s most vulnerable residents for almost 50 

years, ACCESS has become a respected and trusted organization within their community. They 

have used their knowledge of the community, and content expertise, to modify programming to 

meet the needs and overcome barriers for the underserved communities of Southwest Detroit 

and South Dearborn. Demographically, Arab Americans make up 65% of ACCESS’s clientele. 

However, while they were founded to serve the Arab American immigrant community, they 

provide service to anyone who walks through the doors of their multiple locations. Their 

programs and services are delivered in a culturally and linguistically appropriate manner, in 

more than 18 languages. 

ACCESS had also been a partner agency for United Way’s Social Innovation Fund 2011 grant. 

For more information, see: https://www.nationalservice.gov/impact-our-nation/evidenceexchange/united-way-southeastern-michigan-and-access-access-school 

“Participants became goaloriented. The more goals 

participants were able to 

achieve, the more goals 

they wanted to set.”

- Family Check-Up Model 

Specialist, ACCESS
United Way for Southeastern Michigan 35

CARE of Southeast Michigan

CARE of Southeast Michigan’s (CARE) mission is to strengthen resiliency in people and their 

communities through prevention, education and services that improve their quality of life. 

Founded in 1977 to provide free assessments and referrals for those experiencing difficulties 

because of problematic use of alcohol and/or other drugs, CARE has become an anchor agency 

in the community. Their programming still primarily focuses on substance abuse prevention 

and recovery, harm-reduction, co-occurring mental health challenges, and personal or 

workplace issues. They provide parenting, substance abuse, mental health, family support and 

employee assistance services to 20,000 people per year in Macomb County. 

Having provided services and referrals to clients for over 40 years, CARE had developed strong 

partnerships with external agencies and organizations. As part of a continuum of care for 

families, CARE staff was knowledgeable about available community services and resources. 

Prior to participating in the SIF study, CARE had been utilizing the Arizona Self-Sufficiency Matrix 

in their programming and more than 20 staff members had already been training in motivational 

interviewing. 

Leaps and Bounds Family Services

Leaps and Bounds Family Services (LBFS) was founded in 1988 with the mission: “to creatively 

and collaboratively address the educational, health and economic needs of children and 

families at risk.” Since the beginning, the agency has provided services to high risk, low income 

families with children. While a relatively small agency, especially in comparison with other 

partner agencies, LBFS offers a variety of services to areas in the cities of Detroit and 

Hamtramck, as well as Macomb County. LBFS provides adult education, GED preparation 

classes, access to emergency food and baby needs, child care provider training and quality 

improvement, play and learn groups, home visiting and parent education workshops. Their 

small size allowed staff to work collaboratively and collectively to ensure agency clientele have 

information and access to all services. 

Over the years LBFS has developed strong partnerships and connections with other agencies in 

the community. One of their partnerships included being a partner agency on United Way’s 

Social Innovation Fund 2011 grant. For more information, see: 

https://www.nationalservice.gov/impact-our-nation/evidence-exchange/ready-children-readycommunities-final-report 

National Kidney Foundation of Michigan

National Kidney Foundation of Michigan’s (NKFM) mission is to prevent chronic kidney disease 

and improve the quality of life for those living with it. With offices throughout the state of 

Michigan (Ann Arbor, Detroit, Flint, and Grand Rapids) NKFM provides services to increase 

health education, improve health practices, and increase access to healthcare for families to 

increase self-sufficiency and resiliency. It was their vision of helping people increase their selfsufficiency that led them to United Way’s SIF16 study. NKFM believed that the adoption of 
United Way for Southeastern Michigan 36

healthy lifestyle behaviors through prevention efforts was an essential step in gaining selfsufficiency. 

For the current study, NKFM was the only partner agency that did not provide direct early 

childhood services to clients. However, due to their early childhood nutrition program being 

offered in 108 Head Start and Early Head Starts throughout Southeast Michigan, NKFM had 

developed a network of early childhood relationships to draw upon for the SIF study. 

Prior to participation in United Way’s SIF16 study, NKFM had been a partner on United Way’s 

Social Innovation Fund 2011 grant. For more information, see: 

https://www.nationalservice.gov/impact-our-nation/evidence-exchange/national-kidneyfoundation-michigan-final-peach-implementation 

Oakland Family Services

Oakland Family Services (OFS)’s mission is “Providing individuals and families the opportunity to 

build brighter futures.” Founded in 1921, OFS has almost a century of experience in providing 

services to children and families with multiple risk factors including poverty, child abuse and 

neglect, and developmental delays. The organization provides prevention, education and 

treatment services to families from five locations in Oakland County. Some of the programming 

includes developmental assessments of children, free preschool, parent and child care provider 

workshops, playgroups, and in-home parent education and support. 

OFS utilized a “no wrong door” approach similar to that of the current study prior to 

participation in SIF. Any client that came to OFS for services was assessed for other services 

needed and referred to internal and/or external resources. Prior to the SIF study, Oakland 

Family Services had already built a vast network of resources and participated in the Great Start 

Oakland Collaborative which included early childhood service providers, parents, and 

representatives from government and business. 

Participant Satisfaction

The study did not rely exclusively on direct assessments of participant satisfaction with the 

GOALS project. This was an intentional decision as there are a number of difficulties with 

assessments of program satisfaction as an index of program success. Participant program 

satisfaction can be a useful proxy for program engagement and adherence, but it is often not a 

good index of program outcomes or impact. Further, self-report participant satisfaction 

assessments administered by program staff are susceptible to a false-positivity bias due to the 

lack of perceived anonymity and fears of losing services on the part of participants. As a result, 

we chose to also include more direct indicators of satisfaction via program engagement and 

retention. The retention rates for GOALS families were 78.5% and 75.1% for the 6-month and 

12-month follow-up. This is comparatively high for multi-service programs for families with 

young children. A recent analysis of retention rates across 26 home visitation programs found 
United Way for Southeastern Michigan 37

an average 12-month retention of only 58% (Janczewski et al., 2019). Program engagement was 

also very high with [consistency of contacts]

Service Participation Survey

A variety of both quantitative and qualitative measures were used to determine participant 

satisfaction with the study. A Service Participation Survey (see Appendix U) was conducted with 

participants at baseline, 6-month, and 12-month follow-ups. In this survey participants were 

asked about their experiences using services at the partner agency as well as the United Way 2-

1-1 helpline. One of the questions asked participants to rate their satisfaction with their service 

experience from “Very Satisfied” to “Very Dissatisfied.” At both six- and twelve-month follow-up, 

99% of families enrolled in GOALS indicated that they were either very satisfied or satisfied with 

the assistance they were receiving from their agency. In addition, families reported a high level 

of satisfaction with the United Way 2-1-1 helpline. In particular, most families that used the 

service reported that they were provided with referrals that they were eligible for and that they 

actually received the services. Further, at both six- and twelve-month follow-up, nearly all of the 

families that had used the helpline indicated that they were satisfied or very satisfied with the 

help they received.

End of Study Surveys

At the conclusion of the study, 23 current staff completed End of Study Surveys (see Appendix 

V) regarding their experiences implementing the GOALS project and accompanying evaluation. 

The survey included questions that required staff to 

reflect on the client experience and included how well 

GOALS fit with families and what families found most 

beneficial. The overwhelming majority of staff 

surveyed indicated that they thought that the GOALS 

program was a good fit for the families their agency 

served, and they indicated that they believed most of 

the families felt helped by the GOALS program. One 

of the FCMS from CARE described her perception of 

the work she did with one of the families on her 

caseload as follows: “I had a family in the intervention 

group that was homeless at the time of their initial 

assessment and living at a hotel. I was able to connect 

them with housing resources and they eventually 

worked with Salvation Army to help them find housing, as well as connecting them to resources 

for education, mental health, food, clothing and child development needs. The mother was also 

referred to my agency’s in home parenting program where mom was able to set goals and a 

routine for her children once they had secured a home about a month after her initial assessment. 

I think just being a sense of emotional support, getting mom to set goals so that she would have 

something to work on and look forward to, as well as connecting her to resources to help her and 

“I feel that many of my clients 

appreciated the client-centered, 

strengths-based approach that the 

FCMS provides. I also feel that 

most of my clients appreciated the 

one-on-one support when in need 

of resources.” 

- Family Check-Up Model 

Specialist, Oakland Family Services
United Way for Southeastern Michigan 38

her family get back on their feet were the most helpful parts of the model, pertaining to her 

participation in the program.”

Key Informant Interviews

Throughout the study conversations were had with FCMSs and agency Program Managers 

regarding how families were responding to the program. Multiple opportunities were provided 

to staff to participate in these discussions including the monthly Learning Communities, 

Manager Meetings, and agency site visits. Additionally, at the end of the study, Philliber 

interviewed each current staff member including DCSs. United Way also used focus groups and 

open-ended essays to give staff members an opportunity to provide feedback on the overall 

project. 

Staff indicated in close out interviews that they believed families felt helped by the GOALS 

program. FCMS indicated that families increased their motivation to set and reach goals and 

were excited to achieve the goals that they set for their families. The families seemed to feel 

helped by the positive, strengths-based approach that the model used.

“The study helped me to see that people 

need a lot of guidance and a hands on 

approach in order to meet there [sic] 

needs. They need goals set with them 

and to be followed up on, 

encouragement, and help along the 

way.”

- Data Collection Specialist, CARE of 

Southeastern Michigan
United Way for Southeastern Michigan 39

Data Analysis Methods 
United Way for Southeastern Michigan 40

DATA ANALYSIS METHODS

Changes Made for the Final SIF Evaluation Plan

As a result of funding restructuring reducing the timeline of the grant to run from 2016-2020 

instead of 2016-2021, the focus of the SEP shifted from an outcome and impact evaluation to an 

implementation evaluation. In adding, the data collection period was reduced from 4 years to 3 

years in length. 

The initial SEP emphasized reducing missing data via the development of a protocol for 

following up with participants who missed a data collection; first through the partner agency 

and then by Philliber to keep attrition to a minimum. In the revised SEP it was further proposed 

to assess potential biases introduced into the data as a function of missing data and then using 

multiple imputation techniques to obtain complete data with unbiased estimates.

Also as a result of the reduced timeline, the data follow-up protocol removed 18-month 

assessments which were anticipated for participants that enrolled in the first six months of the 

project. Those without 18-month data would be treated as having data missing by design and 

thus it would not introduce bias into the sample statistics. However, once this fourth time point 

assessment was removed it became no longer necessary to use a missing-by-design approach.

Other changes made for the final SEP are as follows:

• Power analyses were adjusted to account for the shorter timeframe of the project.

• The final set of measures was selected and included:

o The Family Profile Form

o Ages & Stages Questionnaires, Third Edition

o Ages & Stages Questionnaires: Social Emotional, Second Edition

o Rothbart Temperament Negative Affect and Effortful Control subscales

o Feeding Your Child Survey

• Randomization protocols were adapted to ensure that randomization did not take place 

until after the agency had secured an initial appointment for assessment with the family.

• Incentives were increased to $50 (from $25) in order to reduce attrition.

Lastly, major evaluation milestones included in the original SEP were shifted to reflect the 

greater focus on implementation rather than impact analysis. This also included the addition 

of regular monthly reports by Philliber, reporting on the status of program implementation. 

Additionally, quarterly interviews with program leads and staff were added to the evaluation 

protocols, as well as exit interviews for outgoing staff. 
United Way for Southeastern Michigan 41

Database Usage

Data were entered by the FCMS or Data Collection Specialist into a platform created by Efforts 

to Outcomes and made available to Philliber Research for analysis by the United Way via 

download from a secure website. The data were monitored by a joint team from United Way 

and Philliber Research who regularly downloaded and screened the data to ensure data 

integrity.

Missing Data

If demographic variables were missing Philliber had the option of checking other sources of 

information or asking the agency to obtain the information at the next meeting with the

participant. Both the enrollment form and the intake form obtain demographic information. If 

information was missing from one form, it was usually available on the other. Also, participants 

met with the FCMS or DCS at each assessment. Missing demographic information was 

sometimes obtained then. United Way conducted periodic data audits of the data in ETO and 

worked with agencies to ensure that all needed data were reported.

Missing data is ubiquitous in social science research and this is especially true in applied 

intervention/prevention studies. These studies often ask about sensitive information and are 

longitudinal in design which inevitably leads to missing data. Historically, missing data has been 

addressed by using listwise deletion (only using individuals in the study that have complete 

data) or some form of replacement, typically replacing the missing value with the sample mean 

for that variable. In the case of longitudinal missing data applied researchers would often take 

the last available data point for an individual participant and “move it forward” under the 

conservative assumption that the participant did not change. However, these methods are all 

problematic and lead to biased statistical estimates (Graham, 2012). Over the last 15 years 

there have been substantial advances in assessing and handling missing data and these 

techniques have been utilized in this study. 

The first step in addressing missing data is to determine the type of missingness. This is a 

process for estimating the underlying reason for why the data is missing. There are three types 

of missingness; data that is missing-completely-at-random (MCAR), data that is missing-atrandom (MAR), and missing-not-at-random (MNAR). The condition of MCAR is met when the 

missing data appears to be truly randomly distributed and unrelated to any other variables 

either measured or unmeasured (e.g., some people might have accidentally skipped a 

question). MAR data occurs when the missing data is systematically related to another variable, 

but it is a variable that is measured in the dataset and the reason the data is missing is unrelated 

to the value of the missing data point. For example, older adults might be more reticent to 

answer questions about income than younger adults, because the latter have more experience 

with being surveyed and being asked to disclose income information. As a result, missing 

income data might systematically be related to participant age, but not the actual income 

amount that was not reported. Missing data that meets the conditions of either MCAR or MAR 

can be reliably estimated from other data points and/or variables on which the participant did 
United Way for Southeastern Michigan 42

provide data. If the missing data is determined to most likely be MNAR (there is no test for 

MNAR) then the pattern of missingness can be included in the statistical model and the bias 

introduced by non-random missing data can be statistically controlled for. 

To test the level of missingness we used the MICE package in R (version 4.0.1). The MICE 

package (Multivariate Imputation via Chained Equations) is a comprehensive tool for both 

assessing patterns of missingness and imputing missing data for analysis. Figure 4. provides the 

proportion of missing data by variable, by assessment point, by intervention group. We first 

conducted a Little’s MCAR chi-square test on all variables to determine whether or not the data 

satisfied the assumptions of MCAR. This test assumes the null hypothesis that the data is 

missing completely at random. The Little’s MCAR test was conducted across all variables and 

across intervention groups at each assessment point. The table below provides the MCAR test 

results for each assessment point:

Figure 4: Little's MCAR Test Results

Baseline 6-month 12-month

χ2 (1464) = 1383, p=.06 χ2 (1464) = 1357, p=.02 χ2 (1464) = 1391, p=.08

Non-significant results suggest that the data does not meet the criteria for MCAR, but in large 

samples (n>500), this test is overly sensitive. We then followed-up the Little’s MCAR test with 

pairwise distributional comparisons to determine whether or not any missing data was 

systematically related to any of the variables in the dataset and found there were no conditional 

dependencies so we could assume the data was, at a minimum, missing at random (MAR). As a 

result, analyses can proceed under the assumption that missing data do not introduce statistical 

biases. 

Baseline Equivalence

The study was designed as a randomized control trial of an intent-to-treat model. However, the 

response rates were not sufficient to make that possible. Randomized control trials are sensitive 

to cases lost to follow-up (people who enroll in a study, are randomized into treatment or 

comparison groups, but then fail for some reason to fully complete follow-up assessments). The 

percentage of people who are randomized and then complete follow-up assessments needs to 

be around 80%. When the percentage is lower than that there is an increased probability of 

bias introduced into the study because those who drop out are different in unknown ways from 

those who continue. However, a quasi-experimental design is a valid option.

Baseline equivalence is critically important in a quasi-experimental study. Its purpose is to 

demonstrate that the families who are in the treatment group (GOALS) are not significantly 

different from those in the comparison group in terms of demographic covariates or measures 

of outcomes at baseline. 
United Way for Southeastern Michigan 43

Equivalence was examined for parent’s age, child’s age, parent’s gender, child’s gender, 

race/ethnicity, language spoken, family size, marital status, receiving assistance, education, and 

health insurance. Equivalence of outcomes at baseline were also examined for variables 

assessed using the Family Profile Form, Ages & Stages Questionnaires, Rothbart Temperament 

Scales, and the Feeding Your Child questionnaire.

Standard significance tests and effect sizes were used to assess baseline equivalence of each 

variable. P-values of each test of significance were examined as well as the means and standard 

deviations for both the intervention and comparison groups. 

Analytic Samples

Two analytic samples were constructed for this study. The first sample was comprised of 

families that completed baseline assessments and six-month follow-up assessments. The 

second sample was made up of families that completed baseline assessments and 12-month 

follow-up assessments. Even if a family missed their six-month data collection, they were still 

contacted to participate in the 12-month data collection. For each outcome, the analytic sample 

was composed of those families who completed demographic data as well as data on the 

outcome being analyzed. Baseline equivalence was determined for each analytic sample.

A total of 992 families completed baseline assessments and were randomized to either GOALS 

(n=518) or to the Comparison group (n=474). All 992 families were eligible for a six-month 

follow-up and 577 families enrolled prior to June 30, 2019 were eligible for a 12-month followup. The Consort Diagram (Figure 5) illustrates how participants progressed through the study.

The six-month analytic sample had an overall attrition rate of 21.5% and a differential attrition 

rate of 5.9%. The 12-month analytic sample had an overall attrition rate of 24.9% and a 

differential attrition rate of 7.4%. 
United Way for Southeastern Michigan 44

Figure 5: Consort Diagram

CONSORT Diagram

Data included in 

report are 

current as of: 

December 15, 

2020

This is an individual-level RCT with families randomly assigned to Intervention or Comparison on a rolling 

basis between February 2018 and December 2019. The study collected baseline data, six-month follow-up 

data, and 12-month follow-up data. Only families enrolled prior to June 30, 2019 were eligible for a 12-month 

follow-up.

 
United Way for Southeastern Michigan 45

Analytic Strategy 

Regression analysis was used to assess whether the outcomes among the GOALS participants 

were significantly different from the comparison participants. The outcome score at follow-up for 

each dimension was treated as a dependent variable. 

T-tests were run to look at 

changes in GOALS families’ 

scores on each of the 

outcome variables between 

baseline and six and 12-

month follow-up in order to 

determine whether they 

demonstrated improvement 

in self-sufficiency and 

developmental readiness after 

participating in the program.

Independent Variables Entered Into the Equations

● Participation in the GOALS or comparison group

● Baseline score on independent variable

● Parent’s age

● Race/ethnicity (classified as African American, Other)

● Language spoken at home (English, Other)

● Living with spouse

● Receiving public assistance

● Parent’s education

● Agency
United Way for Southeastern Michigan 46

Findings, Lessons Learned, 

& Next Steps
United Way for Southeastern Michigan 47

FINDINGS, LESSONS LEARNED, AND NEXT STEPS 

Introduction and Summary

Evaluation results indicate that the GOALS project was implemented successfully, and GOALS 

families showed significant gains in many areas. The project successfully enrolled 518 families 

into the intervention. More than three quarters (77%) of these families were receiving public 

assistance at the time of enrollment, and most were Families of Color (77%). Nearly all (97%) of 

the parents were female, and less than half were living with a spouse (45%). These families 

reported having a lot of needs at baseline. Most frequently they identified having needs with 

regards to housing, clothing, and food. Most (73% at six-month follow-up and 71% at 12-month 

follow-up) of these families stayed enrolled in the program.

GOALS families showed significant improvement at six- and 12-month follow-up in parenting 

skills, ability to meet basic needs, social supports, and behavior problems (parent). GOALS 

families also showed significant improvement on several protective factors to prevent child 

abuse and neglect at both six- and 12-month follow-up. At follow-up, GOALS families showed 

significant improvement in the practices they use to feed their children and a significant 

decrease in the areas of concern identified in their children.

In many areas, there were no differences between GOALS and comparison families. However, 

GOALS families outperformed comparison families in two important areas. At six-month followup, GOALS families scored higher than comparison families on social support, one of the 

protective factors to prevent child abuse and neglect. At both six- and 12-month follow-up, 

GOALS families scored higher than comparison families on an assessment of the practices that 

they use to feed their children. 

Comparison families showed significantly better results than GOALS families on ability to meet 

basic needs and parenting skills on the Arizona Self Sufficiency Matrix at six-month follow-up 

and on parenting skills at 12-month follow-up. Comparison families also demonstrated 

significantly higher scores than GOALS families on the nurturing and attachment protective 

factor at six-month follow-up.
United Way for Southeastern Michigan 48

Communication

Sites used varying communication and recruitment strategies, with some engaging with a multipart initial interview process and some using multiple assessment sessions to complete the 

process of enrollment and data collection. The study as a whole collected 14,602 individual 

points of contact during the program, an overwhelming majority of which were to establish or 

confirm meeting times and check in with participants as indicated in Figure 6. The difference 

between the number of communications to GOALS families versus the number to comparison 

families was expected when the study was designed. While GOALS was designed to be lighttouch, FCMSs were still encouraged to check-in with participants between assessment 

timeframes. DCSs on the other hand were instructed not to initiate check-ins but were able to 

help participants that reached out to them between assessment timeframes.

Figure 6: Count of Types of Communication

Variable Intervention 

N=518

Comparison 

N=474

Email 323 64

In Person (At Agency) 480 294

In Person (At Home of 

Participants Assessment Visits)

2028 1315

Phone (Left Voicemail) 732 395

Phone 2432 1386

Text 3711 990

Key Findings

GOALS Families Showed Improvement In:

• Parenting Skills

• Ability to Meet Basic Needs

• Social Supports

• Behavior Problems (Parent)

• Protective Factors to Prevent Child Abuse and Neglect

• Practices Used to Feed Their Children

GOALS Families Outperformed the comparison group in:

• Social Support

• Practices Used to Feed Their Children
United Way for Southeastern Michigan 49

Unable to Contact 188 133

Other 75 59

Total Contacts 9966 4636

Findings By Research Question

Implementation Questions - Confirmatory

How successful is GOALS (formerly Bib-to-Backpack) in enrolling families? i.e. How many 

families enroll?

GOALS Families

A total of 518 families were enrolled in the GOALS program. The number of families enrolled at 

each agency ranged from 86 to 131 families. At the beginning of the study, each agency had 

created their own enrollment goals ranging from 75 to 175 participants.

Figure 7: Enrollment in GOALS

Number of 

Families % of Total

ACCESS 86 17%

CARE 100 19%

LBFS 88 17%

NKFM 131 25%

OFS 113 22%

Total 518

What are the characteristics of families who enroll? In addition to their demographic 

characteristics, what kinds of needs are identified at the time of enrollment? 

The average age of the parents enrolled in GOALS was 32.1 years. Nearly all (97%) of the 

parents enrolled were female. The average age of the focus child was 2.2 years, and nearly half 

(49%) of the focus children were female. Nearly half (47%) of the families identified as African 

American and just over three quarters (77%) of the families spoke English as their primary 

language. Just over three quarters (77%) of the families reported receiving Public Assistance. 

(See appendix W for a breakdown of demographics by agency.) 
United Way for Southeastern Michigan 50

Figure 8: Characteristics of GOALS Families

Variable N %/ 

Average SD

Parent’s age (years) 511 32.1 7.397

 18-25 110 22%

 26-34 240 47%

 35 and older 161 31%

Child’s age (years) 517 2.2 1.605

Parent’s gender

 Female 514 97% .163

Child’s gender

 Female 517 49% .500

Race/ethnicity1 514

 American Indian 18 4% .184

 Asian 14 3% .163

 African American 241 47% .500

 Hispanic 35 7% .252

 Middle Eastern/North African 116 23% .418

 Pacific Islander 0 0% 0 

 White 120 23% .423

 Other 21 4% .198

Language Spoken 513

 English 394 77% .423

 Spanish 10 2% .138

 Arabic 99 19% .395

 Other 10 2% .138

Household Composition

 Number in household 496 4.7 1.835

 Living with spouse 516 45% .498

 Receiving public assistance 516 77% .419

 Less than high school education 494 23% .423

1

More than one option could be selected.

Families were asked to identify their immediate needs in order to help their FCMS provide them 

with appropriate referrals. GOALS families reported 743 needs at baseline, which is an average 

of 1.43 needs per family. Families were presented with a list of 22 potential needs that they 

might be experiencing. They were also given the option of listing any other needs they might 

be experiencing that were not captured by that list. The most frequently identified needs were 

housing, clothing, and food. 
United Way for Southeastern Michigan 51

Figure 9: Needs of GOALS Families at Baseline

Need (N=518) N % 

Housing 74 14.3%

Clothing 63 12.2%

Food 52 10.0%

Transportation 49 9.5%

Income/employment 48 9.3%

Child care 46 8.9%

Gas/Electric bill 45 8.7%

Dental/Eye care 41 7.9%

Furniture/Appliances 39 7.5%

Rent/Mortgage/Moving 36 6.9%

Baby 33 6.4%

Education (adult) 30 5.8%

Holiday 26 5.0%

Child development 22 4.2%

Counseling (Psych/Sub. Abuse) 22 4.2%

Health 21 4.1%

Home repair/Weatherization 21 4.1%

Water bill 21 4.1%

Education (children) 17 3.3%

Other 16 3.1%

Legal aid 9 1.7%

Property taxes 9 1.7%

Tax preparation 3 0.6%

How well is the Family Check-Up Model implemented? Do families move from assessment 

to services and continue engagement in services? 

GOALS families received payment to support their participation in their feedback sessions with a 

FCMS at each assessment time frame. This is also the session in which families are invited to set 

goals and are given referrals. Thus, a family is considered to have completed the required 

GOALS components at each assessment time frame if they received their support payment. All 

families enrolled in GOALS (518) were expected to complete six-month assessments with their 

FCMS. The payment data indicate that the project ended up with a 73% completion rate at sixmonth follow-up. Families that enrolled prior to June 30, 2019 were expected to also complete 

12-month assessments with their FCMS. Enrollment data indicate that a total of 401 families 

were expected to complete 12-month assessments. The payment data indicate that 71% of 

these families completed their 12-month follow-up with their FCMS. 

GOALS families are expected to set goals and receive referrals from their FCMS to help them 

meet those goals. Of those enrolled, 68% of GOALS families had at least one referral recorded 
United Way for Southeastern Michigan 52

in ETO and 80% had at least one goal recorded in ETO. The percentage of families receiving 

referrals ranged from 34% to 93% by agency. The percentage of families at each agency setting 

at least one goal ranged from 59% to 98%.

What services do families receive? Do families who receive the Family Check-Up Model 

participate in more services than families typically do?

Families were asked at each data collection timeframe to report the number and types of 

programs that they had participated in at the agency which enrolled them in the GOALS 

study. The questions focus specifically on Child Development, Employment, Housing, 

and Parenting programs. It is of note that comparison families were eligible to participate in 

services as usual at the agencies after enrolling in the study. However, comparison families had 

to access agency services using existing entry pathways and protocols at the agencies.

 

At baseline, GOALS families reported participating in significantly more agency programs 

than comparison families (not shown). This may be an indication that GOALS families were 

already more connected to the programs prior to enrolling in the study.

 

Changes in Agency Program Participation Over Time 

There was no significant difference in the number of agency programs that GOALS and 

comparison families reported participating in at six-month follow-up. 

 

Figure 10: Number of Programs - 6-Month Follow-Up

Six Month GOALS (N=296) Comparison (N=256)

Number of 

Programs Number Percent of Total Number Percent of Total

0 172 58% 154 60%

1 80 27% 69 27%

2 35 12% 23 9%

3 3 1% 7 3%

4 6 2% 3 1%
United Way for Southeastern Michigan 53

Figure 11: Average Number of Programs - 6-Month Follow-Up

Adjusted using: Participation in the GOALS or the Comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Similarly, there were no significant differences in the number of programs that GOALS and 

comparison families participated in at 12-month follow-up.

Figure 12: Number of Programs - 12-Month Follow-Up

12 Month GOALS (N=227) Comparison (N=232)

Number of 

Programs Number Percent of Total Number Percent of Total

0 148 65% 165 71%

1 54 24% 35 15%

2 24 11% 26 11%

3 0 0% 4 2%

4 1 <1% 2 1%

Figure 13: Average Number of Programs - 12-Month Follow-Up

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

12 Month 227 .467 .718 232 .461 .826 -.099 -.064 .172

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

How long do families continue to participate in Bib to Backpack? Do families who receive 

the Family Check-Up Model participate longer in services than families typically do?

Completion rates at six- and 12-month follow-up were used as a proxy for how long families 

participated in services. Completion rates of comparison families were used as an indication of 

how long typical families stay engaged at the agencies. Although the completion rates for 

GOALS families at six- and 12-month follow-up were above 70%, they were significantly lower 

than completion rates for the comparison group. 

 

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Six Month 296 .618 .883 256 .578 .855 -.063 -.036 .385
United Way for Southeastern Michigan 54

Figure 14: Program Completion (GOALS and Comparison)

% Completed (6 Month) % Completed (12 

Month) 

GOALS Comparison GOALS Comparison

Completion Rate 73% 81%** 71% 78%*

 Difference based on t-test is statistically significant at *p<.05; ***p<.001. 

Do families enrolled in the Family Check-Up Model improve levels of development and 

self-sufficiency?

Changes in scores on the PICCOLO, the ASSM, the Protective Factors Survey, and the Rothbart 

Temperament Scale between baseline and six- and 12-month follow-up were used to evaluate 

whether GOALS families demonstrated improvement in levels of development and selfsufficiency. 

Parent interactions are scored on the PICCOLO using a scale of 0 (absent), 1 (barely

demonstrated) or 2 (clearly demonstrated). GOALS families showed significant improvement on 

all four domains of the PICCOLO at both six- and 12-month follow-up. 

Figure 15: PICCOLO Pre-post Scale Assessment - 6-Month Follow-Up

Domain Baseline Average

N=220

6-Month Average

N=220 Cohen’s d

Affection 1.73 (SD .290) 1.79** (SD .276) .20

Responsiveness 1.68 (SD .301) 1.72* (SD .270) .05

Encouragement 1.60 (SD .358) 1.68*** (SD .312) .16

Teaching 1.24 (SD .403) 1.42*** (SD .352) .24

 *p<.05;**p<.01;***p<.001 

Figure 16: PICCOLO Pre-post Scale Assessment - 12-Month Follow-Up

Domain Baseline Average

N=157

12-Month 

Average

N=157

Cohen’s d

Affection 1.73 (SD .300) 1.77* (SD .286) .16

Responsiveness 1.65 (SD .293) 1.72** (SD .257) .09

Encouragement 1.56 (SD .352) 1.68*** (SD .300) .19

Teaching 1.16 (SD .381) 1.47*** (SD .327) .48

 *p<.05;**p<.01;***p<.001

GOALS families also showed significant improvement on all four domains of the Arizona Self 

Sufficiency Matrix at both six- and 12-month follow-up. Scores are based on a 1-5 Likert scale 

with 1 indicating a need and 5 indicating a strength.
United Way for Southeastern Michigan 55

Figure 17: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior Issues 

Pre-post Assessment - 6-Month Follow-Up

Domain Baseline Average

N=373

6-Month Average

N=373 Cohen’s d

Ability to meet basic 

needs 3.68 (SD .518) 3.74* (SD .493) .11

Parenting skills 3.84 (SD .926) 4.01** (SD .926) .17

Social supports 3.91 (SD .855) 4.08*** (SD .813) .21

Behavior issues 4.77 (SD .412) 4.82** (SD .367) .13

 *p<.05;**p<.01;***p<.001

Figure 18: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior Issues 

Pre-post Assessment - 12-Month Follow-Up

Domain Baseline Average

N=271

12-Month 

Average

N=271

Cohen’s d

Ability to meet basic 

needs 3.67 (SD .512) 3.75** (SD .477) .16

Parenting skills 3.84 (SD .925) 4.03** (SD .873) .21

Social supports 3.88 (SD .859) 4.13*** (SD .760) .30

Behavior issues 4.79 (SD .399) 4.86** (SD .349) .18

 **p<.01;***p<.001 

GOALS families showed significant improvement at six-month follow-up on two protective 

factors: “Concrete Support” and “Child Development/ Knowledge of Parenting.” Scores can 

range from 1 to 7. A higher score reflects a higher level of the protective factors.

Figure 19: Protective Factors Pre-post Assessment - 6-Month Follow-Up

Domain Baseline Average

N=371

6-Month Average

N=371 Cohen’s d

Family 

Functioning/Resiliency 5.93 (SD 1.23) 6.00 (SD 1.20) .06

Social Support 5.81 (SD 1.37) 5.93 (SD 1.31) .09

Concrete Support 5.29 (SD 1.78) 5.75*** (SD 1.62) .28

Nurturing and 

Attachment 6.76 (SD .386) 6.73 (SD .422) -.09

Child Development/ 

Knowledge of Parenting 5.89 (SD .915) 6.01** (SD .919) .14

 **p<.01;***p<.001 
United Way for Southeastern Michigan 56

At 12-month follow-up, GOALS families showed significant improvement on three protective 

factors: “Social Support,” “Concrete Support” and “Child Development/ Knowledge of 

Parenting”.

Figure 20: Protective Factors Pre-post Assessment - 12-Month Follow-Up

Domain Baseline Average

N=266

12-Month 

Average

N=266

Cohen’s d

Family 

Functioning/Resiliency 5.96 (SD 1.24) 6.06 (SD 1.26) .08

Social Support 5.78 (SD 1.38) 6.01* (SD 1.24) .18

Concrete Support 5.07 (SD 1.88) 5.60*** (SD 1.85) .27

Nurturing and 

Attachment 6.77 (SD .384) 6.72 (SD .657) -.10

Child Development/ 

Knowledge of Parenting 5.90 (SD .892) 6.05**(SD .855) .17

 *p<.05;**p<.01;***p<.001 

There was no significant change in GOALS families’ scores on the child temperament scales at 

either six- or 12-month follow-up. Scores for the Rothbart Temperament Scales are based on a 

7-point Likert scale. 

Figure 21: Child Temperament Outcomes - 6-Month Follow-Up

Domain Baseline Average

N=342

6 Month Average

N=342 Cohen’s d

Negative Affect 3.53 (SD .995) 3.57 (SD 1.08) -.04

Effortful Control 5.49 (SD .799) 5.50 (SD .781) .01

Figure 22: Child Temperament Outcomes - 12-Month Follow-Up

Domain Baseline Average

N=256

12 Month 

Average

N=256

Cohen’s d

Negative Affect 3.56 (SD 1.02) 3.47 (SD .987) .08

Effortful Control 5.47 (SD .825) 5.49 (SD .865) .02
United Way for Southeastern Michigan 57

Do children whose families participate in the Family Check-Up Model improve levels of 

development as demonstrated by improved communication skills, problem solving skills, 

social development, social-emotional health, and eating practices? 

Baseline, six-month, and 12-month scores on the Feeding Your Child questionnaire and ASQ-3 

and ASQ:SE-2 surveys were used to assess whether GOALS families showed improvement in 

communication skills, problem solving skills, social development, social-emotional health, and 

eating practices.

GOALS families showed significant improvement on the Feeding Your Child scale at both sixand 12-month follow-up. 

Figure 23: Feeding Your Child Outcomes - 6-Month Follow-Up

Outcome Baseline Average

N=183

6-Month Average

N=183 Cohen’s d

FYC Score 23.3 (SD 3.94) 24.3** (SD 3.94) .27

**p<.01;***p<.001

Figure 24: Feeding Your Child Outcomes - 12-Month Follow-Up

Outcome Baseline Average

N=144

12-Month 

Average

N=144

Cohen’s d

FYC Score 23.5 (SD 3.80) 24.8*** (SD 3.67) .32

**p<.01;***p<.001 

GOALS families showed a significant decrease in the number of areas of concern on the ASQ at 

both six- and 12-month follow-up. 

Figure 25: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 6-Month Follow-Up

Outcome Baseline Average

N=358

6-Month Average

N=358 Cohen’s d

Areas of Concern 1.12 (SD 1.41) .869*** (SD 1.33) .19

*p<.05;***p<.001 

Figure 26: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 12-Month Follow-Up

Outcome Baseline Average

N=263

12-Month 

Average

N=263

Cohen’s d

Areas of Concern 1.17 (SD 1.50) .932* (SD 1.52) .19

*p<.05;***p<.001 
United Way for Southeastern Michigan 58

Implementation Questions - Exploratory

Is the amount of improvement a family experiences increased by the number of services 

received? 

The project initially planned to look at the relationship between the number of services received 

and outcomes demonstrated on the assessments given to families. As evaluators began 

examining the data, it became clear that this approach would not work. The original plan was to 

use the number of referrals received and number of programs enrolled in as proxy measures for 

the number of services received. However, as evaluators discussed the referral data with the 

United Way in monthly meetings, concerns began to arise that there were differences in the 

approaches that agencies were using to document referrals and that some referrals were not 

being recorded at all. These suspicions were confirmed during site visits with the agencies. The 

United Way responded by providing additional training to the agencies about how to document 

and record referrals. This training, though, happened after the project had been implemented 

for several months. Thus, the early referral data was determined to be an underestimate of the 

actual number of referrals provided to families. In addition, discussions with agencies revealed 

that one approach to helping families that had significant needs was to provide them with as 

many referrals as possible. Thus, more referrals might be more of a reflection of families’ needs 

as opposed to an indicator of their likelihood to show improvement on their assessment scores.

Some of the agencies also explained to evaluators that many families were recruited out of their 

existing programs and that it was unlikely that the FCMS would recommend that the family 

repeat a program even if there was still room for progress to be made in areas such as parenting 

skills. In addition, agencies referred families out to other programs in the community if a 

needed program was not offered or space was not available in their own agency. These outside

programs were not documented in ETO in the same way that internal programs were 

documented. As a result, evaluators felt that the number of programs was not a good indicator 

for predicting how much success a family might experience in the GOALS intervention.

An analysis of communication between FCMS and families also showed little correlation 

between growth and volume of communication. Initial communication tracking strategies were 

not identical across agencies, proven by an analysis of data entry and confirmed via site visits. 

After an intensive analysis of the data and training with input from FCMSs and DCSs, an evolved 

communication log tracking strategy was instigated with an in-depth analysis of data entered in 

a two-month period to evaluate any differences between sites. Analysis demonstrated that very 

‘light touch’ communication like text messaging could be extremely frequent with some families 

but far less frequent in others, and that the number of contacts in general showed no connection 

to how those families scored on the ASQ-3 and Family Profile Form. Staff members reported 

that the amount of communication was largely driven by family preference rather than the need 

for referrals. 
United Way for Southeastern Michigan 59

Is the amount of improvement a family experiences increased by the length of time they 

participate in the program? 

Scores on the PICCOLO, ASSM, Protective Factors Survey, and Rothbart Temperament Scale 

were examined to evaluate whether GOALS families demonstrated better outcomes after twelve 

months of participation in GOALS than they demonstrated after six months of participation in 

GOALS. 

GOALS families showed significant improvement on three of four domains of the PICCOLO 

between six- and 12-month follow-up. 

Figure 27: PICCOLO Pre-post Assessment - 6 and 12 Month

Domain 6-Month Average

N=160

12-Month 

Average

N=160

Cohen’s d

Affection 1.76 (SD .320) 1.78 (SD .299) .04

Responsiveness 1.67 (SD .287) 1.73* (SD .255) .04

Encouragement 1.63 (SD .337) 1.68* (SD .302) .03

Teaching 1.34 (SD .383) 1.47*** (SD .326) .24

 *p<.05;***p<.001 

There were no significant changes in GOALS families between six- and 12-month follow-up on 

any of the domains of the ASSM. 

Figure 28: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior 

Issues Pre-post Assessment - 6 and 12 Month

Domain 6-Month Average

N=270

12-Month 

Average

N=270

Cohen’s d

Ability to meet basic 

needs 3.72 (SD .485) 3.75 (SD .476) .07

Parenting skills 4.04 (SD .840) 4.00 (SD .881) -.04

Social supports 4.11 (SD .747) 4.12 (SD .763) .01

Behavior issues 4.84 (SD .325) 4.86 (SD .341) -.04

Similarly, there were no significant changes for GOALS families on any of the five Protective 

Factors domains between six- and 12-month follow-up. 
United Way for Southeastern Michigan 60

Figure 29: Protective Factors - 6 and 12 Month

Domain 6-Month Average

N=270

12-Month 

Average

N=270

Cohen’s d

Family 

Functioning/Resiliency 6.05 (SD 1.13) 6.06 (SD 1.26) .02

Social Support 5.96 (SD 1.25) 6.02 (SD 1.23) .04

Concrete Support 5.62 (SD 1.73) 5.59 (SD 1.87) -.09

Nurturing and Attachment 6.75 (SD .398) 6.72 (SD .654) -.02

Child Development/ 

Knowledge of Parenting 6.00 (SD .927) 6.06 (SD .849) .06

There was a significant decrease in GOALS families’ scores on the negative affect domain of the 

child temperament scales between six- and 12-month follow-up. That is an indication of 

improvement on this domain.

Figure 30: Child Temperament Outcomes - 6 and 12 Month

Domain 6-Month Average

N=262

12-Month 

Average

N=262

Cohen’s d

Negative Affect 3.59 (SD 1.08) 3.44* (SD .986) -.13

Effortful Control 5.46 (SD .788) 5.51 (SD .870) .05

 *p<.05

GOALS families showed no significant improvement on the Feeding Your Child scale between 

six- and 12-month follow-up. 

Figure 31: Feeding Your Child - 6 and 12 Month

Outcome 6-Month Average

N=160

12-Month 

Average

N=160

Cohen’s d

FYC Score 24.2 (SD 3.99) 24.7 (SD 3.64) .05

 

GOALS families did not show any significant change in the number of areas of concern 

identified on the ASQ-3 and ASQ:SE-2 between six- and 12-month follow-up. 
United Way for Southeastern Michigan 61

Figure 32: Pre-post Assessment for GOALS Families on Average Number of Categories of 

Concern - 6 and 12 Month

Outcome 6-Month Average

N=254

12-Month 

Average

N=254

Cohen’s d

Areas of Concern .909 (SD 1.40) .858 (SD 1.41) -.036

 

 

Impact Questions

A total of 992 families completed baseline assessments and participated in GOALS (n=518) or in 

the comparison group (n=474).

The final sample for the six-month analyses was equally distributed between GOALS (50%) and 

comparison (50%) families. The two groups were similar on most characteristics at baseline. 

However, at baseline, GOALS families reported a significantly higher average number of people 

living in their households, they were more likely to be living with a spouse, and were more likely 

to be receiving public assistance than comparison families. Almost all of the parents that 

enrolled in the study were women and about half were between the ages of 26 to 34. They were 

most often African American or of Middle Eastern/North African or White origin. Most families 

reported that the primary language their family used at home was English. 

The What Works ClearinghouseTM (WWC) standards determine if baseline equivalence is met for 

individual characteristics by calculating the effect size (the difference between the GOALS group 

and comparison group average divided by the pooled standard deviation). If the effect size has 

an absolute value < 0.05, then baseline equivalence is satisfied (represented as ↑ in Figure 33). 

If the effect size has an absolute value > 0.05 and <0.25, then statistical adjustment is required to 

satisfy baseline equivalence (→), and if an effect size has an absolute value > 0.25, then baseline 

equivalence is not met ( ↓). Figure 33 below also outlines the baseline equivalence of GOALS 

and comparison families that completed six-month follow-up data. All of the individual 

characteristics either met the standard or could be adjusted statistically.

Figure 33: Baseline Equivalence of Individual Characteristics - 6-Month Follow-Up Sample

Variable

GOALS Comparison Difference

in % or 

Average

Pooled

SD

Effect

Size

WWC 

Standard

Met N % / 

Average SD N % / Average SD

Assigned group 392 50% 387 50% 0%

Parent’s age 390 32.6 7.269 381 33.4 8.474 .8 yr 7.887 .101 →

Child’s age 392 2.2 1.576 387 2.3 1.513 .1 yr 1.545 .065 →

Parent’s gender

 Female 391 97% .158 385 98% .151 1% .155 .065 →

Child’s gender

 Female 392 48% .500 387 52% .500 4% .500 .08 →
United Way for Southeastern Michigan 62

Race/ethnicity1 391 385

 American 

Indian 14 4% .186 7 2% .134 2% .162 .123 →

 Asian 11 3% .166 12 3% .174 0% .170 0 ↑

 African 

American 173 44% .497 171 44% .498 0% .497 0 ↑

 Hispanic 22 6% .231 14 4% .187 2% .210 .095 →

 Middle Eastern 

 /North African 103 26% .441 105 27% .446 1% .443 .023 ↑

 Pacific Islander 0 0% 0 0 0% 0 0% 0 0 ↑

 White 92 24% .425 86 22% .417 2% .421 .048 ↑

 Other 14 4% .186 16 4% .200 0% .193 0 ↑

Language 

Spoken 391 385

 English 275 70% .457 282 73% .443 3% .450 .067 →

 Spanish 8 2% .142 4 1% .102 1% .124 .080 →

 Arabic 99 26% .435 91 24% .425 2% .430 .047 ↑

 Other 9 2% .150 8 2% .143 0% .147 0 ↑

Household 

Composition

 Number in 

household 391 4.8 1.851 384 4.6 1.982 0.2* 1.917 .104 →

 Living with 

spouse 

391 50% .501 386 40% .490 10%** .496 .202 →

 Receiving 

public 

assistance

391 79% .406 386 70% .458 9%** .433 .208 →

 Less than high 

school 

education 

389 23% .424 374 27% .443 4% .433 .092 →

 1 More than one option could be selected.

 Difference based on t-test is statistically significant at *

p<.05; **p<.01; ***p<.001. 

Figure 34 outlines baseline equivalence for families that completed 12-month follow-up data. 

The sample was equally distributed between GOALS (50%) and comparison (50%) families. All 

but one of the individual characteristics either met the WWC standards or could be adjusted 

statistically to satisfy baseline equivalence. Receiving public assistance did not meet the WWC 

standard for baseline equivalence. At baseline, GOALS families who completed the 12-month 

follow-up were more likely to report receiving public assistance than comparison families.
United Way for Southeastern Michigan 63

Figure 34: Baseline Equivalence of Individual Characteristics - 12-Month Follow-Up Sample

Variable

GOALS Comparison Difference 

in % or 

Average

Pooled

SD

Effect

Size

WWC 

Standard

Met N % / 

Average

SD N % / 

Average SD

Assigned 

group

287 50% 290 50% 0%

Parent’s age 286 32.4 7.417 287 33.4 8.539 1.0 yr 8.000 .125 →

Child’s age 287 2.2 1.559 290 2.3 1.548 .1 yr 1.553 .064 →

Parent’s 

gender

 Female 286 98% .144 289 98% .131 0% .138 0 ↑

Child’s 

gender

 Female 287 49% .501 290 48% .501 1% .501 .020 ↑

Race/

ethnicity1 286 289

 American 

Indian 11 4% .193 6 2% .143 2% .170 .118 →

 Asian 7 2% .155 10 3% .183 1% .170 .059 →

 African 

American 104 36% .482 117 40% .492 4% .487 .082 →

 Hispanic 21 7% .261 12 4% .200 3% .232 .129 →

 Middle 

Eastern / 

 North 

African

91 32% .467 91 32% .465 0% .466 0 ↑

 Pacific 

Islander 0 0% 0 0 0% 0 0% 0 0 ↑

 White 65 23% .420 60 21% .406 2% .413 .048 ↑

 Other 12 4% .201 16 6% .229 2% .216 .093 →

Language 

Spoken 286 289

 English 182 63% .482 201 69% .461 6% .472 .127 →

 Spanish 8 3% .165 2 1% .083 2% .130 .154 →

 Arabic 88 31% .462 78 27% .445 4% .454 .088 →

 Other 8 3% .165 8 3% .164 0% .164 0 ↑

Household 

Composition

 Number in 

household 286 4.9 1.787 289 4.7 1.926 0.2 1.858 .108 →

 Live

w/spouse

286 51% .501 290 45% .499 6% .500 .120 →

 Receiving 

public assist. 286 82% .386 290 69% .463 13%*** .427 .304 ↓
United Way for Southeastern Michigan 64

 Less than 

High School

education 

285 24% .429 280 31% .462 7% .446 .157 →

 1 More than one option could be selected.

 Difference based on t-test is statistically significant at *

p<.05; **p<.01; ***p<.001. 

Do families who receive the Family Check-Up model make significantly greater 

improvements in self-sufficiency compared to families who only receive standard services 

as evidenced by improved parenting skills, ability to meet basic needs, increased social 

supports, and reduced risk behaviors?

At six-month follow-up, the comparison families showed significantly higher scores on their 

ability to meet basic needs and on parenting skills on the Arizona Self-Sufficiency Matrix. At 12-

month follow-up, comparison families scored significantly higher than GOALS families on 

parenting skills.

Figure 35: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior Issues Pre-post 

Assessment - GOALS and Comparison Families - 6-Month Follow-Up

Six Months

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Ability to meet 

basic needs 377 3.74 .492 380 3.84 .512 -.085 -.084 .005

Parenting skills 376 4.00 .926 372 4.20 .858 -.146 -.081 .020

Social supports 377 4.08 .809 378 4.12 .685 -.027 -.018 .578

Behavior issues 377 4.82 .366 379 4.90 .295 -.028 -.041 .167

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Figure 36: Family's Ability to Meet Basic Needs, Parenting Skills, Social Supports, and Behavior Issues Pre-post 

Assessment - GOALS and Comparison Families - 12-Month Follow-Up

12 Months 

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD Regression

Coef. β p 

Ability to meet 

basic needs 291 3.76 .480 291 3.85 .514 -.054 -.054 .133

Parenting skills 290 4.00 .882 286 4.22 .918 -.206 -.117 .005

Social supports 291 4.11 .774 288 4.01 .809 .031 .020 .617

Behavior issues 291 4.85 .353 290 4.89 .325 -.020 -.032 .388

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 
United Way for Southeastern Michigan 65

Protective Factors

At six-month follow-up, the GOALS participants scored significantly higher on the social support 

dimension and the comparison group scored significantly higher on the nurturing and 

attachment dimension. At 12-month follow-up there were no statistically significant differences.

While we did calculate Cohen’s f for these analyses, we did not include them in these tables 

because the standardized regression weights are provided and can be squared to obtain a 

percentage of variance accounted for by treatment group status. This is a more intuitive effect 

size for most readers and is more robust to the deviations from normality and heteroscedasticity 

of the variables, which is to be expected for risk variables in a vulnerable population.

Figure 37: Protective Factors - 6-Month Follow-Up

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Figure 38: Protective Factors - 12-Month Follow-Up

12 Month

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Family 

Functioning/

Resiliency

291 6.02 1.29 289 6.12 .109 -.084 -.038 .325

Social 

Support 290 5.95 1.30 289 5.94 1.21 .040 .017 .670

Concrete 

Support 290 5.61 1.84 289 5.52 1.75 .159 .045 .237

Six Months

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Family 

Functioning/

Resiliency

376 6.00 1.21 375 6.03 1.17 -.005 -.002 .953

Social 

Support 376 5.93 1.30 375 5.74 1.40 .170 .064 .047

Concrete 

Support 376 5.76 1.63 376 5.60 1.62 .199 .061 .067

Nurturing 

and 

Attachment 

375 6.73 .427 375 6.77 .540 -.073 -.077 .032

Child 

Development

/ Knowledge 

of Parenting

374 6.02 .914 375 6.19 .883 -.074 -.041 .214
United Way for Southeastern Michigan 66

Nurturing 

and 

Attachment 

290 6.72 .641 289 6.78 .419 -.070 -.063 .139

Child 

Development

/ Knowledge 

of Parenting

290 6.07 .842 289 6.24 .781 -.127 -.076 .060

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Do children in families who receive the Family Check-Up model make significantly greater 

improvements in development compared to children in families who only receive standard 

services as evidenced by improved communication skills, problem solving skills, social 

development, social emotional health, and eating practice?

Child Development Outcomes

As indicated in figures 39 and 40, few children scored at risk on each of the areas assessed by 

the Ages & Stages Questionnaires at baseline, six months and at 12 months.

Figure 39: Change in Child's Development - 6-Month Follow-Up

Baseline Six Month

Communication

GOALS

N=341

Comparison

N=353

GOALS

N=341

Comparison

N=353

At Risk 7.9% 8.8% 7.6% 4.3%

Monitor 12.3% 10.2% 8.5% 9.9%

No Risk 79.8% 81.0% 83.9% 85.8%

Gross Motor 

Skills N=340 N=351 N=340 N=351

At Risk 7.9% 6.5% 4.1% 4.6%

Monitor 6.2% 7.7% 8.2% 4.6%

No Risk 85.9% 85.8% 87.7% 90.8%

Fine Motor 

Skills N=338 N=347 N=338 N=347*

At Risk 6.8% 9.2% 3.6% 8.1%

Monitor 14.2% 19.0% 14.2% 11.5%

No Risk 79.0% 71.8% 82.2% 80.4%

Problem Solving N=338 N=349 N=333 N=349

At Risk 6.5% 8.0% 3.2% 5.7%

Monitor 11.0% 9.2% 9.5% 6.9%

No Risk 82.5% 82.8% 87.3% 87.4%

Personal Social N=341 N=350 N=341 N=350
United Way for Southeastern Michigan 67

At Risk 7.0% 6.3% 5.9% 4.9%

Monitor 12.0% 8.6% 7.3% 8.6%

No Risk 81.0% 85.1% 86.8% 86.5%

ASQ:SE-2 N=350 N=358 N=350 N=358

At Risk 8.9% 8.7% 8.9% 8.9%

Monitor 11.1% 10.9% 9.1% 9.2%

No Risk 80.0% 80.4% 82.0% 81.9%

* p<.05 (CHI2)

Figure 40: Change in Child's Development - 12-Month Follow-Up

Baseline 12 Month

Communication

GOALS

N=248

Comparison

N=253

GOALS

N=248

Comparison

N=253

At Risk 8.5% 9.9% 7.2% 8.3%

Monitor 14.5% 9.9% 8.5% 5.5%

No Risk 77.0% 80.2% 84.3% 86.2%

Gross Motor 

Skills N=248 N=250 N=248 N=250

At Risk 10.1% 7.2% 4.0% 2.8%

Monitor 6.4% 8.0% 6.5% 6.0%

No Risk 83.5% 84.8% 89.5% 91.2%

Fine Motor 

Skills N=246 N=250* N=246 N=250

At Risk 6.5% 7.6% 9.8% 8.0%

Monitor 12.6% 21.2% 11.8% 12.8%

No Risk 80.9% 71.2% 78.4% 79.2%

Problem 

Solving N=246 N=250 N=246 N=250

At Risk 8.1% 8.0% 5.3% 3.2%

Monitor 11.0% 10.0% 9.8% 6.4%

No Risk 80.9% 82.0% 84.9% 90.4%

Personal Social N=249 N=250 N=249 N=250

At Risk 7.6% 5.6% 6.8% 4.8% 

Monitor 13.7% 11.2% 10.9% 9.2% 

No Risk 78.7% 83.2% 82.3% 86.0% 

ASQ:SE-2 N=254 N=256 N=254 N=256

At Risk 9.8% 7.8% 9.8% 11.3%

Monitor 9.8% 9.8% 7.9% 8.2%

No Risk 80.4% 82.4% 82.3% 80.5%

* p<.05 (CHI2)

Figure 41 presents a summary of the total number of ASQ-3 and ASQ:SE-2 domains in which 

children were assessed to be in the “at risk” or “monitoring” category at six-month follow-up. 
United Way for Southeastern Michigan 68

Fifty-six percent of the GOALS children and 59% of the comparison children scored in the “no 

risk” category on all of the ASQ-3 and ASQ:SE-2 domains at six-month follow-up. The remaining 

44% of GOALS and 41% of comparison children had at least one category of concern. 

Figure 41: Number of Categories of Concern - 6-Month Follow-Up

Six Month GOALS (N=370) Comparison (N=373)

Number of At Risk 

or Monitoring 

Categories1

Number 

of 

Children

Percent of 

Total

Number of 

Children

Percent of 

Total

0 206 56% 221 59%

1 86 23% 79 21%

2 35 9% 26 7%

3 18 5% 25 7%

4 14 4% 12 3%

5 5 1% 7 2%

6 6 2% 3 1%

There was no significant difference between the GOALS and comparison groups in the 

percentage of families in which children scored in the “at risk” or “monitoring” categories on at 

least one domain at six-month follow-up. 

Figure 42: Percent of Participants with at Least One Category of Concern 6-Month Follow-Up

Six Month

GOALS Comparison Logistic Regression

N Unadjusted 

Percentage N Unadjusted Percentage

Adjusted 

Difference

Regression

Coef. p 

Percent of families with 

one or more categories 

of concern

370 44.32% 373 40.75% 3.01% .165 .358

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency.

Figure 43 presents similar data at 12-month follow-up. Fifty-nine percent of the GOALS children 

and 56% of the comparison children scored in the “no risk” category on all of the ASQ-3 and 

ASQ:SE-2 domains at 12-month follow-up. The remaining 41% of GOALS and 44% of 

comparison children had at least one category of concern. 
United Way for Southeastern Michigan 69

Figure 43: Number of Categories of Concern - 12-Month Follow-Up

12 Month GOALS (N=273) Comparison (N=270)

Number of Refer or 

Monitoring 

Categories1

Number 

of 

Children

Percent of 

Total

Number of 

Children

Percent of 

Total

0 161 59% 150 56%

1 52 19% 69 25%

2 23 8% 20 7%

3 16 6% 19 7%

4 5 2% 5 2%

5 8 3% 5 2%

6 8 3% 2 1%

There was no significant difference between the GOALS and comparison groups in the 

percentage of families that scored in the “at risk” or “monitoring” categories for at least one 

domain at 12-month follow-up. 

Figure 44: Percent of Participants with at Least One Category of Concern - 12-Month Follow-Up

12 Month

GOALS Comparison Logistic Regression

N Unadjusted 

Percentage N Unadjusted Percentage

Adjusted 

Difference

Regression

Coef. p 

Percent of families 

with one or more 

categories of 

concern

273 41.03% 270 44.44% 3.05% -.175 .383

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency.

Temperament Outcomes

It is of note that comparisons of the current study participants’ temperament scores across time 

should be interpreted with caution since some children aged into different versions of the 

temperament measures between data collections. 

The differences between the groups were not significant at six- or 12-month follow-up for 

negative affect or effortful control.
United Way for Southeastern Michigan 70

Figure 45: Child's Temperament Outcomes - 6-Month Follow-Up

Six 

Month

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD Regression

Coef. β p 

Negative 

Affect 373 3.60 1.08 366 3.63 1.08 -.017 -.008 .822

Effortful 

Control 373 5.52 .786 366 5.51 .773 .035 .022 .517

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Figure 46: Child's Temperament Outcomes - 12-Month Follow-Up

12 Month

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Negative 

Affect 279 3.46 .984 292 3.51 1.02 -.052 -.026 .540

Effortful 

Control 279 5.48 .864 292 5.50 .760 .012 .007 .858

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Feeding Your Child Assessment Outcomes

GOALS families had significantly higher scores on the Feeding Your Child survey than the 

Comparison group at both six- and 12-month follow-up. 

Figure 47: Child's Feeding Practices Outcomes - 6-Month Follow-Up

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Six Month

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD RegressionCoef. β p 

Feeding Your 

Child 221 24.07 3.87 243 22.81 4.19 .827 .102 .039
United Way for Southeastern Michigan 71

Figure 48: Child's Feeding Practices Outcomes - 12-Month Follow-Up

Adjusted using: Participation in the GOALS or the comparison group, Baseline score on independent variable, 

Parent’s age, Race/ethnicity (classified as African American, Other)

Language spoken at home (classified as English, Other), Living with spouse, Receiving public assistance, Parent’s 

education, Agency. 

Discussion

GOALS families showed significant improvement in many areas between pre and post-test. 

However, the results indicate that they only outperformed the comparison group in two areas. 

Several factors likely contribute to the fact that the two groups looked similar in many ways at 

follow-up. First, the recruitment strategy used to enroll families into the study included 

recruiting families out of high quality, evidence-based programs in areas like parenting at four 

of the five agencies. In addition, these families were sometimes still participating in these highquality programs while they were enrolled in either the intervention or comparison group. Thus, 

some families in the comparison group were receiving interventions that have been shown in 

previous research to have positive impacts on some of the same areas assessed in this study. A 

plan to look at the data generated by these programs for GOALS and comparison families was 

unable to be implemented due to the shortened period. 

Another factor that likely contributed to the similarity in the two groups is the fact that the 

comparison group received a higher level of care than standard care in these agencies. 

Comparison families received all but one of the assessments that the intervention group 

received – assessments that are not typically given to families in these agencies. In addition, 

comparison families received feedback about the results of these assessments along with a list 

of community resources, even though the feedback was not as comprehensive as the feedback 

provided to the GOALS families. Along the same lines, GOALS families received on average 

19.2 contacts with staff compared to 9.7 contacts per family on average for control families. 

While that is a substantial difference, it does highlight the extent of communications between 

agency staff and control group families. 

12 Month

GOALS Comparison Regression

N Unadjusted 

Average SD N Unadjusted Average SD Regression

Coef. β p 

Feeding Your 

Child 211 24.26 3.70 221 22.12 4.32 1.92 .226 .000
United Way for Southeastern Michigan 72

Additionally, the needs of both GOALS families and 

control group families were quite heterogeneous. 

Aggregating group outcomes might be masking more 

substantial differences if needs at baseline were 

disaggregated. This would, in many cases, result in small 

samples and reduced power, but subsequent studies may 

focus on these disaggregated samples in an exploratory 

fashion. 

Future study of the GOALS intervention might include a comparison of families that receive 

GOALS to families who are not receiving services from the agencies. This might provide a 

clearer picture of the true impact of this intervention.

Finally, some of the assessments involved in the GOALS intervention and evaluation are not 

designed to detect marginal gains, such that might be experienced by some of the families 

targeted by this intervention. For example, moving to a higher category on the Arizona Self 

Sufficiency Matrix often requires a large change in a family’s level of functioning. The FCMSs 

who worked on this project reported on their Case Closure Forms that they saw progress in 

these families that might not have been detectible by some of the assessments used. Future 

studies should involve more sensitive assessments that detect smaller steps towards selfsufficiency.

Lessons Learned

In addition to the successes and challenges this study has discussed, this section highlights 

substantive challenges the project experienced throughout its implementation and includes a 

discussion of the modifications and/or recommendations for future implementers. It is 

organized by category, challenge, and modification/recommendation. 

Category: Conducting Assessments 

Challenge: Many families seemed to have difficulty with the Likert scales on the assessments.

Modifications/Recommendations: A staff member developed a visual depiction of the Likert 

scale for each assessment that she brought to the assessment session. She shared this 

approach with other FCMSs and DCSs.

Category: Assessments 

Challenge: The overall assessment package was quite long, typically taking multiple hours for 

families to complete.

Modifications/Recommendations: The assessment package could be trimmed to the most 

essential components that were most readily understood by families and closely linked to 

families’ most common goals. The trimmed down assessment package could include direct 

observation of parenting, assessment of child developmental competence, and assessment of 

the most relevant family self-sufficiency domains (e.g., access to health care and child care).

“The greatest need was found 

to be the need for belonging 

and self-actualization.”

- Program Manager, CARE of 

Southeastern Michigan
United Way for Southeastern Michigan 73

Category: Assessments 

Challenge: Some assessments, particularly the assessments of temperament and nutrition, were 

reported to be more problematic by the FCMSs and DCSs.

Modifications/Recommendations: Assessments seen as less valuable for feedback or more 

confusing to families could be dropped in future implementations of the GOALS program. 

Continually review the salience of assessments and how they are connected to work with 

families.

Category: Assessments - Temperament scales

Challenge: The Strengths and Difficulties Questionnaire (SDQ) is recommended for use with 

the Family Check-Up, but the SDQ is recommended for ages 3-16 and the GOALS program 

targets families with children between newborn and 5. 

Modifications/Recommendations: The Rothbart temperament assessments (IBQ-R, ECBQ, 

CBQ) were added to the assessment protocol as a replacement for the SDQ. 

The Rothbart temperament assessments were selected because they have item overlap with the 

SDQ but have been validated on infants and toddlers. The SDQ provides 5 subscale scores: 

Emotion Symptoms, Conduct Problems, Hyperactivity/Inattention, Peer Relationship Problems, 

and Social Problems.

Category: Assessments - Temperament scales

Challenge: The Rothbart scales provide 3 subscales: Negative Affect, Effortful Control, and 

Surgency. The Surgency dimension was challenging to interpret for FCMSs and they also found 

it hard to incorporate the temperament dimensions into caregiver feedback.

Modifications/Recommendations: To address these challenges the Surgency subscale was 

dropped from the scoring and training was provided to FCMS to frame Negative Affect and 

Effortful Control temperament traits as aspects of their child that might lead to additional 

parenting challenges / stress and require adaptive parenting strategies, rather than something 

of concern with the child that needed to be addressed.

Category: Assessments - Feeding Your Child Survey

Challenge: The Feeding Your Child Survey (FYCS) was included in the GOALS assessment 

protocol because the UWSEM FEAST program was a core pathway for the program. The FYCS is 

a relatively new measure and focuses on attitudes, norms, and behaviors around food rather 

than specific nutritional behaviors. This measure was challenging on a number of fronts. Parents 

expected more information regarding incorporating healthy foods into their children’s diets 

instead of broader approaches to food in general. Some of the items were also confusing (e.g., 

“I am comfortable with providing meals for my family”).

Modifications/Recommendations: Training was provided to FCMSs related to how to 

communicate to caregivers about this scale and how to frame results in feedback sessions.

Category: Automatic Data Scoring and Feedback Forms
United Way for Southeastern Michigan 74

Challenge: There were a number of challenges related to incorporating the ETO system into 

the data utilization process for the GOALS program. ETO was to be utilized in two different 

capacities: 1) Automated scoring of assessments and generating family feedback forms, 2) the 

primary data management system for the evaluation of the GOALS program. The overarching 

challenge presented by ETO is that it is designed for case management and agency 

performance outcomes rather than a traditional relational database, and the assessment heavy 

nature of the GOALS program stretched the capabilities of the ETO system. Specifically, the 

scoring of the ASSM from the Family Profile Form required a complex scoring algorithm (see 

assessments section of the report) that was extremely challenging for the logical operator-based 

queries in ETO. A missing item or inconsistent response would prevent the scoring algorithm 

from executing and resulted in large amounts of missing data that would have to be checked 

against hand scored ASSMs. This was true of other measures as well but was most pronounced 

in the ASSM scoring. Additionally, the relational structure of ETO made it challenging to link 

Family IDs with Child IDs often resulting in inaccurate counts and orphaned data. Similarly, the 

linkage of Family ID and Child ID made it difficult to pull information from different database 

tables and this resulted in widespread missing data on variables such as child age, sex, etc.

Modifications/Recommendations: A subgroup met on a bi-weekly basis for approximately 18-

months, beginning in March of 2018, to review and address ETO data challenges. This involved 

an item-by-item review of scoring algorithms. FCMSs also, in many cases as issues were being 

addressed, continued to hand score the assessments to confirm accuracy. Data audits were also 

conducted to ensure accuracy of the data in ETO. 

It should also be noted that despite extensive technical expertise on the project team, United 

Way had to rely on Social Solutions for some of the more technically complex reporting builds 

and projects should be sure to budget for this type of technical assistance. This also impacted 

project timelines and the possibility for this type of external delay should be discussed and 

planned for during the design and pilot phases of the project. 

Additionally, work with a data management system that is an open relational database (e.g., 

SQL) that gives more control and flexibility to agencies implementing this program. 

Additionally, develop a formal process for transferring data from the data management system 

to data analysis and reporting systems to ensure more efficiency.

A shortened pilot period also impacted the team’s ability to address these issues prior to full 

launch. Every effort should be made to test all data systems and associated protocols prior to 

launch. 

Category: Communications Regarding Implementation

Challenge: FCMSs and DCSs had concerns or questions about the delivery of the assessments 

and feedback. They also encountered challenges unique to specific cases in their caseload.

Modifications/Recommendations: Monthly “Learning Communities” were set up for FCMSs to 

present challenging cases and to discuss broader concerns and receive additional training on 
United Way for Southeastern Michigan 75

specific topics (e.g., goal setting). DCSs also had monthly meetings to discuss assessment 

delivery and other concerns.

Category: Sharing Feedback with Families

Challenge: FCMSs expressed concerns about sharing areas of weakness that may need 

attention with families during feedback sessions.

Modifications/Recommendations: The initial Family Check-Up training emphasized that the 

program uses a strengths-focused approach. FCMSs were encouraged during training and in 

subsequent Learning Communities to share feedback in a way that was consistent with the data 

and results while highlighting families’ strengths and adjusting feedback in response to 

caregivers’ perspectives.

Category: Goal Setting

Challenge: Initially, many families did not set goals, and FCMSs sometimes struggled helping 

families to set goals.

Modifications/Recommendations: In subsequent training sessions during monthly Learning 

Communities, the importance of goal setting was emphasized and barriers to goal setting were 

discussed. Regular check-ins with all staff, especially on key components of the project, should 

be conducted to ensure understanding. It may be helpful to have multiple teams or individuals 

conduct these to capture different perspectives, as some individuals may have difficulty 

discussing some issues with the funding agency. 

Category: Pathways

Challenge: It is difficult to anticipate every need that project participants will have and to preidentify quality interventions for every referral. Projects that rely on external resources want to 

remain nimble around their ability to activate around new opportunities. 

Modifications/Recommendations: Pathways were added through a mix of opportunities from 

the community as long as it met the spirit of, and complied with, the intervention and project 

requirements and need expressed by the participants and program staff (e.g. Citizenship 

Pathway and Literacy Pathway). 

Category: Pathways 

Challenge: FCMSs indicated during site visits that there were some areas of confusion 

regarding how to use pathways and the services associated with the pathways. 

Modifications/Recommendations: FCMSs indicated that it would be helpful to have 

documentation outlining concrete steps for enrolling families in pathways and providing the 

associated services. In order to detect gaps in understanding and use of pathways quickly, more 

early and intense monitoring of pathway data along with coaching for FCMSs specifically aimed 

at supporting families enrolled in various pathways might be beneficial.

Category: Blurring of Conditions 

Challenge: The GOALS and comparison conditions may have been more similar than intended. 

Specifically, even though DCS were named “Data Collection Specialists” they also provided 
United Way for Southeastern Michigan 76

feedback to families (albeit more limited) and assisted with referrals, likely to varying degrees 

across agencies. It is difficult to know how similar this comparison condition was relative to care 

“as usual” at these agencies.

Modifications/Recommendations: Small samples stratified by level of engagement might be 

able to tease this apart. 

Additionally, because there remains an obligation to treat, more monitoring of the 

communication and referral data specifically for the comparison condition to ensure that all 

services received are controlled for in the analysis. 

Category: Randomization of Participants

Challenge: Randomization protocols instructed agencies to begin the randomization process 

for families recruited via word of mouth or at large recruitment events as soon as they expressed 

interest in the project. Families who expressed interest in the study were immediately randomly 

assigned to either the intervention or comparison group by the agencies. The agencies would 

then follow up with families to set up the initial assessment appointment. There was often a gap 

of days or weeks between when a family initially expressed interest and when they were 

contacted by the agency to set up an appointment. Agencies found that some families lost 

interest during that time and never actually enrolled in the study. Other families, particularly 

those recruited at large community events, may have never been interested or may not have 

understood what enrollment in the study entailed. As a result, a large number of families who 

were randomized early in the study never actually enrolled in the study. This led to high 

baseline attrition numbers.

Modifications/Recommendations: Under the new protocols, agencies did not immediately 

randomize families that expressed interest in the study. Instead, the agencies recorded contact 

information from these families and let the families know that they would receive a call from the 

agency when there was room to immediately enroll new families into the study. 

If the families expressed both that they remained interested in enrolling and that they were 

prepared to set up an appointment immediately, they were offered a spot in the study. After the 

phone call, the agency would randomly assign the family to the intervention or comparison 

group using the updated randomization protocol. If a family was randomly assigned to the 

intervention group, a Family Check-Up Model Specialist immediately contacted them to set up 

the first appointment. If a family was randomly assigned to the comparison group, a Data 

Collection Specialist immediately contacted them to set up a first appointment. 

Category: Staff Turnover 

Challenge: There was a high level of turnover in FCMSs and DCSs, although the rate of turnover 

varied considerably across agencies and across time. United Way as the project lead also 

experienced a high-level turnover among its executive staff who oversee overall strategy for the 

organization. 

Modifications/Recommendations: The project team anticipated this turnover and one of the 

first major documents pulled together following the pilot phase of the project when most 

processes had been codified was to create a comprehensive implementation manual. This 

manual pulled together overviews, process flows, job aides, and other materials related to the 
United Way for Southeastern Michigan 77

project to assist in onboarding and to serve as a reference for issues that came up. United Way 

also instituted a “Help Ticket” model to support staff with technical issues. 

Another recommendation from project partners that could not be implemented due to 

compliance issues around how these funds could be used was to create a retention bonus for

staff that stayed through the full project period to help ensure full staffing through the final 

months of the project. 

For future efforts and communicating with executive staff members this study would 

recommend creating high-level overviews, infographics, and presentations that can help key 

decision makers quickly understand a project this complex. 

Next Steps

The goal of all Social Innovation Fund projects is to “figure out what works and make it work for 

more people” United Way intends to support this effort in three ways. 

First, United Way will continue to review the data generated by this project and deepen its 

analysis, as is practicable and funding allows. Additional articles, infographics, and 

presentations to the field will continue to support the knowledge sharing efforts around this 

work. The COVID-19 impact data is of particular interest as United Way serves as a local hub for 

pandemic relief efforts in Southeast Michigan and this data will help deepen the organization’s 

understanding as it continues to support crisis relief and community resilience efforts. 

Second, United Way is planning to continue to support key GOALS pathways and components 

of the assessment in its Center for Early Childhood Excellence. This will include the ASQ-3 and 

ASQ-SE screening tools and READY4K texting platform. United Way has also modified the 

READY4K texting pathway to respond to ASQ-3 screening data creating a tailored experience 

for parents. Under this new partnership, a parent or childcare provider will enter the screening 

responses and the data is then sent through an API to a proprietary algorithm created by 

ParentPowered Public Benefit Corporation specifically to support this pathway expansion. The 

algorithm then selects texts based on the caregiver’s answers and delivers messages and 

activities that respond directly to the child’s needs. This is repeated every time an ASQ is 

conducted. 
United Way for Southeastern Michigan 78

Additionally, FCMSs repeatedly cited the difficulty 

families had in finding childcare in their 

communities. Leveraging funds from this project 

and others in service of our scaling and sustainability 

efforts, United Way has been able to create a new 

one-stop-shop to digitally house several GOALS 

pathways and support families in finding childcare 

called www.Connect4CareKids.org. In a pilot with 

the City of Detroit, this new platform expands the 

texting pathway to allow parents to determine their 

eligibility for subsidized childcare, locate childcare 

settings, and begin the enrollment process all from 

the texting app on their phones or through the 

website. Text prompts through the same system will also help United Way staff begin to 

proactively ascertain other needs families may have and direct them to services using processes 

adapted from GOALS. 

Lastly, United Way is embarking on the work to create a Community Information Exchange, or 

CIE, to help bridge the data divide between social services and healthcare partners and move 

from reactive information and referral to proactive social service navigation supports. GOALS 

staff have been part of the planning efforts around this work and will continue to support on 

implementation with the goal being to infuse the learnings generated from GOALS into this new 

system of care. Of particular interest is the work around the Family Profile Form and using 

motivational interviewing to support family goal setting. This has the potential to greatly 

enhance the 2-1-1 model and change United Way’s service delivery model in ways that 

empower families, bolster systems, and leverage data to drive positive outcomes. 

“The biggest commonality no 

matter the culture, was that 

children’s learning seemed to most 

often be families’ highest area of 

interest, and this topic would 

frequently take precedence over 

resources, regardless of level of 

need.”

- Data Collection Specialist, 

Oakland Family Services
United Way for Southeastern Michigan 79

COVID-19 Pandemic 

Effects 
United Way for Southeastern Michigan 80

COVID-19 PANDEMIC EFFECTS

COVID-19 Timeline

December of 2019: The first reported cases of a novel Corona virus (Corona Virus ID 2019 or 

COVID-19) emerged in Wuhan, China. 

December 31, 2019: Last date of program enrollment for the GOALS project.

January 21, 2020: The first case of COVID-19 was reported in the United States. 

March 11, 2020: Michigan had its first reported case; this case was identified in Oakland 

County. 

March 18, 2020: GOALS project began development of remote service delivery and evaluation 

protocols. 

March 23, 2020: Michigan Governor issued an executive order requiring residents to shelterin-place and all non-essential business along with schools to close.

April 2, 2020: Michigan reported the 3rd highest number of cases in in the U.S. with 10,791 

cases, 79.5% of the cases occurring in the Metro-Detroit region with Detroit accounting for 33% 

of the Metro cases. Furthermore, the mortality rate was disproportionately impacting the 

African American community (https://www.michigan.gov/coronavirus/0,9753,7-406-

98163_98173---,00.html) which accounted for 40% of COVID-19 deaths in Michigan, nearly 

double the rate of Caucasian deaths (26%).

April 28, 2020: GOALS IRB amendment was approved to include two COVID-19 impact 

measures that were administered remotely beginning with currently enrolled families, followed 

by reaching out to previously enrolled families.

August 31, 2020: Data collection on the GOALS project was completed. Michigan had 

reported 102,468 cases of COVID-19 and 6,480 deaths. The Metro-Detroit area which is the 

catchment area for the GOALS project accounted for 54% of all COVID-19 cases in Michigan 

and 72% of COVID-19 deaths. City of Detroit residents alone accounted for 23% of deaths and 

had a death rate of 10.2%, more than twice the Michigan average of 4.9%. 

COVID-19 Impact and Implications

The COVID-19 pandemic had a tremendous negative impact on the families being served by 

the GOALS project. African Americans, which comprise 47% of our sample, in Michigan are 1.9 

times more likely to contract the virus and 3.6 times more likely to die from COVID-19 than any 

other racial demographic group. Long standing health disparities put African Americans at 

much greater risk because of disproportional rates within the African American community of 
United Way for Southeastern Michigan 81

the risk factors with the highest COVID-19 death rates

(https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm) cardiovascular disease (10.5% 

death rate), diabetes (7.3% death rate), chronic respiratory disease (6.3% death rate), and 

hypertension (6.0% death rate). This is further complicated by increased immunosuppression in 

the African American community resulting from chronic exposure to stressors (Black, Johnson, & 

VanHoose, 2015). This is particularly true for African American women (Lewis, et al., 2017). 

In addition to the direct impact of COVID-19 on vulnerable families, they are also the most 

severely impacted by societal 

ramifications of the virus. 

The cumulative impact of 

COVID-19 on an asymmetrical 

and inequitable social 

infrastructure is that the most 

vulnerable families will be hit 

earliest, hardest, and have the 

most difficult time recovering 

from this public health crises. 

This will likely have a 

generational impact due to 

the ripple effects of lost 

economic and educational 

opportunity and straining 

public social services for 

decades, ultimately leading to 

further societal disparities and 

injustices.

COVID-19 Impact on GOALS participants

As noted in the timeline above, current and former study participants were contacted by partner 

agency staff via phone and asked to complete two COVID-19 impact questionnaires (see 

appendices X and Y). One questionnaire asked about exposure to COVID-19 by the participant 

and within the participants family and friends, as well as COVID-19 symptoms. The other 

questionnaire was focused on the ways in which COVID-19 directly and indirectly, via stay-athome orders, etc., impacted participants’ daily life. Participants who were currently active in the 

GOALS program were contacted first followed by families who had completed the GOALS 

program in reverse order of enrollment date. Thus, families with the most recent involvement in 

the program were contacted first in order to maximize recruitment. The final sample consisted 

of 380 participants. 

To administer the COVID-19 surveys partner agency staff were instructed to begin with study 

participants who had been recently in contact with an FCMS or DCS as these were the people 

Societal Ramifications of COVID-19 on Vulnerable 

Populations

Families are more likely to:

• Have low income, hourly-wage jobs with no paid sick leave

• Be laid off indefinitely

• Have unstable housing and higher likelihood of eviction

• Lack adequate health care coverage and access to health 

care services

• Rely on public transportation

• Limited access to food and other household necessities

• Be more negatively impacted by the need for childcare 

and school closings

• At higher risk for legal and judicial actions resulting from 

crimes of poverty 

• Lack of social capital

• Long-term family disruption due to illness and or death

• Barriers to obtaining social and economic supports
United Way for Southeastern Michigan 82

more likely to have up-to-date contact information. After completing those calls, staff was then 

instructed to call participants that had not had recent contact. Additionally, in an effort to 

maintain case closure, staff members were asked not to contact participants that had previously 

been assigned to their caseload except in extenuating circumstances (ex: a language barrier). 

Public health reports across the United States have shown that individuals from marginalized 

populations are at much higher risk of COVID-19 exposure and risk of dying from COVID-19. 

The GOALS families reported COVID-19 exposure rates that were consistent with these National 

findings. 

These findings illustrate the substantial and 

disproportional exposure to the virus that 

GOALS families experience. Compared to the 

general population GOALS families, like most 

members of marginalized communities are 

bearing the brunt of the pandemic. Perhaps 

because GOALS families have such widespread 

exposure to the virus, they report a very high 

compliance with masking. Approximately 94% 

of respondents reported wearing a mask when 

outside their own home. However, social and 

economic inequities often prevent GOALS 

families from a “shelter-in-place” approach 

putting them at greater risk for contracting 

COVID-19 despite high mask compliance. On 

average GOALS families left home between 3-4 

days per week. 20% of respondents reported 

leaving home for work and 55% reported 

leaving home in order to get groceries. While leaving home for groceries is common across 

demographic groups, it appears from our data that GOALS families are leaving home more 

frequently which may be due to economic and transportation barriers that restrict the ability to 

buy in sufficient bulk to reduce the frequency of leaving home. Moreover, when leaving the 

home, GOALS families reported having close contact with 7-8 people when they left the home. 

In addition to the direct impact of experiencing COVID-19, GOALS families reported substantial 

negative indirect effects as well. 72% of participants reported that they had a significant 

decrease in income as a result of the pandemic, with one-third (31%) reporting that they lost 

their income completely. More than one-fifth of families reported a moderate to severe 

negative impact on food access and 45% of respondents reported a moderate to severe 

increase in stress as a result of the pandemic.

GOALS Mitigation of COVID-19 Effects

While the GOALS project had stopped enrolling new participants on December 31, 2019, 

families that had enrolled in the program as early as April 2019 (n=374) had a baseline 

Reported COVID-19 Exposure in Study 

Participants

• 4% reported testing positive for 

COVID-19

• 11% reported that one or more 

immediate family members had 

tested positive for COVID-19

• 40% reported that one or more 

members of their extended family 

and/or close friends had tested 

positive for COVID-19.

• 18% reported that they have had a 

family member or close friend die 

from COVID-19
United Way for Southeastern Michigan 83

assessment prior to the onset of COVID-19 and either a 6-month or 12-month assessment after 

COVID-19. This natural experiment allowed for a direct test of the impact of COVID-19 on 

families in two ways. First, it allowed for the comparison of rates of change in outcomes 

between GOALS families and control families across the onset of the pandemic. It also allows 

for comparisons of rates of change pre-COVID-19 to post-COVID-19. Focusing on the first 

comparisons allowed for the assessment of the differential impact of COVID-19 between GOALS 

families and control group families. The ASSM outcome domains were dichotomized into highrisk (scores of 1,2, or 3) and low risk (scores of 4 or 5). Multilevel logistic regression with 

assessment occasion (baseline, 6-months, 12-months) as the level 1 factor and intervention v. 

control as the level 2 factor was then used. Analyses were further stratified by COVID-19 phase, 

with Phase 1 defined as the period from 3/13/20 (one week before the Michigan Shelter-InPlace Order) to 4/30/20 (the first curve flattening in Michigan), and Phase 2 extended from 

5/1/20 thru 8/30/20. 

It was found that there was a significant increase in the likelihood of either staying in or moving 

into the high-risk category for both the intervention and control groups during the COVID-19 

Phase 1 period across multiple ASSM domains: Health Care, Employment, Family Social 

Connections, Community Engagement, Parenting, and Mental Health. However, during Phase 

2, the families enrolled in the GOALS program were significantly more likely to move to the lowrisk category in areas of Mental Health, Parenting, Family Connection, and Health Care. The 

odds ratios for these analyses ranged from 1.8 to 3.5 indicating a nearly two-fold decrease in 

risk across these domains at a minimum. It is reasonably speculated that this positive buffering 

effect is at least in part related to the GOALS program providing an established and trusted 

support system to help navigate the needs of families in the face of the COVID-19 pandemic.

 

 
United Way for Southeastern Michigan 84

"From the start, the SIF [GOALS] program was an incredible experience. I thought in the

beginning [it was] only doing surveys and giving the results to the clients. In fact, after

each term or session, my spiritual growth grew a lot due to reflecting on my lifestyle. It 

changed my outlook on life such as my negative thoughts turned into positive, more

patient. I am more open minded and laid back, I learned to give my kids more chances

and time to make the change, be more independent, and build trust. I am proud to be

part of SIF program due to how it changed my perspective. I am proud of being able to

help myself, my children, and the people/clients that I worked with."

- Family Check-Up Model Specialist, ACCESS
United Way for Southeastern Michigan 85

References

Arizona State University Research and Education Advancing Children’s Health Institute. (2016). 

Family Check-Up Overview, 17.

Black, L. L., Johnson, R., & VanHoose, L. (2015). The relationship between perceived 

racism/discrimination and health among black American women: a review of the literature

from 2003 to 2013. Journal of racial and ethnic health disparities, 2(1), 11-20.

Centers for Disease Control and Prevention. (2020, April 02). Preliminary Estimates of the 

Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus

Disease 2019 - United States, February 12–March 28, 2020. 

https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm

Dishion, T. J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The family 

check‐up with high‐risk indigent families: Preventing problem behavior by increasing 

parents’ positive behavior support in early childhood. Child development, 79(5), 1395-

1414.

Graham, J. W. (2012). Missing Data: Analysis and Design. Springer Science & Business Media.

Janczewski, C.E., Mersky, J.P., & Brondino, M.J. (2019). Those Who Disappear and Those Who 

Say Goodbye: Patterns of Attrition in Long-Term Home Visiting. Prevention Science, 20, 

609-619.

Lewis, J. A., Williams, M. G., Peppers, E. J., & Gadson, C. A. (2017). Applying intersectionality to 

explore the relations between gendered racism and health among Black women. Journal 

of counseling psychology, 64(5), 475.

Michigan.gov. (n.d.). Michigan Coronavirus Data. 

https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html

Shaw, D. S., Dishion, T. J., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a 

family-centered approach to the prevention of early conduct problems: 2-year effects of 

the family check-up in early childhood. Journal of consulting and clinical psychology, 

74(1), 1.
United Way for Southeastern Michigan 86

Appendices 

 
United Way for Southeastern Michigan 87

APPENDICES 

Appendix A: Glossary

 

2-1-1 United Way’s call-based information and referral system.

ALICE Asset Limited, Income Constrained, Employed – a construct used 

by United Way and its partners to describe families that are above 

the technical poverty line, but financially vulnerable.

ASU REACH 

Institute 

Arizona State University’s Research and Education Advancing 

Children’s Health Institute is the home of the FCU.

Bib-to-Backpack The name of the United Way for Southeastern Michigan’s (United 

Way) SIF2016 proposal that was awarded a 5-year, $6 million 

grant to implement a study testing the ability to implement the 

Family Check-Up model in five Greater Detroit agencies to 

increase the engagement of families in services through an 

integrated Service Delivery system thereby strengthening the 

developmental readiness and well being of their children.

DCS Data Collection Specialists were staff trained to serve the controlgroup families.

ETO Efforts to Outcomes by Social Solutions, the data platform used in 

the study.

FCMS Family Check-Up Model Specialists were staffed trained in the 

model and who served GOALS (intervention) families.

FCU As described by REACH, the Family Check-Up is a brief, 

strengths-based intervention model for children ages 2 through 

17. It promotes positive child outcomes by improving parenting 

and family management practices. The Family Check-Up has 

more than 30 years of evidence demonstrating strong 

intervention effects.

GOALS GOALS (Gain Opportunities to Achieve Lasting Success) is a 

connected continuum of evidence-based services which recruit, 

engage, and empower parents and parents of children age 5 and 

under.
United Way for Southeastern Michigan 88

Pathways A portfolio of evidence-based programming available to GOALS 

families through various partnering agencies. These previously 

established programs were adapted to support a “no wrong 

door” approach to offering services. 

Philliber Philliber Research and Evaluation an independent research and 

evaluation firm, specializing in outcome-based evaluation and 

planning services was awarded the role of lead evaluator after a 

rigorous bid process.

SIF The Social Innovation Fund was a federally funded program 

through the Corporation for National and Community Service 

(CNCS) that united public, private and nonprofit organizations to 

identify and support sustainable evidence-based programs. 

Partner Agencies Through two rigorous Request for Qualifications processes, 

United Way for Southeastern Michigan (United Way) identified 

five community partners to be subrecipients of the SIF grant and 

work with United Way to implement this program model within 

their agencies. They included Arab Community Center for 

Economic and Social Services (ACCESS), Community 

Assessment Referral and Education (CARE) of Southeastern 

Michigan, 

Leaps and Bounds Family Services (LBFS), National Kidney 

Foundation of Michigan (NKFM), and Oakland Family Services 

(OFS).

United Way United Way for Southeastern Michigan works to create 

positive, measurable and sustainable change in the 

community and was awarded a Social Innovation Fund 

(SIF) grant in 2016 to implement Bib-to-Backpack, 

making it the lead investigator of the project. This was 

the second SIF grant awarded United Way for 

Southeastern Michigan.

WSU Wayne State University, a premier research-tiered university 

located in Detroit, long-time partner with United Way, and home 

to two project consultants.

 

 
United Way for Southeastern Michigan 89

Appendix B: Sample Recruitment Flyer (for July - December 2019)
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Appendix C: Agency Recruitment Strategies

Agency Recruitment Strategies

ACCESS Agency Programs

ACCESS to School program (Dearborn and Detroit)

ACCESS WIC Clinic (Dearborn and Detroit)

ACCESS Social Services (Dearborn)

ACCESS Clinic (Dearborn)

Community Programs

Reading Works (Metro Detroit)

Wayne Metro Head Start

Walk-in Families (ex: people who call or come in after seeing the flyer or 

through word of mouth)

Community Events

CARE Agency Programs

Supportive Opportunities for Families

Nurturing Parents

Active Parenting

Community Programs

Brilliant Detroit

Walk-in Families (ex: people who call or come in after seeing the flyer or 

through word of mouth)

Community Events

LBFS Agency Programs

Home Visiting

Play Groups

Early On

Early Learning Community

Walk-in Families (ex: people who call or come in after seeing the flyer or 

through word of mouth)

Community Events

NKFM Agency Programs

PE-Nut Elementary Program

Community Programs

Reggie’s Rainbow Adventures

NAP SACC

Enhance Fitness

DPP

PATH
United Way for Southeastern Michigan 91

WIC

Federally Qualified Health Centers

Walk-in Families (ex: people who call or come in after seeing the flyer or 

through word of mouth)

Community Events

OFS Agency Programs

Parents As Teachers

Play Groups

Community Programs

Libraries

The Department of Health and Human Services

Walk-in Families (ex: people who call or come in after seeing the flyer or 

through word of mouth)

Community Events
United Way for Southeastern Michigan 92

Appendix D: Service Areas and Recruitment Zones by Agency
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Appendix E: Baby Bundle Distribution Form
United Way for Southeastern Michigan 102

Appendix F: Recruitment Form
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Appendix G: Sample Individualized Randomization 

Randomization Protocol for NKFM

This document outlines the recruitment and randomization protocol for your agency. At the end of 

this document, we have listed the steps for randomization. 

Program Brief Description Are you still 

planning to 

recruit from 

this 

program?

Randomization 

Strategy 

Regie’s Rainbow 

Adventure and NAP 

SACC 

(Head 

start/preschool 

locations)

NKFM will utilize existing 

partnerships to recruit 

families that currently 

participate in our early 

childhood programs. We will 

work with center 

directors/teachers to identify 

families to participate.

 Yes 

 No

Randomization by 

numbered 

recruitment forms

Health Pathways 

(Enhance Fitness, 

DPP, PATH)

NKFM will utilize existing 

partnerships to recruit 

families that currently 

participate in our health 

pathway programs.

 Yes 

 No

Randomization by 

numbered 

recruitment forms 

WIC/ FQHC NKFM will work with new and 

existing partnerships with 

WIC/FQHC to identify 

families interested in the 

program.

 Yes 

 No

Randomization by 

numbered 

recruitment forms 

PE-Nut elementary 

program (SNAP-Ed) 

NKFM will utilize existing 

partnerships to recruit 

families that currently 

participate in our PE-Nut 

programs.

 Yes 

 No

Randomization by 

numbered 

recruitment forms 
United Way for Southeastern Michigan 105

SIF 2016 Recruitment Form Instructions

These are general guidelines for using the recruitment form to enter families into the SIF 2016 

evaluation. It is important that each agency review all of their programs with Philliber to determine 

which randomization strategy to use for each program. 

Randomization by Recruitment Form

The manager of the Family Checkup Model program at your agency should give a stack of blank 

recruitment forms to whomever is leading the event (or handling intake calls or handling referrals 

through the clinic). That person should then do the following:

• Step 1: Bring an appropriate number of blank forms to each event (or keep an appropriate 

number of forms at a desk).

• Step 2: Give a blank form to every family that you approach about participating in the 

study. This can be done one-on-one (e.g., during home visiting programs) or in big groups 

(e.g., play group, parenting program). Use the language on the form to explain the project 

to the family.

• Step 3: Have (or help) each family complete a form- even if they are not interested in 

participating. This will help us monitor the percentage of the refusals we get as well as 

programs that are hardest/easiest to recruit from. If the family says no, mark that on the 

form and write down the reason the family declined the invitation.

• Step 4: Give the completed forms to the manager of the Family Checkup Model program at 

your agency.

The manager of the Family Checkup Model program at the agency should take the following steps:

• Step 5: Review the forms as quickly as possible.

• Step 6: Separate out all forms for families who decline the invitation and enter those forms 

into the appropriate section of ETO.

• Step 7: Review the forms from families who have accepted the invitation and screen for 

eligibility. If a family is ineligible, remove them from the pile and enter them into ETO 

indicating why they are not eligible. 

• Step 8: Gather all of the forms for families who are eligible to participate and who agreed to 

participate. Call or text these families to ensure that they are still interested in participating. 

If they are not still interested, remove them and enter them into ETO as declined. Place all 

remaining forms in a pile. One at a time, take a form from the pile and give it a number. 

The form at the top of the pile would get a “1”. The next form would get a “2”, and so on. 

Make sure you number every form. Forms that have an odd number should be put into one 

pile. Forms that have an even number should be put into another pile. We will tell you 

which pile is randomized to the intervention group and which pile is randomized to the 

control group. Please note that you will undergo this process several times throughout the 

project and numbering should be sequential over time. So, if the first time you number 

forms, you assign them the numbers 1 through 5, the next time you undergo the process 

you should start with the number 6. At the end of the project, each of your families should 

have their own unique randomization number.

• Step 9: Give the intervention pile to the Family Checkup Model Specialist (FCMS) and 

instruct the FCMS to review the form to confirm eligibility and make contact with the family 

to set up the introductory session.

• Step 10: Give the control pile to the staff member that will be collecting data for the control 

group and instruct them to review the form to confirm eligibility and make contact with the 

family to set up the introductory session.
United Way for Southeastern Michigan 106

Appendix H: Onsite Randomization Protocols Update

SIF 2016 Onsite Randomization Instructions- CARE

These are general guidelines for onsite randomization for the SIF 2016 evaluation. Onsite 

randomization should be used if a family presents themselves to the agency and is ready to enroll 

in the study and complete their data collection immediately onsite. 

Onsite Randomization

Prior to beginning the randomization, confirm that both an FCMS and a DCS are present onsite 

and available to collect data from the family, if they are eligible. Remember, families may be 

randomized to either the intervention or control group so the appropriate staff member needs to be 

available to meet with the family as soon as randomization is complete. 

• Step 1: Thank the family for their interest in participating and confirm that they are available 

for the next two hours to conduct the first assessment. 

o If the family is not available to stay for the next two hours to complete their first 

assessment DO NOT USE THIS PROTOCOL TO RANDOMIZE THEM. Instead 

have them complete a recruitment form and either be randomized using your normal 

protocol or come back when they are available to stay for two hours to be 

randomized and complete the initial assessment.

• Step 2: Review the recruitment form and confirm that the family is eligible. 

• Step 3: Use the language on the recruitment form to explain the study to the family.

• Step 4: Answer any questions that the family has about the study. Confirm that the family 

is still interested and is willing to stay onsite for the next two hours to complete the initial 

assessments.

• Step 5: Add the family to the first available row in the onsite random assignment list. If the 

group listed on the family’s row is “A” that family gets assigned to the intervention group 

(Family Checkup Model group). If the group listed on the family’s row is “B” that family gets 

assigned to the control group.

• Step 6: Walk the family to the appropriate staff person (an FCMS for families assigned to 

group A, a DCS for families assigned to group B) so that they can immediately begin their 

assessments.

• Step 7: Upload an updated version of the onsite randomization list to your evaluation folder 

in Sharepoint each week when you upload your updated enrollment list.

• Step 8: Let Heather Hirsch at Philliber (hhirsch@philliberresearch.com) know when you 

reach participant number 30 so that we can send you a new onsite randomization list to be 

used once the current list is full.
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Onsite Random Assignment List

Agency Name:

Participant 

Number

Group

A= 

Intervention

B=Control

Date Participant Name

1 A 

2 B 

3 A 

4 A 

5 B 

6 B 

7 A 

8 B 

9 A 

10 B 

11 A 

12 B 

13 B 

14 A 

15 B 

16 A 

17 A 

18 B 

19 B 

20 B 

21 B 

22 A 

23 A 

24 A 

25 A 

26 B 

27 B 

28 A 

29 A 

30 A 

31 A 

32 B 

33 B 

34 B 

35 A 

36 A 

37 B 
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38 B 

39 B 

40 A 

Randomization generated on 02/19/19 by https://www.graphpad.com/quickcalcs/randomize1.cfm
United Way for Southeastern Michigan 109

Appendix I: Family Profile Form: Development and Assessment

Background

One of the central tenants of the GOALS project was that through the Family Check-Up Model’s 

comprehensive assessment, use of motivational interviewing techniques, goal setting and 

supports linked to the expansive referral capacity of United Way, families would become more 

empowered and less vulnerable to societal marginalization. This is one of the hallmark features 

of the GOALS programs that sets it apart from the majority of family prevention programs. 

Rather than being focused on a singular domain of family functioning (e.g., education, housing, 

employment) the GOALS program recognizes the interconnectedness of all domains of family 

functioning and that to achieve sustainable and transformational outcomes a prevention 

intervention must have the capacity to engage the family holistically. 

One of the most well-developed and widely used instruments for assessing individuals and 

families in a holistic manner is the Arizona Self-Sufficiency Matrix (ASSM). The ASSM is derived 

from work examining the true impact of poverty on families and extending the notion of poverty 

beyond the federally established poverty line, which does not take into account economic and 

social context (Pierce & Brooks, 1999). This initial work in the late 1990’s culminated in a 

methodological approach in which core domains impacted by poverty were identified and an 

ordinal rating scale was used to assess the level of risk for each domain. The initial Sufficiency 

Matrix identified 25 potential domains; however, the framework was always intended to be 

adapted to include any domains that were salient to a particular population and/or community. 

This approach to assessing vulnerabilities to self-sufficiency was quickly adopted by researchers, 

practitioners, and policy makers working in the area of homelessness and the ASSM was 

formally developed in that context and became widely used and well validated (Cummings, 

2018). 

One of the most useful features of the Self-Sufficiency Matrix1 approach is the level of flexibility 

in identifying domains most salient to a community and the program(s) serving that community. 

These measures are extremely flexible. The other key feature is the scoring / rating process 

which uses functionally defined anchors for each of the response categories. These ratings use a 

decision tree logic in which each response anchor must be satisfied before considering the next 

in an hierarchical fashion. For example, figure 1 below provides an example of this process for 

income assessment with scores ranging from 1 “client is in crisis” to 5 “client is self-sufficient” 
United Way for Southeastern Michigan 110

Figure 1. Decision logic for scoring income self-sufficiency 

For use in the GOALS project we adapted the ASSM to assess 17 key domains: Housing, 

Income, Food, Adult Education, Employment, Transportation, Health Care Access, Mental 

Health, Substance Abuse, Disability, Child Care, Child Education, Parenting Skills, Family Social 

Supports, Community Involvement, Safety, Life Skills, and Judicial System Involvement (labeled 

Legal in the ASSM). 

Development of the FPF 

Beginning in May of 2017, a committee comprised of UNITED WAY staff, Philliber Research and 

Evaluation staff, site managers from ACCESS, Leaps and Bounds Family Services, CARE of 

Southeast Michigan Macomb County, and Oakland Family Services2

, and three consultants from 

two Wayne State University and Here2There, LLC Consultants convened a work group that met 

6 times from May 2017 to August 2017 to identify questions that could be used to provide 

responses to the ASSM in a consistent manner. Traditionally the ASSM is filled out by a frontline 

staff member based on interview and case notes. This leaves open the possibility for differences 

in ratings between staff members or across agencies because of the type of information and the 

nature of the questions are not uniform across interviewers. Using a uniform questionnaire that 

is completed by the staff member through a structured interview with the participant normalizes 

the responses and ensures that all participants were asked about the same domains of family 

functioning and in the same manner. One of the guiding principles of this process was to use 

existing sources of data wherever possible. While no single agency regularly collected intake 

data that could be used for the entire ASSM, across the partner agencies there were enough 

existing assessments that approximately 80% of the items on the Family Profile Form were 

already being collected by at least one of the partner agencies. An iterative process of 

discussion and consensus building was conducted by the assessment work group across several 

meetings resulting in the final Family Profile Form tool. 
United Way for Southeastern Michigan 111

Use of FPF for ASSM Scoring

Following the development of the FPF instrument a smaller workgroup comprised of 6-8 

members representing all stakeholder groups met on a regular basis through August and 

September to establish a scoring rubric through which responses on the FPF were converted to 

standardized criteria defining each of the categories in the ASSM. These scoring criteria start 

with the lowest risk category (5) and work down to the highest risk category (1) using a flow 

chart decision tree method. For example, on the FPF questions 4-8 ask about housing. To get a 

score of 5, the participant has to indicate that they either own, rent, or share a house, consider 

that housing permanent, pay for or contribute to the rent/mortgage themselves, that the 

rent/mortgage is 30% or less of their income, and that the housing is adequate for them and 

their family. If all of these are not satisfied the scoring moves to a category of 4 and must satisfy 

all of those criteria which include all of the items for a score of 5 with the exception that the 

housing is subsidized formally or by family members and the monthly housing cost is greater 

than 30% of their income. If all of those criteria are not satisfied the scoring moves to a 3 and 

another set of criteria are assessed. This process continues until all of the criteria for a score are 

met or the process reaches category 1. The full scoring rubric is presented in appendix B.

During the pilot phase of the project ASSM scoring was completed by hand using the FPF and 

scoring rubric by the data specialists. From October of 2017 – July of 2018 a small workgroup 

worked to develop automatic scoring of the ASSM directly from the FPF scores through the data 

management software for the project (ETO). This was an iterative process with scoring 

algorithms being developed, tested on client data, checked against hand scored ASSM values, 

and data auditing. Through this process the scoring protocols were adjusted to remove logical 

inconsistencies which caused ETO to produce missing scores. By July of 2018 the ETO scores 

were reliably reproducing hand scored ASSM values and were no longer generating missing 

values. 

Reliability and Concurrent Validity

During the pilot phase of the project we evaluated the inter-rater reliability and concurrent 

validity of the ASSM scoring via the FPF. 

A sample of 10 families were recruited for this study from the population of families being 

served by the four service agency partners participating in the SIF 16 grant. Families were 

identified by the FCMS and asked to participate in this validation study. Once the study details 

were explained to the family by the FCMS and the family agreed to participate, they were 

provided with a consent form (See Appendix Z). Each family was interviewed by two FCMS and 

interviews were scheduled within two-weeks of each other to ensure that the information 

obtained by each interviewer remained the same. Each FCMS conducted four interviews in total 

such that each FCMS was paired with the other four FCMS such that all-pairwise comparisons 

between FCMS on the same family could be assessed. The assignment design is illustrated in 

Figure 2 below. 

For the purpose of assessing the concurrent validity, each interview was audio recorded and 

uploaded to a cloud-based server at United Way. The audio recordings of the interviews were 
United Way for Southeastern Michigan 112

then labeled and put on a thumb-drive to be provided to ASSM expert raters. Each interview 

was rated by two ASSM experts. The ASSM experts listened to the audio recordings of the 

interview and used the ASSM to make ratings according to standards of practice in the field. 

Two of the expert ASSM raters were advanced Ph.D. students programs in the clinical 

psychology program at Wayne State University. Both students were experienced with the ASSM 

and have had multiple years of training in clinical assessment with urban populations similar to 

the families participating in this validation study. In addition, they were provided with 

approximately 6 hours of in-person training across two 3-hour long sessions. They were also 

provided with the official training materials developed by 1) the State of Michigan 

Homelessness Management Information System; 2) the National Homeless Management 

Information System; 3) the Snohomish County Self-Sufficiency Task force in Washington State. 

Two additional ASSM raters were recruited from Oakland Family Services. These two raters 

have been using the ASSM as a part of their case management services for several years.

Figure 2. Graphical display of rater assignments across families.

Results

In order to test the inter-rater reliability across the five FCS raters cross-tabulation contingency 

tables were constructed and an index of percent agreement was calculated across all families. 

The average percent agreement across all sample families was 92%. The range of 

agreements ranged from 68% (parenting skills) to perfect agreement. Examination of the 

contingency tables indicated that the majority of disagreements were cases in which one rater 

scored the family a 4 and the other rater scored the family a 5. In one instance, one rater scored 

the family a 4 on child care and the other scored the family as a 2. In another instance (safety) 

there was a disagreement where one rater had scored the family as a 1 and the other scored the 

family as a 5. Closer examination revealed that there had been a shooting at a public event in 

which the family had been attending. According to the notes, the child was unaware that 

anything had even occurred. A strict interpretation of the scoring guidelines would indicate a 1, 

but the score was not at all reflective of the family’s overall functioning. In the notes, the FCMS 
United Way for Southeastern Michigan 113

that rated the family a 1 put a 5 in parentheses with a question mark. As such, this level of 

disagreement is not reflective of the overall agreement for the tool and was a circumstantial 

outlier. The percent agreement for each of the ASSM domains is provided in table 1 below.

Table 1. Average percent agreement across all FCMS raters

Domain Percent 

Agreement

Percent Agreement 

when 4 & 5 are 

considered a match

Housing 90% 100%

Income 90% 100%

Food 90% 100%

Adult Education 100% 100%

Employment 90% 100%

Transportation 90% 100%

Health Care Access 90% 100%

Mental Health 90% 100%

Substance Abuse 100% 100%

Disability 100% 100%

Child Care 90% 90%

Child Education 100% 100%

Parenting Skills 70% 90%

Family Social Supports 80% 100%

Community Involvement 100% 100%

Safety 90% 90%

Life Skills 100% 100%

Legal 90% 100%

To test the concurrent validity the same analyses as described above for inter-rater reliability 

were conducted comparing FCMS raters to expert raters. Each FCMS rater's scores were 

compared to two expert rater scores and then the percent agreement was averaged across the 

two comparisons. These average agreement ratings were then pooled across all families to 

yield an overall average percent agreement. The overall agreement was 88%. The level of 

agreement ranged from 70% for income and safety to 100% for disability, community 

involvement, and life skills. As was the case for the former set of analyses, when disagreements 

comprised of 4 v. 5 ratings were considered a match the degree of agreement approaches near 

perfect agreement. The domain specific ratings are provided in Table 2 below.

 
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Table 2. Average percent agreement between FCMS and expert raters on ASSM

Domain Percent 

Agreement

Percent Agreement 

when 4 & 5 are 

considered a match

Housing 94% 100%

Income 70% 80%

Food 85% 100%

Adult Education 82% 100%

Employment 90% 100%

Transportation 95% 100%

Health Care Access 80% 100%

Mental Health 95% 100%

Substance Abuse 95% 100%

Disability 100% 100%

Child Care 90% 100%

Child Education 90% 90%

Parenting Skills 80% 95%

Family Social Supports 80% 90%

Community Involvement 100% 100%

Safety 72% 100%

Life Skills 100% 100%

Legal 90% 100%

 

Conclusion

Overall, these results suggest that the use of the FPF as a semi-structured interview produces 

high levels of inter-rater reliability in ASSM assessments. This, as noted above, is critical for the 

evaluation as it rules out "rater effects" as a possible confound to impact analyses relating to the 

ASSM domains. It is recommended that periodically throughout the course of the evaluation a 

subset of family assessments are audio-recorded using the methodology used for the expert 

rater validation assessment, and cross-rated by all five FCMS in order to avoid rater "drift" over 

time. 

The findings also suggest that the ASSM ratings provided by the FCMS are consistent with 

ASSM ratings obtained from independent expert raters. This provides evidence of concurrent 

validity which suggests that the ASSM ratings of the project are not only reliable among FCMS 

staff but are valid assessments of the ASSM. 

Family Profile Form: Scoring

The Family Profile Form was created to help systematize the scoring of the ASSM. As families 

began completing the Family Profile Form, testing began to determine how well the initial 
United Way for Southeastern Michigan 115

scoring guide was able to convert responses on the Family Profile Form to scores on the ASSM. 

Initial results indicated that the scoring left many families without ASSM scores on multiple 

domains. The project then formed a working group to examine the initial scoring guidance and 

develop a revised scoring protocol.

The Family Profile Form working group consisted of members of the evaluation team, members 

from the United Way for Southeast Michigan’s SIF 2016 leadership team, and Dr. Robert Ty 

Partridge. The group met bimonthly over a period of several months to develop a scoring 

protocol for each ASSM domain. The focus of these discussions was to:

1. Identify the most common situations that led to a family not receiving a score on a given 

ASSM domain;

2. Come to a consensus on the information needed to accurately score each ASSM domain;

3. Determine which questions on the Family Profile Form provided relevant information for 

the scoring of each ASSM domain; and,

4. Create a logical scoring convention for each ASSM domain based on relevant responses 

from the Family Profile Form.

Once a scoring convention for a given domain was agreed upon by members of the working 

group, the evaluation team:

1. Scored each family using the new scoring protocol;

2. Reviewed the results of the new scoring protocol with the working group; and,

3. Made any needed additional changes before finalizing the scoring protocol for the ASSM 

domain.

The final scoring protocol was shared widely throughout the project. The ASSM, like other 

assessments used in the study, is autoscored once data are entered into the project’s Efforts To 

Outcomes database. Once the new scoring protocol was finalized, the auto scoring procedures 

were also updated. 
United Way for Southeastern Michigan 116

Appendix J: Family Profile Form

. 

Family Profile Form

HOUSING

1. What is your current marital status? (Check one option.)

 Married, living with Spouse

 Married, not living with Spouse

 Cohabitating (living with significant other, not married) 

 Divorced

 Single 

 Widowed 

 Other: 

2. Who lives in your household? (Check all that apply.)

 All of my children

 Some of my children

 Mother

 Father

 Spouse/Partner

 Your child’s other parent (and who is not your current Spouse/Partner)

 Niece/Nephews

 Siblings

 Aunt/Uncle

 Cousins

 Other: 

3. Total number of adult household members (including yourself): 

Total number of children living in your home: 

4. Current family housing arrangement:

 Own

 Rent

 Shared housing (with relatives or roommates)

 Temporary (shelter, staying with friends or family)

 Homeless or currently threatened with eviction

Agency 

logo can 

go here

Date Completed: 

Participant Name: 

Case Number: 

Survey Start Time: 
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5. Do you consider this arrangement to be permanent? (Meaning that housing will stay the 

same for at least the next 90 days.) 

 Yes 

 No

6. Who pays for your rent or mortgage on a regular basis? (If you pay your rent every month 

using one or more options, check all that apply.)

 Myself and/or my partner/spouse

 Family members who do live with me

 Family members who do not live with me

 Subsidy (Section 8 or Low-Income Housing) 

 I am not currently paying to live where I am.

 Other: 

How much is your rent/mortgage monthly? 

7. Is your current housing adequate to meet the needs of you and your family?

 Yes 

 No

 Sometimes

If no or sometimes, what could be different about your housing so it does meet your needs?

 

INCOME

For the questions in this section, “household” refers to you and those impacted by the 

income.

8. What is your household’s current weekly take-home income? 

or what is your household’s current monthly take-home income? 

9. What is your household’s estimated gross (or total before taxes) annual income?

 No income

 Less than $9,999

 $50,000 - $59,999

 $60,000 - $69,999

 $10,000 - $19,999  $70,000 - $79,999

 $20,000 - $29,999  $80,000 or more

 $30,000 - $39,999

 $40,000 - $49,999
United Way for Southeastern Michigan 118

10. Are you or others in your household currently receiving any forms of financial assistance? 

(Check all that apply.)

You Your 

Child/Children

Other Household 

Member

Food Stamps (Bridge Card)    

Cash assistance (such as TANF)    

WIC    

SSI (Social Security)    

Financial help from family and/or 

friends

   

Alimony/Child Support    

Free/Reduced Lunch Eligible    

Subsidy for Childcare    

Other: 

___________________________

   

11. Is your current household income, plus any financial assistance you receive, enough to 

meet your household needs?

 Yes 

 No

12. Does your current household income cover enough to make minimum payments on any 

debt/mortgage/loan payments on most months?

 Yes 

 No

13. Do you have extra funds at the end of most months, after meeting your household’s basic 

needs, to save or spend in discretionary items? (Discretionary items are things that are not 

needs and that your household could live without, such as entertainment, toys, electronics, 

extra clothing, travel, etc.)

 Yes 

 No 

FOOD

14. If you are receiving food stamps, is it enough to cover your family’s food expenses for the 

whole month?

 Yes 

 No

 N/A (Not receiving food stamps because I don’t qualify.) 

 N/A (Not receiving food stamps because I haven’t applied.) 
United Way for Southeastern Michigan 119

15. In the last 6 months, how many times have you had to rely on other sources, such as family 

or friends, food banks, or churches, to get food for your family?

 None

 1 – 2 times

 3 – 4 times

 5 or more times

16. My family can choose to eat/purchase any food we desire.

 Yes 

 No

EDUCATION

17. What is the primary language you and your family use at home?

 English

 Arabic 

 Spanish

 Other: 

18. How well do you speak English? 

 Very well

 Well

 Not well

 Not well at all 

19. How well do you read English? 

 Very well

 Well

 Not well

 Not well at all 

20. Are your English skills ever a barrier for employment? 

 Yes 

 No 

If yes, are you enrolled in an ESL/Literacy program?

 Yes 

 No 

21. Select your highest level of education: 

 Less than high school

 High school diploma/GED 

 Some college

 2 year Associate’s degree

 4 year Bachelor’s degree

 Graduate Degree (Masters/Doctorate)
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 Any other type of vocational training or certification (for example: Licensed Practical 

Nurse (LPN), Child Development Associate, medical assistant, master electrician, 

etc.)

22. Are you currently enrolled in GED program?

 Yes 

 No 

23. Are you currently enrolled in a secondary education program? (Such as college, vocational 

training or certification.)

 Yes 

 No 

24. With your current education level and skill set are you able to get a job that meets your 

financial needs? 

 Yes 

 No 

EMPLOYMENT 

25. Are you employed? (If you select N/A, skip to question 30).

 Yes 

 No

 N/A (Not currently seeking employment)

If yes:

What is your occupation? 

Have you been at your job(s) for 3 months or more? 

 Yes 

 No

26. Considering your hours across any/all jobs that you currently have; do you work: 

 Full-time (More than 32 hours)

 Part-time (Less than 32 hours)

27. Considering any/all jobs, are you employed: 

 Long-term

 Temporary/Seasonal

28. Are your wages sufficient to cover your share of the financial responsibilities for your 

household (such as your half of the rent), without public assistance? 

 Yes 

 No
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29. Does your employer provide you any of the following benefits? (Check all that apply.)

 Healthcare

 Sick time

 Paid vacation/ holidays

 Contributions to a retirement plan

 Other: 

30. Is anyone else in the household employed? 

 Yes 

 No

TRANSPORTATION 

31. Do you have adequate transportation to meet the needs of you and your family?

 Yes 

 No

32. How do you primarily get around? (Check that one that mostly applies.)

 I have and drive my own car. 

 I borrow a car that is mostly available to me when I need it.

 I use rideshare options (Uber, Lyft) or a taxi when I need it.

 I use public transportation, such as the bus.

 I have friends or family who can drive me around when I need it.

 I have no regular access to transportation.

 Other: 

33. If you have and drive your own car, check all that apply:

 I am a licensed driver.

 My car is currently insured.

 I consider my car to be reliable.

HEALTHCARE

34. Do you and/or your significant other or spouse have health insurance?

 Yes, just me

 Yes, just my significant other/spouse

 Yes, both of us

 No, neither of us have health insurance.

35. Does your child/children have health insurance?

 Yes 

 No
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If yes to 34 or 35, do you receive insurance through: 

 Medicaid

 Medicare

 Children’s Health Insurance Program (CHIP)

Are there any medical needs that you or members of your household have that are not 

being addressed because your insurance does not cover treatment? 

 Yes 

 No

Do you consider your health care coverage to be affordable, meaning the cost of your 

coverage doesn’t strain or limit spending on other necessities?

 Yes 

 No

If no to 34 or 35: 

Do you have an immediate need for healthcare coverage for you or members of your 

household? 

 Yes 

 No

Are there any medical needs that you or members of your household have that are not 

being addressed because you do not have medical coverage?

 Yes 

 No

36. Do you have a doctor that you see regularly? 

 Yes 

 No 

37. Do you have a pediatrician/doctor that your child sees regularly? 

 Yes 

 No

38. Have you ever been told by a health care provider that you had gestational diabetes? 

 Yes 

 No

 N/A

39. Has a health care provider ever told you that you have a health condition that can continue 

from year to year? 

Some examples of these health conditions include: asthma, diabetes, cancer, migraines, or 

mental health condition (e.g., depression, anxiety, stress disorder), etc.

 Yes 

 No

If yes, which health condition? 
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40. Are you a caregiver for someone, such as a friend or family member, that has an ongoing 

health condition such as those in the previous question? (Do not answer yes if caregiving is 

your job.)

 Yes 

 No

If answered yes to questions 39 or 40, thinking back over the last year, how often did 

having this health condition or being a caregiver for someone with an ongoing health 

condition make it hard for you to keep up with your work or social / family life? 

 Never/Almost Never

 Not Very Often

 Fairly Often

 Very Often

 Always

MENTAL HEALTH

41. Do you have a mental health condition that interferes with your day to day life? (If you 

answer no, skip to question 46.)

 Yes 

 No

42. How difficult has this condition made it for you to do your work?

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult 

43. How difficult has this condition made it for you to get along with other people? 

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult

44. How difficult has this condition made it for you to take care of things at home?

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult 

45. Over the last two weeks, have you had thoughts that you would be better off dead or of 

hurting yourself in some way?

 Yes 

 No
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If yes, how often have you had these thoughts?

 Once

 A few times

 More than half of the days

 Nearly everyday

SUBSTANCE ABUSE

46. Has there ever been a time in your life when using alcohol or other drugs affected your 

personal relationship, school, work, or overall well-being? (If you answer no, skip to 

question 51.)

 Yes 

 No

47. Have you ever felt you should cut down on your drinking or drug use? 

 Yes 

 No

How many times in the last 6 months?

 1 

 2 

 3 

 4 

 5 or more

48. Have people ever annoyed you by criticizing your drinking or drug use? 

 Yes 

 No

How many times in the last 6 months?

 1 

 2 

 3 

 4 

 5 or more

49. Have you ever felt bad or guilty about your drinking or drug use? 

 Yes 

 No
United Way for Southeastern Michigan 125

How many times in the last 6 months?

 1 

 2 

 3 

 4 

 5 or more

50. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a 

hangover (as an “eye opener”)? 

 Yes 

 No

How many times in the last 6 months?

 1 

 2 

 3 

 4 

 5 or more

DISABILITIES

51. Do you have a physical, developmental, or learning disability? (If you answer no, skip to 

question 56.)

 Yes 

 No

52. What are you doing to manage your condition?

 Medication

 Treatment

 Physical therapy

 Assistive equipment

 Other: 

53. How difficult has this condition made it for you to do your work?

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult 

54. How difficult has this condition made it for you to get along with other people? 

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult
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55. How difficult has this condition made it for you to take care of things at home?

 Not difficult at all

 Only rarely

 Somewhat difficult

 Very difficult

 Extremely difficult 

CHILDCARE

56. Are there times during the day or evening when you need to do things without your child 

and you use/need childcare? Reasons for needing childcare could include: work, school, 

errands, appointments, meetings, etc. Examples of childcare could include: childcare 

centers, friends or neighbors, babysitters, family members, etc.

(If you answer no, skip to question 62.)

 Yes 

 No

57. Is your childcare available? (Childcare is considered available when you can use it at the 

time of day you need it, the center is not full/on a waitlist, and when your child is eligible to 

attend the childcare.)

 Yes 

 No

58. Is your childcare accessible? (Childcare is considered accessible if you are able to get 

there or they are able to get to you in a reasonable amount of time and they have a spot 

available for your child)

 Yes 

 No

59. Is your childcare reliable? (Childcare is reliable if they are consistently available when 

needed and rarely cancels.)

 Yes 

 No

60. Is your childcare affordable? (Childcare is affordable if your household spends no more 

than 15% of income on childcare and/or the cost of this childcare has not forced you to 

reduce your work hours due to disproportionate cost.)

 Yes 

 No

61. Check all that apply about your childcare:

 My child's teacher/caregiver knows and cares about my child and responds to 

her/his individual needs.

 I feel comfortable and at ease leaving my child at childcare each day.

 My child is happy and safe at their childcare.

 The meals and snacks served are nutritious and varied.

 The curriculum meets my child's needs and is fun for my child.
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CHILDREN’S EDUCATION

62. Have you established a reading habit (20 minutes or more most days of the week) with your 

child(ren)? Examples include reading a book, telling a story, practicing letter sounds or 

words, or other activities to help your child learn to read.

 Yes 

 No

63. Do you have any children aged 5 or older? (If no, skip remaining questions in this 

category.)

 Yes 

 No

64. Are all of your children aged 5-18 enrolled in school?

 Yes 

 No

If no, please describe why your child(ren) may not be enrolled: 

 

65. How often do your school-aged children attend classes?

 None of the time

 Less than half the time

 More than half the time

 Most or all of the time

66. Have you ever been notified by the school that any of your children is considered truant?

 Yes 

 No

PARENTING SKILLS

Select one option for how much you agree with each of the following statements:

Strongly 

Disagree 

Mostly 

Disagree 

Slightly 

Disagree 

Neutral Slightl

y 

Agree 

Mostly 

Agree 

Strongl

y Agree 

67. There are many times 

when I don’t know what 

to do as a parent. 

1 2 3 4 5 6 7 

68. I know how to help my 

child learn. 1 2 3 4 5 6 7 

69. My child misbehaves just 

to upset me. 1 2 3 4 5 6 7 

70. I praise my child when 

he/she behaves well. 1 2 3 4 5 6 7 

71. When I discipline my 

child, I lose control. 1 2 3 4 5 6 7 
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72. I am happy being with 

my child. 1 2 3 4 5 6 7 

73. My child and I are very 

close to each other. 1 2 3 4 5 6 7 

74. I am able to soothe my 

child when he/she is 

upset. 

1 2 3 4 5 6 7 

75. I spend time with my 

child doing what he/she 

likes to do. 

1 2 3 4 5 6 7 

FAMILY/SOCIAL RELATIONS

76. Who do you feel that you can rely on when you need support? (check all that apply)

 Church/Religious Community

 Spouse/Partner

 Relatives or family mentor

 Friends/Neighbors

 Coach, Mentor, or Teacher

 Service Provider (Home visitor, case manager, doctor, nurse)

 Other: 

77. Have you had any contact with Child Protective Services (CPS) for your child(ren) in the 

last 6 months?

 Yes 

 No

If yes, was the claim substantiated by CPS?

 Yes, and the case is ongoing 

 Yes, and the case is resolved

 No

Select one option for how much you agree with each of the following statements:

Strongly 

Disagree 

Mostly 

Disagree 

Slightly 

Disagree 

Neutral Slightl

y 

Agree 

Mostly 

Agree 

Strongl

y Agree 

78. In my family, we talk 

about problems. 1 2 3 4 5 6 7

79. When we argue, my

family listens to “both 

sides of the story.” 

1 2 3 4 5 6 7

80. In my family, we take

time to listen to each

other.

1 2 3 4 5 6 7 

81. My family pulls together

when things are stressful. 1 2 3 4 5 6 7 

82. My family is able to solve

our problems. 1 2 3 4 5 6 7 
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83. I have others who will 

listen when I need to talk 

about my problems. 

1 2 3 4 5 6 7 

84. When I am lonely, there 

are several people I can 

talk to. 

1 2 3 4 5 6 7 

85. I would have no idea 

where to turn if my

family needed food or 

housing. 

1 2 3 4 5 6 7 

86. I wouldn’t know where 

to go for help if I had 

trouble making ends 

meet. 

1 2 3 4 5 6 7 

87. If there is a crisis, I have 

others I can talk to. 1 2 3 4 5 6 7 

88. If I needed help finding a 

job, I wouldn’t know 

where to go for help.

1 2 3 4 5 6 7 

COMMUNITY INVOLVEMENT

89. How would you rate your involvement in the community?

 Very Involved

 Involved

 Somewhat Involved

 Not Involved

90. In what ways are you involved in the community? (Check all that apply.)

 School Programs (either your school or your child’s school)

 Church/Religious Activities

 Support Groups

 Volunteering

 Sports Leagues

 Political Activities

 Other: 

91. Do you find that you have experienced any of these barriers to being involved in your 

community? (Check the one that mostly applies.)

 I am too concerned about meeting my family’s basic needs (such as food and 

housing) to worry about getting involved right now.

 I’d like to be more involved, but I am not sure how.

 I have a language barrier.

 I can’t find the childcare or transportation that I need to get involved.

 I am not involved because I don’t like to be involved.

 I don’t have any regular barriers to being involved.

 Other: 
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SAFETY 

92. Do you generally feel safe in your home?

 Yes 

 No

93. Do you generally feel safe in your neighborhood?

 Yes 

 No

94. Are you currently concerned about your child(ren)’s safety?

 Yes 

 No

95. Are you currently concerned about the safety of you and/or your child(ren)’s safety in the 

next 6 months?

 Yes 

 No

96. Are there changes you make to your routine on a regular basis to adapt or cope with your 

safety concerns?

 Yes 

 No

97. Have you and/or your child(ren) witnessed or experienced dangerous behavior or a crime in 

the past 6 months?

 Yes 

 No

98. Are you and/or your child(ren) currently experiencing threats to your safety?

 Yes 

 No

LIFE SKILLS

Review this list of activities you may do every day:

Bathing Climbing Stairs

Dressing Eating

Oral Care (Brushing teeth) Shopping

Toileting Cooking

Transferring from sitting to 

standing

Using phone

Walking Housework
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Laundry Driving

Managing Medication Managing Finances

99. Are you able to regularly complete the activities listed above for yourself and your family? 

(If you answer yes, skip to question 101.)

 Yes 

 No

 Sometimes

100. Do you have any challenges on a regular basis completing any of the activities listed 

above? 

 Yes 

 No

 Sometimes

If yes or sometimes, is there anyone that comes over and helps you with completing these 

activities on regular basis? 

 Yes 

 No

 Sometimes

LEGAL

101. Have you ever been charged with a misdemeanor or felony?

 Yes 

 No

102. In which ways have you been involved with the criminal justice system within the 

last 12 months? 

 Have not been involved with the criminal justice system 

 Current unresolved ticket 

 Current open warrant

 Current pending charges, not yet been to court

 Currently involved with trial/court proceedings for pending charges

 An arrest within the last 12 months (whether or not charged)

 A felony conviction within the last 12 months

 Other: ______________________

103. Are you currently on probation or parole? 

 Yes 

 No

If yes, are you currently compliant with the terms of your probation or parole? 

 Yes 
United Way for Southeastern Michigan 132

 No

If no, have you successfully completed a probation or parole in the last 12 months? 

 Yes 

 No

104. Does your legal situation (past or present) interfere with your ability to provide for 

your family (such as getting a job, finding a place to live, etc.)? 

 Yes 

 No

Staff Use Only:

Survey Start Time: Survey End Time: 
United Way for Southeastern Michigan 133

Appendix K: Family Profile Form Scoring Worksheet

Family Profile Form Scoring Worksheet

ASSM DOMAIN: HOUSING

Score Summary:

5 A score of 5 is received when a family lives in an own, rent, or shared situation that they report as 

adequate to meet their needs and they are paying for their own rent using income.

Question 4: Own, Rent, or Shared Housing 

+ Question 5: Yes

+ Question 6a: Myself and/or my partner/spouse

+ Question 7a: Yes

+ Rent or Mortgage is no more than 30% of monthly income: 6b/8b

= ASSM 5

4 A score of 4 is received when a family lives in an own, rent, or shared situation that they report as 

adequate to meet their needs and they are having their rent or mortgage paid by others or a subsidy.

Question 4: Own, Rent, or Shared Housing

+ Question 5: Yes

+ Question 6a: Family Members, Subsidy, or Not Paying

+ Question 7a: Yes

+ Rent or Mortgage is more than 30% of monthly income: 6b/8b

= ASSM 4

3 A score of 3 is received when a family lives in an own, rent, or shared situation that they report is not 

adequate to meet their needs and they are having their rent or mortgage paid by others or a 

subsidy.

Question 4: Own, Rent, or Shared Housing

+ Question 5: Yes

+ Question 6a: Family Members, Subsidy, or Not Paying

+ Question 7a: No

+ Rent or Mortgage is more than 30% of monthly income: 6b/8b

= ASSM 3

2 A score of 2 is automatically received when a family is living in a temporary situation as reported by 

selecting temporary or reporting that they don’t foresee their current situation lasting more than 90 

days.

Question 4: Temporary (shelter, staying with friends or family) 

and/or 

Question 5: No

= ASSM 2

1 A score of 1 is automatically received when a family is homeless or currently threatened with 

eviction.

Question 4: Homeless or currently threatened with eviction
United Way for Southeastern Michigan 134

= ASSM 1

ASSM DOMAIN: INCOME

Score Summary:

5 A score of 5 is received when a family’s income is sufficient to meet basic needs without assistance, 

pay off debt/save, has appropriate spending habits, and has discretionary funds.

Question 8a and 8b + Question 9 ≠ 0 

+Question 10: none

+Question 11: Yes

+Question 12: Yes

+Question 13: Yes

= ASSM 5

4 A score of 4 is received when a family’s income is sufficient to meet basic needs without assistance, 

pays off debt most months, and has appropriate spending habits but is not able to save much nor 

have many discretionary funds.

Question 8a and 8b + Question 9 ≠ 0

+Question 10: none

+Question 11: Yes

+Question 12: Yes

+Question 13: No

= ASSM 4 

3 A score of 3 is received when a family’s income is sufficient to meet basic needs with assistance and 

has appropriate spending, but is not be able to save/ pay off debts most months nor have 

discretionary funds.

Question 8a and 8b + Question 9 ≠ 0

Question 11: Yes

Question 12: No

=ASSM 3

2 A score of 2 is received when a family’s income is insufficient to meet basic needs with assistance 

and/or has inappropriate spending habits. These families are unable to manage debts nor save and 

have no discretionary funds.

Question 8a and 8b + Question 9 ≠ 0

+Question 11: No

= ASSM 2

1 A score of 1 is received when a family has no income and no financial assistance.

Question 8a and 8b: $0

+ Question 9: No Income

+ Question 10: None
United Way for Southeastern Michigan 135

= ASSM 1

ASSM DOMAIN: FOOD

Score Summary:

5 A score of 5 is received when a family is not on food stamps, has not sought out other sources of 

food to feed their family beyond their income in the last 6 months, and can purchase any food 

desired.

Question 14: N/A

+Question 15: None

+ Question 16: Yes

= ASSM 5

4 A score of 4 is received when a family is not on food stamps, has not sought out other sources of 

food to feed their family beyond their income in the last 6 months, but cannot purchase any food 

desired. 

Question 14: N/A

+ Question 15: None

+ Question 16: No

= ASSM 4

3 A score of 3 is received when a family is not on food stamps, has sought out other sources of food to 

feed their family beyond their income 1 or more times in the last 6 months, and cannot purchase any 

food desired.

Question 14: N/A

+ Question 15: 1-2 or higher

+ Question 16: No

= ASSM 3

2 A score of 2 is received when a family is on food stamps and it is enough to cover the cost of food to 

feed their family for the month.

Question 14: Yes

+ Question 15: None

= ASSM 2

1 A score of 1 is received when a family is on food stamps and it is not enough to cover the cost of food 

to feed their family for the month, and has sought out other sources of food to feed their family 

beyond their income 1 or more times in the last 6 months.

Question 14: No

+ Question 15: 1-2 or higher

= ASSM 1

ASSM DOMAIN: ADULT EDUCATION
United Way for Southeastern Michigan 136

Score Summary:

5 A score of 5 is received when an individual’s language proficiency and literacy is not a barrier to 

employment and their current education level/skills provide them the opportunity for adequate 

employment that fits their needs.

Question 20a: No

+ Question 24: Yes

= ASSM 5

4 A score of 4 is received when an individual’s language proficiency and literacy is not a barrier to 

employment and they are currently enrolled in a secondary education/training/certification program 

that is needed in order to get adequate employment that fits their needs.

Question 20a: No

+ Question 24: No

+ Question 23: Yes

= ASSM 4

3 A score of 3 is received when an individual’s language proficiency and literacy is not a barrier to 

employment, but they need a secondary education/training/certification program in order to get 

adequate employment that fits their needs and are not currently enrolled.

Question 20a: No

+ Question 24: No

+ Question 23: No

= ASSM 3

2 A score of 2 is received when an individual’s language proficiency and literacy is a barrier to 

employment, and they are currently enrolled in an ESL and/or Literacy program.

Question 20a: Yes

+ Question 20b: Yes

= ASSM 2

1 A score of 1 is received when an individual’s language proficiency and literacy is a barrier to 

employment, and they are not currently enrolled in an ESL and/or Literacy program

Question 20a: Yes

+ Question 20b: No

= ASSM 1

ASSM DOMAIN: EMPLOYMENT

Score Summary:

5 A score of 5 is received when an individual’s combined employment is full-time, long-term and 

also provides adequate pay and benefits.

Question 25a: Yes

+ Question 26: Full-time

+ Question 27: Long-term
United Way for Southeastern Michigan 137

+ Question 28: Yes

+ Question 29: 2 or more

+ Question 25c: yes

OR

Question 25a: Yes

+ Question 26: Part-time

+ Question 27: Long-term

+ Question 28: Yes

= ASSM 5

4 A score of 4 is received when an individual’s combined employment is full-time and provides 

adequate pay and benefits; but isn’t considered long-term.

Question 25a: Yes

+ Question 26: Full-time

+ Question 27: Long-term

+ Question 28: Yes

+ Question 29: 2 or more

+ Question 25c: no

=ASSM 4

3 A score of 3 is received when an individual’s combined employment is full-time, but pay is 

inadequate and/or there are few to no benefits.

Question 25a: Yes

+ Question 26: Full-time

+ Question 27: Long-term

+ Question 28: No

OR

Question 25a: Yes

+ Question 26: Full-time

+ Question 27: Long-term

+ Question 28: Yes

+ Question 29: 1 or less

= ASSM 3

2 A score of 2 is received when an individual’s combined employment is part-time, temporary or 

seasonal, and pay is inadequate with no benefits.

Question 25a: Yes

+ Question 26: Part-time

+ Question 27: Temporary/Seasonal

OR
United Way for Southeastern Michigan 138

Question 25a: Yes

+ Question 26: Part-time

+ Question 27: Long-term

+ Question 28: No

OR

Question 25a: Yes

+ Question 26: Full-time

+ Question 27: Temporary/Seasonal

= ASSM 2

1 A score of 1 is received when an individual is not currently employed and wants/needs 

employment.

Question 25a: No

= ASSM 1

N/A A score of N/A is received when an individual is not currently employed, but is not currently 

seeking employment.

Question 25a: N/A

= ASSM N/A

ASSM DOMAIN: MOBILITY (TRANSPORTATION)

Score Summary:

5 A score of 5 is received when a participant has their own car which is considered reliable and they 

report that they are licensed and insured.

Question 31: Yes

+ Question 32: 1

+ Question 33: All selected

= ASSM 5

4 A score of 4 is received when a participant reports that their transportation options are adequate to 

meet their needs and relies on borrowing a car, using rideshare or taxis, or public transportation.

Question 31: Yes

+ Question 32: 2, 3, or 4

= ASSM 4

3 A score of 3 is received when a participant reports that their transportation is not adequate to meet 

their needs, but reports having access to one of the transportation options available.

Question 31: No

+ Question 32: 2, 3, or 4

= ASSM 3
United Way for Southeastern Michigan 139

2 A score of 2 is received when a participant reports that their transportation is not adequate to meet 

their needs and they have their own car, yet that car is not insured or reliable or the participant 

reports not being licensed.

Question 31: No

+ Question 32: 1

+ Question 33: 2 or less selected

= ASSM 2

1 A score of 1 is received when a participant reports that their transportation is not adequate to meet 

their needs and that they have no access to transportation.

Question 31: No

+ Question 32: 5

= ASSM 1

ASSM DOMAIN: HEALTH CARE COVERAGE

Scoring Summary:

5 A score of 5 is received when a participant reports that all members are covered by affordable, 

adequate health insurance.

Question 34a: Yes, both of us

+ Question 35a: Yes

+ Affordable

+ Question 34/35b: No (Adequate)

= ASSM: 5

4 A score of 4 is received when a participant reports that all members can get medical care when 

needed, but may strain budget

Question 34a: Yes, both of us or Yes, just me (for single-parent households only)

+ Question 35a: Yes

+ Not affordable and/or not adequate (Question 34/35b: No)

= ASSM: 4

3 A score of 3 is received when a participant reports that only some family members (i.e. Children or 

Partner only) have health insurance

Question 34a: Yes, just me (when there are two adults in the family) OR Yes, just my significant 

other/spouse

AND/OR

Question 35a: Yes

= ASSM: 3

2 A score of 2 is received when a participant reports that 

Question 34a: No, neither of us

+ Question 35a: No
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+ Question 34/35c: No

+ Question 34/35d: No

= ASSM: 2

1 A score of 1 is received when a participant reports that

Question 34a: No, neither of us

+ Question 35a: No

+ Question 34/35c: Yes AND/OR Question 34/35d: Yes

= ASSM: 1

ASSM DOMAIN: MENTAL HEALTH

Scoring Summary:

5 A score of 5 is received when a participant reports that they do not have a mental health condition 

that interferes with daily life.

Question 41: No

= ASSM: 5

4 A score of 4 is received when a participant reports that reports that they do have a mental health 

condition that interferes with daily life and makes work, social life, and self-care rarely difficult or not 

difficult at all. Also, participant does not have suicidal or self-harm thoughts.

Question 41: Yes

+ Question 42-44: All rarely or not difficult at all

+ Question 45: No

= ASSM: 4

3 A score of 3 is received when a participant reports that reports that they do have a mental health 

condition that interferes with daily life and makes work, social life, and self-care only somewhat 

difficult. Also, participant does not have suicidal or self-harm thoughts.

Question 41: Yes

+ Question 42-44: All somewhat difficult or higher

+ Question 45: No

= ASSM: 3

2 A score of 2 is received when a participant reports that reports that they do have a mental health 

condition that interferes with daily life and makes work, social life, and self-care rarely difficult or not 

difficult at all. Also, participant does not have suicidal or self-harm thoughts.

Question 41: Yes

+ Question 42-44: All very difficult or higher

+Question 45: No

= ASSM: 2

1 A score of 1 is received when a participant reports that reports that they do have a mental health 

condition that interferes with daily life and makes work, social life, and self-care rarely difficult or not 

difficult at all. Participant does not have suicidal or self-harm thoughts, regardless of how other 

questions were answered.
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Question 41: Yes

+ Question 42-44: At least one question rated extremely difficult

OR

Question 45: Yes

= ASSM: 1

ASSM DOMAIN: SUBSTANCE ABUSE

Scoring Summary:

5 A score of 5 is received when a participant reports there has not been a time in their life when using 

alcohol or other drugs affected their personal relationship, school, work, or overall well-being

Question 46: No

= ASSM: 5

4 A score of 4 is received when a participant reports there has been a time in their life when using 

alcohol or other drugs affected their personal relationship, school, work, or overall well-being. The 

Participant also reports thinking about changing their drinking or drug habits, been criticized for their 

drinking or drug habits, and/or felt guilty about their drinking or drug habits 1-2 time in the last 6 

months.

Question 46: Yes

+ Question 47-50: 1-2 times in the last 6 months for any question

= ASSM: 4

3 A score of 3 is received when a participant reports there has been a time in their life when using 

alcohol or other drugs affected their personal relationship, school, work, or overall well-being. The 

Participant also reports thinking about changing their drinking or drug habits, been criticized for their 

drinking or drug habits, and/or felt guilty about their drinking or drug habits 3 times in the last 6 

months.

Question 46: Yes

+ Question 47-50: 3 times in last 6 months for any question

= ASSM: 3

2 A score of 2 is received when a participant reports there has been a time in their life when using 

alcohol or other drugs affected their personal relationship, school, work, or overall well-being. The 

Participant also reports thinking about changing their drinking or drug habits, been criticized for their 

drinking or drug habits, and/or felt guilty about their drinking or drug habits 4 times in the last 6 

months.

Question 46: Yes

+ Question 47-50: 4 times in last 6 months for any question

= ASSM: 2

1 A score of 1 is received when a participant reports there has been a time in their life when using 

alcohol or other drugs affected their personal relationship, school, work, or overall well-being. The 

Participant also reports thinking about changing their drinking or drug habits, been criticized for their 
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drinking or drug habits, and/or felt guilty about their drinking or drug habits 5 or more times in the 

last 6 months.

Question 1: Yes

+ Question 2-5: 5 or more times in last 6 months for any question

= ASSM: 1

ASSM DOMAIN: DISABILITIES

Scoring Summary:

5 A score of 5 is received when a participant reports they do not have physical, developmental, or 

learning disability

Question 51: No

= ASSM: 5

4 A score of 4 is received when a participant reports that do have a physical, developmental, or 

learning disability, but they are taking steps to manage the disability, so it rarely makes work, social 

life, and self-care difficult.

Question 51: Yes

+ Question 52: At least one selected

+ Question 53-55: All Rarely or Not difficult at all

= ASSM: 4

3 A score of 3 is received when a participant reports that do have a physical, developmental, or 

learning disability, but they are taking steps to manage the disability so it sometimes makes work, 

social life, and/or self-care difficult.

Question 51: Yes

+ Question 52: At least one selected

+ Question 53-55: All somewhat difficult or higher

= ASSM: 3

2 A score of 2 is received when a participant reports that do have a physical, developmental, or 

learning disability, but they are taking steps to manage the disability, so it makes work, social life, 

and/or self-care very difficult.

Question 51: Yes

+ Question 53-55: All very difficult or higher

= ASSM: 2

1 A score of 1 is received when a participant reports that do have a physical, developmental, or 

learning disability, but they are taking steps to manage the disability, so it makes work, social life, 

and/or self-care extremely difficult.

Question 51: Yes

+ Question 53-55: Extremely difficult or higher for at least one question

= ASSM: 1

ASSM DOMAIN: CHILDCARE
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Score Summary:

5 A score of 5 is received when childcare is accessible, reliable, affordable, and is of the parent’s 

quality standard.

Question 56: Yes

+ Question 57: Yes

+ Question 58-60 (combined): 3 Yes

+ Question 61: 4 or more

= ASSM 5

4 A score of 4 is received when childcare is accessible, reliable, and affordable; but is not ideal 

choice per parent’s quality standard.

Question 56: Yes

+ Question 57: Yes

+ Question 58-60 (combined): 3 Yes

+ Question 61: 3 or less

= ASSM 4

3 A score of 3 is received when childcare is 2 out of 3: inaccessible, unreliable, and unaffordable.

Question 56: Yes

+ Question 57: Yes

+ Question 58-60 (combined): 2 Yes

= ASSM 3

2 A score of 2 is received when childcare is inaccessible, unreliable, and unaffordable.

Question 56: Yes

+ Question 57: Yes

+ Question 58-60 (combined): 1 Yes

= ASSM 2

1 A score of 1 is received when childcare is needed but not available nor accessible.

Question 56: Yes

+ Question 57: No

OR

Question 56: Yes

+ Question 57: Yes

+ Question 58-60 (combined): 0 Yes

= ASSM 1

N/A A score of N/A is received when there is no childcare needed.

Question 56: No

= ASSM N/A

ASSM DOMAIN: CHILDREN’S EDUCATION
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Score Summary:

5 A score of 5 is received when the household’s school-aged children are all enrolled in school and 

attending classes most or all of the time.

Question 63: Yes

+ Question 64: Yes

+ Question 65: Most or All of the time

= ASSM 5

4 A score of 4 is received when the household’s school-aged children are all enrolled in school and 

attending classes more than half the time, but not consistently.

Question 63: Yes

+ Question 64: Yes

+ Question 65: More than half the time

= ASSM 4

3 A score of 3 is received when the household’s school-aged children are all enrolled in school, but 

one or more children are attending classes less than half the time. (50% or less)

Question 63: Yes

+ Question 64: Yes

+ Question 65: Less than half of the time

= ASSM 3

2 A score of 2 is received when all of the household’s school-aged children are all enrolled in school, 

but one or more children are not attending classes.

Question 63: Yes

+ Question 64: Yes

+ Question 65: None of the time

= ASSM 2

1 A score of 1 is received when one or more of the household’s school-aged children are not 

enrolled in school.

Question 63: Yes

+ Question 64: No

= ASSM 1

N/A A score of N/A is received when a household does not have any school aged-children

Question 63: No

= ASSM N/A

ASSM DOMAIN: PARENTING SKILLS

Scoring Summary

Note: Questions 67, 69, and 71 require reverse coding. For example, an answer of 1, strongly disagree, for 

Question 88 would be scored a 7.
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Questions 67-75 come from the Protective Factors Survey and comprise one factor and one subscale within 

that tool. To assign an ASSM score for the Parenting Skills Domain, a score must be calculated for each 

subscale:

Child Development/Knowledge of Parenting: Questions 67-71 make up the Child Development/Knowledge 

of Parenting factor. Due to the nature of these questions, they will be considered individually, not as a 

scale. Keep in mind that questions 67, 69, and 71 need to be reverse coded.

Nurturing and Attachment: Questions 72-75 make up the Nurturing and Attachment subscale. If at least 3 

items are complete, take the average of scores to questions 72-75 as the overall score for this subscale.

5 A score of 5 is received when a participant reports no CPS involvement and well-developed parenting 

skills.

Question 77a: No

+Questions 67-71: all rated ≥ 6

+Questions72-75: Subscale ≥ 6

= ASSM 5

4 A score of 4 is received when a participant reports no CPS involvement and adequate parenting skills.

Question 77a: No

+Questions 67-71: all rate ≥ 5

+Questions 72-75: Subscale ≥ 5

= ASSM 4

3 A score of 3 is received when a participant reports no CPS involvement and apparent but inadequate 

parenting skills.

Question 77a: No

+Questions 67-71: all rated > 4

OR

Question 77a: No

+Questions 72-75: Subscale > 4

= ASSM 3

2 A score of 2 is received when a participant reports no CPS involvement and minimal parenting skills.

Question 77a: No

+ Questions 67-71: At least one question ≤ 4

+ Questions 72-75: Subscale ≤ 4

= ASSM 2

1 A score of 1 is automatically received when a participant reports any CPS involvement (Question 77 

which can be found in the Family/Social Relations Domain).

Question 77a: Yes

+ Question 77b: any response
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= ASSM 1

ASSM DOMAIN: FAMILY/SOCIAL RELATIONS

Score Summary:

Note: Questions 85, 86, and 88 require reverse coding. For example, an answer of 1, strongly disagree, for 

Question 88 would be scored a 7.

Questions 78-88 come from the Protective Factors Survey and comprise three separate subscales within 

that tool. To assign an ASSM score for the Family Social Relations Domain, a score must be calculated for 

each subscale:

Family Functioning/Resiliency: Questions 78-82 make up the Family Functioning/Resiliency subscale. If at 

least 4 items are complete, take the average of scores to questions 78-82 as the overall score for this 

subscale.

Social Support: Questions 83, 84, and 87 make up the Social Support subscale. If at least 2 items are 

complete, take the average of scores to these questions as the overall score for this subscale.

Concrete Support: Questions 85, 86, and 88 make up the Concrete Support subscale. If at least 2 items are 

complete, take the average of scores to questions 78-82 as the overall score for this subscale. Keep in mind 

that these questions need to be reverse coded.

5 A score of 5 is received when a participant reports supports in all three subscales and no 

abuse/neglect.

Question 77a: No

+Questions 78-88: All three subscales ≥ 4.5

OR

Question 77a: Yes

+Question 77b: No

+Questions 78-88: All Three subscales ≥ 4.5

= ASSM 5

4 A score of 4 is received when a participant reports support in two subscales and no abuse/neglect.

Question 77a: No

+Questions 78-88: Two subscales ≥ 4.5

OR

Question 77a: Yes

+Question 77b: No

+Questions 78-88: Two subscales ≥ 4.5

= ASSM 4
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3 A score of 3 is received when a participant reports support in one subscale and no abuse/neglect

Question 77a: No

+Questions 78-88: One subscale ≥ 4.5

OR

Question 77a: Yes

+Question 77b: No

+Questions 78-88: One subscale ≥ 4.5

= ASSM 3

2 A score of 2 is automatically received when a participant reports limited family/social support or that 

CPS has been involved, but the case is resolved

Question 77a: No

+Questions 78-88: All three subscales < 4.5

OR

Question 77a: Yes

+Question 77b: No

+Questions 78-88: All three subscales < 4.5

OR

Question 77a: Yes

+ Question 77b: Yes, but resolved

= ASSM 2

1 A score of 1 is automatically received when a participant reports there is current, active CPS 

involvement.

Question 77a: Yes

+ Question 77b: Yes, and ongoing

= ASSM 1

ASSM DOMAIN: COMMUNITY INVOLVEMENT

Score Summary:

5 A score of 5 is received a participant reports that they are very involved or involved in their 

community and they offer examples of their involvement.

Question 89: Very Involved or Involved

+ Question 90: At least one selection

= ASSM 5
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4 A score of 4 is received when a participant reports that they are involved or somewhat involved in 

their community, but they also report that there are logistical barriers to their involvement, such as 

language, childcare, or transportation.

Question 89: Involved or Somewhat Involved

+ Question 91: Language barrier AND/OR Can’t find the childcare or transportation I need

= ASSM 4

3 A score of 3 is received when a participant reports that they don’t know how to get involved.

Question 91: I’d like to be more involved, but I am not sure how

= ASSM 3

2 A score of 2 is automatically received when a participant reports that they are not involved and also 

reports that they are not involved because they do not want to be.

Question 89: Not Involved

+ Question 91: I am not involved because I don’t like to be involved

= ASSM 2

1 A score of 1 is automatically received when a participant reports that their barrier to involvement is 

basic needs.

Question 91: Too concerned about meeting my family’s basic needs

= ASSM 1

ASSM DOMAIN: SAFETY

Score Summary:

5 A score of 5 is received a participant reports that they generally feel safe in their home and 

neighborhood and have no current or future concerns about their safety.

Question 92: Yes

+ Question 93: Yes

+ Question 94: No

+ Question 95: No

= ASSM 5

4 A score of 4 is received when a participant reports that they currently feel safe in their home and 

neighborhood, but they have concerns about their safety in the next 6 months.

Question 92: Yes

+ Question 93: Yes

+ Question 94: no

+Q95: Yes

= ASSM 4

3 A score of 3 is received when a participant reports that they are not currently feeling safe in their 

home and/or neighborhood and/or they are concerned about their child’s safety and they are 

making changes to their regular routine to cope with any safety concerns they have.
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Question 92: No

OR

Question 93: No

AND/OR

Question 94: No

+ Question 96: Yes

= ASSM 3

2 A score of 2 is automatically received when a participant reports that they or their child(ren) are 

currently receiving threats to their safety.

Question 98: Yes

= ASSM 2

1 A score of 1 is automatically received when a participant reports they or their child(ren) have 

witnessed or experienced a crime.

Question 97: Yes

= ASSM 1

ASSM DOMAIN: LIFE SKILLS

5 A score of 5 is received a participant reports that they are able to provide beyond basic needs of daily 

living for self and family.

Question 99: Yes

= ASSM 5

4 A score of 4 is received when a participant reports that they are able to meet basic needs of living 

sometimes and have assistance when needed.

Question 99: No

Question 100a: No

OR

Question 99: No

Question 100a: Sometimes

+ Question 100b: Yes

= ASSM 4

3 A score of 3 is received when a participant reports that they are able to meet basic needs of living 

and have access to assistance sometimes.

Question 99: No

Question 100a: Sometimes
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+ Question 100b: Sometimes

OR

Question 99: No

Question 100a: Yes

+ Question 100b: Yes

= ASSM 3

2 A score of 2 is automatically received when a participant reports that they are not able to meet basic 

needs of living but have access to help sometimes OR they are able to meet basic needs of living 

sometimes but do not have access to help when need.

Question 99: No

Question 100a: Yes

+ Question 100b: Sometimes

Or

Question 99: No

Question 100a: Sometimes

+ Question 100b: No

= ASSM 2

1 A score of 1 is automatically received when a participant reports they are not able to meet basic 

needs of living and does not have access to help.

Question 99: No

Question 100a: Yes

+ Question 100b: No

= ASSM 1

ASSM DOMAIN: LEGAL

5 A score of 5 is received when an individual doesn’t have any criminal justice history, occurring in the 

last 12 months and no history of felony/misdemeanor. 

Question 102: No

+ Question 103: Option #1

+ Question 104: No

+ Question 104b: No

+ Question 105: No

=ASSM 5

4 A score of 4 is received when an individual has no current charges within the last 12 months and has 

successfully completed parole or probation in the last 12 months.

Question 103: Option #1
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+ Question 104: No

+ Question 104b: Yes

+ Question 105: No

= ASSM 4

3 A score of 3 is received when an individual is currently on parole or probation but is fully compliant.

Question 104: Yes

+ Question 104a: Yes

+ Question 105: Yes

= ASSM 3

2 A score of 2 is received when an individual has been arrested but not yet been to court, or if they are 

currently in trial or court proceedings, or is not compliant with probation or parole.

Question 103: Option #4 and/or #5

AND/OR

Question 104: Yes

+Question 104a: No

=ASSM 2

1 A score of 1 is automatically received when an individual has current unresolved ticket or open 

warrant.

Question 103: Options #2 and/or #3

(regardless of all other answers)

= ASSM 1
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Appendix L: Feeding Your Child Survey
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Appendix M: Case Closure Form
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Appendix N: GOALS Family Feedback Form 
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Appendix O: Comparison Family Feedback Form
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Appendix P: Family Goal Setting Form
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Appendix Q: Pathway Programs

GOALS Pathway Programs

Parenting Education

ACCESS: Systematic Training for Effective Parenting (STEP)

STEP is a classroom-based parenting program for parents with children ages 0 to 5. It focuses 

on child development, discipline, communication strategies, and how to build child self-esteem. 

The materials are adapted to be suited for ELLs (English Language Learners). The classes are 

facilitated in three languages simultaneously: English, Arabic, and Spanish.

ACCESS: Citizenship Program

The Citizenship Program is a classroom-based environment for individuals who desire to 

become naturalized citizens of the United States and have already applied for their citizenship. 

The classes are designed to prepare participants for the US Citizenship Naturalization Test. 

Participants in the Citizenship Program learn about US history, government, and English as a 

Second Language (ESL) skills. The ESL portion of the class provides participants with the skills 

necessary to talk about themselves, understand the information on their application, and pass 

the English portion of the US Citizenship Naturalization Test. 

While citizenship classes are open to everyone, they are designed for low-level English 

speakers. GOALS participants who are native or high-level English speakers are provided the 

study literature to review at their own pace. Workshop style events are also offered for 

participants who cannot commit to weekly classes. 

Black Family Development: LENA Start

LENA Start is a United Way funded program offered through a partner agency. The program 

uses wearable LENA technology to record speech and language environments at home a day 

after each LENA Start class. LENA Technology is research-based technology used worldwide to 

measure early talk for research, intervention, and clinical use. LENA Start classes address the 

early talk gap, using feedback from LENA Technology and through curriculum that teaches 

parents simple strategies to improve talk. LENA Start is a free 13-week program with 

entertaining lessons which included videos and hands-on activities where parents are coached 

on speaking and reading more to their child. Parents are also given take home material and 

easy to use Talking Tips to build conversations, along with receiving a book at each session.
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CARE of Southeastern Michigan: Active Parenting

Active Parenting is a 4-week parenting course for parents with children birth to age 5, focused 

on discipline techniques, cooperation, responsibility, and self-esteem in children. 

CARE of Southeastern Michigan: Nurturing Families

Nurturing Families is a classroom-based parenting class for non-custodial parents of children 

age birth to 17 years who have an open Child Protective Services case and are required to take 

parenting courses. 

CARE of Southeastern Michigan: Supportive Opportunities for Families (SOF)

SOF is an intensive home visiting program using the Nurturing Families parenting curriculum for 

parents with children age birth to five. It consists of 12 visits which are spaced out based on the 

family’s level of need for support.

Leaps & Bounds Family Services and Oakland Family Services: Parents as Teachers (PAT)

Parents as Teachers is a home visiting program for parents of children birth to age 31⁄2 years 

focused on teaching parents to be their child’s first teacher and getting them ready to learn. It 

covers topics such as child development, parenting skills, and general family well-being.

United Way for Southeastern Michigan: ABCMouse

ABCMouse is an online program that is a step-by-step research driven curriculum with more 

than 850 lessons in ten levels. As the child completes each lesson it guides them to the next 

lesson, motivated by a ticket and reward system. A progress tracker is also available so parents 

are able to view the learning activities completed and progress by academic level and subject. 

The system promotes literacy from early literacy to reading paragraphs. There are more than 

450 books and beginning readers in the program, along with writing and language skills that 

include sentence structure, punctuation, parts of speech and more. 

United Way for Southeastern Michigan: Earned Income Tax Credit Program

Every year the residents of Metro-Detroit leave millions of dollars in tax credits unclaimed. 

United Way for Southeastern Michigan, along with its partners work to combat that with their 

Earned Income Tax Credit Program. Volunteers for this program provide free tax preparation 

services for low to moderate income individuals. These trained volunteers help individuals 
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maximize their return and claim the Earned Income Tax Credit (EITC). The EITC is a refundable 

tax credit for low to moderate income working individuals and couples. 

United Way for Southeastern Michigan: Reading is Fundamental

Reading is Fundamental (RIF) has developed content and resources that produce measurable 

results. Through RIF’s various programs and partnerships, they provide opportunities for 

children and their families to experience the life-changing impact of reading. Reading is the 

fundamental building block to all life’s essential skills. The program invites parents to explore 

the program by bringing books and literacy resources to children at home. The GOALS 

program provided all intervention families with 6 books at each baseline, 6-month, and 12-

month assessment visit. 

Additionally, FCMS’ share approved print materials about the online resources available at 

www.rif.org. These resources supported parents with the literacy programming in conjunction 

with the books. 

United Way for Southeastern Michigan: Ready4K

Ready4K is an evidence-based text messaging program that sends age appropriate facts, tips, 

and growth opportunities directly to parents of children ages newborn-8 years old. Developed 

by educational researchers, these text messages are based on a curriculum that aligns with the 

educational standards set by the State of Michigan. Parents receive three text messages each 

week that help them maximize already established family routines to help build their child’s 

skills. Some examples included:

1. FACT: The grocery store is great for building literacy skills. On the way to the store, ask: 

If you could only eat one food forever, what would it be? Why?

2. TIP: When you’re at the store, go on a letter hunt. Can your child find an “A” on a sign, 

box, or food label? What about “B”? Can s/he go all the way to “Z”?

3. GROWTH: Keep preparing 4K at the grocery store! As you walk by the eggs, ask: What 

rhymes with egg? Leg, peg, beg. Try it with cheese. Bees, knees, please!

These messages help parents take on more of an active role in their child’s learning.

Health Care Access & Support

National Kidney Foundation of Michigan: Diabetes Prevention Program

Diabetes Prevention Program participants are part of a small, supportive group lead by a trained 

lifestyle coach. This lifestyle change program helps people with prediabetes eat healthier, 

become more physically active, and lose weight with the goal to delay or even prevent the onset 

of Type 2 Diabetes. Participants learn about healthier eating habits, ways to be more physically 
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active, and other behavior changes over the course of 16 weekly one-hour sessions. The group 

continues to meet monthly, completing a full year of the Diabetes Prevention Program. 

Participants work towards losing 5-7% of their starting body weight and being physically active 

for 150 minutes per week.

National Kidney Foundation of Michigan: Enhance Fitness

Enhance Fitness is a physical activity program for adults that is designed to improve functional 

fitness and well-being. Functional fitness means keeping strong, balanced, and flexible to retain 

the ability to do the daily activities of life that you normally would do. They give people an 

opportunity to exercise and socialize with their friends. The classes focus on balance, strength, 

endurance, and flexibility exercises and are adjustable to all levels of fitness. Classes are taught 

by certified fitness instructors who are specifically trained in Enhance Fitness procedures and 

the exercise program. 

National Kidney Foundation of Michigan: PATH

The Stanford Chronic Disease Self-Management Program (PATH in Michigan) was developed 

and tested by Stanford University to help people learn to better manage their long-term health 

conditions. It is a six-week workshop conducted in 21⁄2 hour sessions each week. PATH is 

designed to benefit adults with chronic or ongoing health conditions including arthritis, heart 

disease, diabetes, emphysema, asthma, bronchitis, and depression. Family members, friends, 

and parents are also encouraged to attend.

There are a variety of PATH workshops to choose from for those people with specific health 

challenges such as diabetes, kidney disease, and chronic pain. These workshops are similar to 

the traditional PATH but offer additional information and support for people with those 

conditions:

● General PATH is for anyone with a chronic health condition such as arthritis, 

hypertension, cancer, and other long-term health problems.

● Diabetes PATH is for people who are living with Type 2 Diabetes.

● Chronic Pain PATH is for people living with chronic pain.

● Kidney PATH is for people living with chronic kidney disease.

● Cancer Thriving & Surviving is for cancer patients, cancer survivors and their loved ones.

United Way for Southeastern Michigan: Asthma Program

A pathway for all families that have children on Medicaid and uncontrolled asthma. The 

Michigan MATCH program was developed by the Asthma Network of West Michigan in the 

Grand Rapids area, and is implemented in greater Flint, Ann Arbor, Ingram and Wayne County 
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areas. Anyone can refer clients to the MATCH program. The premise for the program is for 

each client and family to work with a case manager to improve their asthma self-management.

WCHAP provides asthma education to families whose child(ren) may have uncontrolled asthma 

that are on Medicaid. They talk with the families, help to educate the families on proper usage 

of medication, and to identify triggers in and out of the home. They do six or more home visits, 

visits to school or work, and/or the physician’s office. They will help to create or update an 

asthma action plan for that child.

United Way for Southeastern Michigan: MI Bridges Navigator

The MI Bridges Navigator assists community residents to identify their needs and connects them 

to community resources through community programs and organizations through partnership 

with 2-1-1. The MI Bridges Navigator helps to improve community residents’ experiences 

making the Michigan Department of Health and Human Services (MDHHS) process of accessing

benefits easier for them. Through one-on-one sessions the Mi Bridges Navigator helps to 

answer questions, complete a needs survey, find local resources, or apply online for benefits. In 

addition, the MI Bridges Navigator helps community partners play a significant role by assisting 

them if needed to access benefits and support for their families.

United Way for Southeastern Michigan: WCHAP (FQHC, PCP, and Health Plans)

Wayne Children’s Healthcare Access Program (WCHAP) is a not-for-profit organization located 

in downtown Detroit, Michigan. WCHAP staff works with primary care physicians, health plans, 

parents, and other community agencies in a collective effort to improve the healthcare 

outcomes of all children throughout the City of Detroit and Wayne County. 

WCHAP promotes the health of children by helping parents and their children get the most out 

of their relationship with their pediatrician or family physician. WCHAP provides health 

education to families, helps doctors improve the quality of their care, and acts as a voice for 

issues affecting children’s health. 

United Way for Southeastern Michigan: Virtual Children’s Healthcare Access Program

Born out of Kent County, Michigan, CHAP is an evidence-based model that improves the quality 

of care and health outcomes for children with Medicaid while reducing the cost of care. When 

families have sufficient access to quality pediatric patient centered medical homes, they are 

significantly more likely to use their medical home for primary care, ultimately leading to 

healthier children and reduced costs.
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Virtual CHAP provides education, care coordination, accessing transportation and other 

necessary services to address social determinants of health and barriers to medical access for 

children on Medicaid. Services are provided over the phone by a trained VCHAP specialist.

Nutrition/Family Feeding Practices

United Way for Southeastern Michigan: FEAST

FEAST (Feeding, Eating, and Succeeding Together) is a four-class series that teaches parents 

strategies to help their children grow into healthy, happy eaters. Learning is done through 

dialogue and group discussion rather than lectures. Each class is 1 hour and 15 minutes long, 

and they are taken one per week over four weeks.

The topics of the four classes are: 

● Reducing stress around feeding

● Roles and responsibilities at mealtime

● Family meals and routines

● Learning to like new foods
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Appendix R: Pilot Survey Summary

Training Area Responses

Understanding of 

SIF grant purpose 

and goals

Most participants agreed (65%) or strongly agreed (25%) that they 

understood the project. The two who disagreed did not attend this 

session.

Understanding of 

project evaluation 

and goals

Most participants agreed (60%) or strongly agreed (20%) that they 

understood the evaluation. 

55% agreed and 25% strongly agreed that they understood their 

agency’s pilot recruitment plan. Twenty percent have had previous 

experience with random assignment studies. All but two (90%) 

understood procedures for obtaining informed consent. 

Preparation for 

implementation of 

the Family CheckUp model

All participants were new to the Family Check-Up model at the 

beginning of the training series. By the end, three quarters of 

participants agreed (70%) or strongly agreed (5%) that they felt 

prepared to administer it. 

Most understood how the FCU differed from the normal standard of 

care at their agency (65% agreed, 20% strongly agreed) and almost all 

(90%) understood their role in the project.

Open ended feedback included two comments that the FCU training 

could have been more helpful if it was more tailored to how the SIF 

project will be using the model.

Although only 10% of the group had experience with 211 before the 

trainings, almost all (90%) felt they understood the role of 211 in the 

Family Check-Up model. Slightly less (75%) felt they understood the 

role of text messaging.

Only 40% felt prepared to use the Family Check-Up model with 

families who are not fluent in English. We note that the agencies vary 

in terms of what percentage of their clients is not fluent in English.

Preparation for 

administration of 

measurement 

tools

ASQ-3 and ASQ:SE-2: 60% of the group had experience with ASQs 

before the training. After, 90% felt prepared to administer them and 

85% felt prepared to score and interpret them. 
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ASSM: 35% of the group had experience with the ASSM before the 

training. After, 80% felt prepared to administer it and 75% felt 

prepared to score and interpret it. Two open ended responses 

requested more training on scoring and interpretation. 

We did not ask if participants had previous experience with the 

following three assessments.

Feeding Your Child: After the training, 80% felt prepared to 

administer it and 75% felt prepared to score and interpret it.

Child Temperament: After the training, 75% felt prepared to 

administer it and only 65% felt prepared to score and interpret it. One 

open ended response requested more training on scoring and 

interpretation. 

All FCMS indicated they felt prepared to administer, score, and 

interpret the ASQ-3 and ASQ:SE-2. All but one felt prepared to 

administer, score, and interpret the ASSM and Feeding Your Child 

Questionnaire. All but one felt prepared to administer the Child 

Temperament Questionnaire and two did not feel prepared to score 

and interpret it. 

Preparation to give 

feedback and set 

goals

Motivational interviewing: 35% of the group had experience with 

motivational interviewing prior to participation (5 of 11 FCMS had 

experience). One open ended response requested more practice on 

this and more information about how control visits would differ.

Providing feedback on assessments: after the training, 60% agreed 

and 15% strongly agreed they were prepared to give feedback based 

on the assessments. One open ended response requested training on 

how to provide research to go along with results during feedback 

sessions. Another requested more practice on delivering difficult 

results or having hard conversations. Another open ended response 

indicated a need to better understand the purpose behind many of 

the questions in the assessments. 

Sixty percent of participants agreed and 20% strongly agreed they 

were prepared to help families set goals based on assessments. 

Preparation for 

implementation of 

No participants indicated they had experience with ETO before the 

training. One open ended response expressed a preference to hold 
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administrative 

processes (ETO, 

payments, etc.)

off on ETO training until the database was complete. 

Access client information in ETO: 70% agreed they were prepared, 

15% strongly agreed. 

Understand evaluation support payments: 65% agreed they were 

prepared, 15% strongly agreed. 

Enter enrollment data in ETO: 60% agreed they were prepared, 15% 

strongly agreed. 

Enter assessment data in ETO: 55% agreed they were prepared, 10% 

strongly agreed. 

Overall 

assessment of 

training 

The majority agreed (60%) or strongly agreed (25%) that the training 

met their needs for information and skill development at this time. 

Open ended responses included a preference for task-based training, 

rather than lecture-based training, although others felt the format and 

context were appropriate. One participant suggested that the lead for 

each agency could have created a sample case for the assessments 

before working with the practice families. Another requested a 

checklist for completion of forms and two participants requested a 

model of someone going through the entire intervention. One simply 

requested more practice for the group to ensure consistent results.

Additional requests included a clear outline for the process for the 

FCU and referral processes for the pathways outside of 211.
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Appendix S: Referral Log Form
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Appendix T: Partner Agency Quarterly Progress Report
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Appendix U: Service Participation Report
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Appendix V: End of Study Survey with Results

SIF 2016 End of Study Survey – Responses

(updated 8/26/2020 with surveys completed through 8/5/2020)

1. What is your agency? 

What is your agency? Manager (N=7) FCMS (N=13) DCS (N=5)

ACCESS 2 (29%) 3 (23%) 1 (20%)

CARE 1 (14%) 4 (31%) 1 (20%)

LBFS 1 (14%) 2 (15%) 1 (20%)

NKFM 2 (29%) 1 (8%) 1 (20%)

OFS 1 (14%) 3 (23%) 1 (20%)

2. What is your current role on the SIF 2016 project? (check all that apply)

What is your current role on the SIF 

2016 project? (check all that apply) Manager (N=7) FCMS (N=13) DCS (N=5)

FCMS 0 (0%) 11 (85%) 1 (20%)

DCS 0 (0%) 2 (15%) 5 (100%)

Manager 4 (57%) 1 (8%) 0 (0%)

Other 3 (43%) 1 (8%) 0 (0%)

Notes: Other (Manager): Previous Manager (1), FCMS Manager (1), Director overseeing Manager (1); 

Other (FCMS): No longer on the project (1)

3. What previous roles have you had in the SIF 2016 project? (check all that apply)

What previous roles have you had in 

the SIF 2016 project? (check all that 

apply) Manager (N=7) FCMS (N=13) DCS (N=5)

No previous SIF 2016 role 2 (29%) 8 (62%) 4 (80%)

FCMS 1 (14%) 5 (38%) 0 (0%)

DCS 0 (0%) 0 (0%) 0 (0%)

Manager 0 (0%) 0 (0%) 0 (0%)

Other 0 (0%) 1 (8%) 0 (0%)

Notes Other (FCMS): ESL instructor/work with female adults and Childcare monitor (1)

Family Checkup Model (FCMS and Managers)

4. How good of a fit do you think the Family Checkup Model was for the families your 

agency served? 

How good of a fit do you think the Family 

Checkup Model was for the families your 

agency served? Manager (N=7) FCMS (N=13)

Very good fit 1 (14%) 5 (38%)

Good fit 5 (72%) 7 (54%)

Not a good fit 1 (14%) 1 (8%)

Not a fit at all 0 (0%) 0 (0%)
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4a.Please explain your answer: 

Manager

• Families seemed to respond positively to having a supportive person in their life helping 

guide them to achieve their goals.

• Most families really seemed to enjoy the working with their FCMS and the goal setting 

process. We saw some families make really significant progress on the goals that they set 

& the overall well-being of their family. We had a few families really struggle with the 

concept of goal setting and it was difficult to motivate them to take steps towards goals or 

improving their family's well-being.

• The families at our agency are often afflicted with a number of needs.

• The overall goal and purpose of the FCU fit very well with our families. There were certain 

aspects of the evaluation and study that needed to be tailored for our target community, but 

we were able to make those changes as needed. A lot of what the FCU provided was 

information and support that families didn't know they needed until they started in the 

program.

• While most intervention families needed extra help to create their own goals (because that 

is farther outside their cultural context than for English-speaking Americans), overall they 

had a positive experience in the program.

• The Family Checkup Model was a great addition to our services offered. Some other 

aspects of the GOALS program were not as beneficial (poor database for data entry, 

research evaluation that was not consistent across agencies.)

• We don't provide in house services, or work directly with families. most of our recruitment 

was through other partners that do have those types of services.

FCMS

• I feel that many of my clients appreciated the client-centered, strengths based approach 

that the FCMS provides. I also feel that most of my clients appreciated the one-on-one 

support when in need of resources.

• I think it was a great fit because of the clientele that our agency works with. A lot of the 

families that ended up joining this program were referred to us by other programs in the 

agency.

• I've been able to link and refer families to resources and services that have been helpful to 

them

• Many of the families we work with were looking for slightly more intense services.

• Many participants appeared to find value in the model and appreciated the strength based 

and reflective approach. Some participants preferred for a quicker, more direct feedback. 

Our team believes the most beneficial approach for the families we have served in an ongoing model would be to provide a feedback even more tailored to the participants than 

what the model is. We could do this by providing the Family Check-Up Model to those fully 

interested in the full conversation, but to others who like a direct approach, the case 

manager could use their discretion to provide a DCS model of feedback, while perhaps 

adding a few reflective questions.

• My response to this question varies drastically depending on the client. Many clients began 

the project scoring highly, these clients seemed to enjoy learning about their children's 

development but would have been a-okay without the intervention. Other clients who 

scored in the "needs attention" range at the beginning of the project seemed to be helped 

more by having a listening ear than anything. More times than not, they had needs much 

greater than our resources. Needs like childcare and housing that are near impossible to 

solve. However, having someone to listen and support seemed to be a great emotional 

help.

• Our agency works with many low-income families that need additional community support 

so I thought that it was a good fit for those purposes.
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• Some of the families seemed to be doing very well without assistance and didn't really need 

resources, but most of them benefited

• The idea of focusing on a families strengths and looking at areas that may need 

improvement still in a more positive light really benefits families.

• With my previous experience of working and teaching adults ESL and childcare areas. 

These factors were a good opportunity to start as A FCMS, allows me to work with 

participants confidently, and truly respect their background and culture, working hard to 

make families fitting well and living safely in this community.

Training of FCMS (FCMS)

5. How prepared did you feel to implement the Family Checkup Model after taking the 

training provided by UWSEM?

 Very prepared 6 (46%)

 Prepared 5 (39%)

 Not very prepared 2 (15%)

 Not prepared at all 0 (0)%)

5a.What additional training would have been useful?

• After taking the training and watching the clips provided, I felt very comfortable 

implementing the Family checkup model. Coming into the program later than it had started, 

I also had coworkers that had been implementing this program for awhile and that also was 

a huge help with starting to implement it on my own.

• All training provided me with what I needed in order to allow the hands on experience to 

further my understanding of the model.

• Although both trainings were great, I felt that there was a lack of consistency in the training I 

received for this role. The training I received from Chris at UW was different from the 

training I received from my supervisor at my agency. It overall left me confused.

• How to find different resources and communicate with referrals appropriate for families' 

various needs

• I was a part of the original, very intensive training. From those trainings, yes it was very 

helpful. Myself and the CARE SIF team has always felt that a training on how to complete 

DHHS forms would have been incredibly helpful. Also, the training Delonda mentioned that 

allows case managers to navigate DHHS benefit pages (for free) would have been an 

incredible asset to the program and I believe would have assisted significantly in our 

enrollment numbers. https://www.michigan.gov/mdhhs/0,5885,7-339-

71551_82637_82640---,00.html

• I was really just filling in until a new case manager was hired, so there was a LONG period 

of time between my training from UWSEM and my actual implementation of the program.

• I wished we had a thorough training on the temperament questionnaire at the beginning of 

the GOALS implementation to know what the indicators behind each question are. In the 

beginning, I had to research and study each question and what lies behind each question 

then later during the implementation we obtained some information in the learning 

community.

• I would have loved more motivational interviewing training. Additionally, because I do not 

yet have a clinical background, any training in that aspect would have been much 

appreciated. I pride myself in my ability to be empathetic and kind. These traits definitely 

helped in situations where conversations with my clients became very similar to those a 

psychologist may have with a patient, however, often times I wish I had more training/than 

these traits to fall back on.
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• It's something that definitely takes practice and experience to feel proficient, but I think the 

trainings helped prepare us as much as they could; really the Learning Communities helped 

contribute to my preparedness immensely.

• all training that I attended in the past was so excellent to upgrade my knowledge, feed up 

my learning skills, moved up my work in the right pathway. What it could help me as FCMS 

due to COVID10 have more resource of Basic Need, not only apply for food stamp but also 

have easy contact with social service, I would like to train more of childcare development 

programs (mental health, and speaking difficulties)

FCMS Certification (FCMS) 

6. Did you complete FCMS Certification? 6a. Please explain your answer. If yes, why? or If 

no, why not?

 Yes 8 (62%), why?

• Because I thought it was a requirement of the project, and also it seemed like a good idea.

• I felt becoming certified could only benefit me.

• I thought it was important to become certified as a reminder to myself and others that I am 

competent enough to carry out the FCU Model

• It was requested of us in the program.

• Its a part of my job to be a FCMS specialist, it allows me to do my work efficiently because 

it gives me the resources and knowledge to do so.

• One of the great outcomes of this study that I personally benefited although I wished that 

we had the motivational interviewing skill training early in the study. My credentials 

background is education. I did not come from the social work or psychology background 

which motivational interviewing skills is the foundation of their work. But I am an educator. I 

am always searching, learning, and educating myself to provide high quality performance.

• To make it right

• it is part of my job requirement 

 No 5 (38%), why not? 

• I was busy with workload at first and then it was nearing the end of the study

• I was going to complete the certification process, but the Coronavirus got in the way of me

being able to finally do the video certification process.

• I went through all of the training but at that time the priority was to get the assigned FCMS 

case managers certified before additional staff.

• To complete the certification, you must record your feedback session with two families. I 

completed this recording with one and got feedback from Chris; however, I was unable to 

record a second session due to COVID-19.

• Was going to, however, Covid and no in person visits has prevented this 

6b. Please explain any challenges that made obtaining certification difficult.

• Families are less than willing to have interactions video taped in their home. It takes 

sometimes more than three visits to gain trust of the family.

• I almost wish clients were randomly selected to be part of the certification (with our right to 

veto if a client was in severe crisis). I admire that we were trusted to pick a family ourselves, 

but I struggled to decide which family to choose. Some families were doing great, so I felt 

recording feedbacks with them would not show all my skills. Some families had children too 

young or too old for some assessments (i.e. PICCOLO, IBQ and ASQs) so they could not 

be selected. Some families were in crisis mode and I would not have felt comfortable 

choosing them. My overthinking/indecisiveness along with being very, very busy at the time 

of certification made it difficult to "keep the ball rolling".

• It takes too long
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• It was not a challenge as mush as seeking more information on how to use the motivational 

interviewing skills with the community we work with. Trying to make participants be in 

charge and see what best for them coming from themselves, changing some core beliefs 

embedded in them without lecturing.

• N/A

• None that I can think of.

• The only challenges I faced were the feedback session steps because it took me some time 

to understand how to do them properly.

• The only challenges I felt, were the personal ones I put on myself. I never feel I can 

prepare enough.

• The pandemic caused this program to change to virtual and because of this I was not able 

to do the home visits in person and do the video certification process.

• There were minor challenges for me determining my certification families and some 

technical difficulties with the ASU website; but they were resolved.

• Video technology.

• distractions during recording, I had to attempt my second certification video twice due to 

distractions out of my control.

• n/a

Project support (FCMS, DCS, Managers)

7. How much technical support did your agency receive for using ETO?

How much technical support did your 

agency receive for using ETO? Manager (N=7) FCMS (N=13) DCS (N=5)

More than enough support 2 (29%) 4 (31%) 1 (20%)

Just the right amount of support 3 (42%) 8 (61%) 4 (80%)

Not enough support 2 (29%) 1 (8%) 0 (0%)

7a. Please explain your answer and provide any comments about any additional support 

that would have been helpful.

Manager

• ETO consistently had issues throughout the course of SIF. The support staff for ETO was 

spread across multiple programs and not always available to assist in a timely manner.

• ETO was very hard to work with at the beginning of the project, but once it was up and 

running any questions/issues were handled in a timely manner. However, if given the 

choice, I would not use ETO as a platform in the future due to the number of issues over 

the years.

• I can only speak for the past year or so (2019-mid 2020), but to me, the support has been 

great. I know some issues remain that the caseworkers have grappled with more than I 

have, so I'll leave that to them.

• I think support for ETO came in waves. When information was needed at a higher level, 

then the focus was brought back to ETO and its shortcomings. At the end of the project 

there were still a lot of redundancies in the system and the flow in entering information was 

never streamlined. There were a lot of changes in the beginning as ETO was being built out 

that lead to inconsistencies in data entry between staff. I feel that the ETO team at United 

Way was trying their best to work out all the kinks, but there were a lot of kinks. I do not 

believe that we didn't get enough support because if we had questions about ETO, they 

were usually answered in a timely fashion. I do believe that ETO and data entry should 

have been better planned out prior to us starting the project in full. I still believe that some 

of the scores in ETO may be incorrect based on the automatic scoring. While this did get 

better as the project went on, it is almost impossible to account for everything.
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• Our data entry staff had a fairly easy time with ETO, so we did not need much support. I 

think the fact that we had limited staff entering data into ETO played a role in not requiring 

much support. When we did have questions or run into problems, support was readily 

available.

• Professional development provided was just the right amount. Technical support in the 

traditional sense as help desk support was not enough. It was often completed later than 

expected. Additional help desk support with administrator capabilities would have been 

helpful on this project.

• Its actually a mixed answer, the 1st half of the study I feel we didn't get the support and 

direction we needed. after staffing changes I feel this improved greatly and was happy with 

the TA we received.

FCMS

• All assistance needed with ETO was provided.

• I was involved for such a short time that I am not really sure.

• I'm not a personal fan of the ETO software but I do feel that we received quick responses 

from UW when we had technical difficulties with it.

• It was difficult to get the amount of support we all needed for a system that has so very 

many issues and is so not user-friendly.

• Maya has been very helpful with troubleshooting difficulties and updates with ETO.

• Maya was extremely helpful with ETO updates and technical support. I know ETO had 

many issues during the duration of this program and Maya helped try and mend some of 

those issues. Unfortunately I think there were too many issues with ETO for Maya to always 

be able to fix, but she helped endlessly with updates.

• This question is also difficult to answer. Honestly, I do not feel that ETO was set up to 

handle the information we put in it. ETO was constantly having issues- scoring incorrectly, 

missing questions, adding questions and even taking data entered for one client and 

randomly placing it in another client's touchpoint. These inconsistencies along with ETO 

being far from user friendly concern me in terms of the validity of our project. However, 

Maya has always been receptive and helpful with our ETO issues. Maya is hardworking, a 

genius when it comes to ETO and very easy to talk with. She is the best we could have 

hoped for and yet still not enough to handle all the issues ETO has to offer (which has me 

convinced that no one is).

• We got more than enough support for using ETO. Data was saved in easy and accessible 

steps, it backed up information, and updated data entry. We were able to contact technical 

support, record E-Ticket, email team leaders for problem-solving, or delete incorrect data

• We have always had support for ETO available to us. The issue was that there have been 

on-going changes and issues with ETO throughout the course of the study, which has taken 

a lot of time to adjust. There have been several times when a ticket and/or email for tech 

support was requested and not answered until asked several times. This was more 

prevalent during the transition of UW staff and early in the study, however it has occurred in 

more recent months as well. While it is known that we can ask for support, and it is 

provided, there are delays which can impact our work as we move on with our other 

participants, having the simular ETO issues.

DCS

• When there was a problem during our usage of ETO and additional technical problems we 

were able to get it figured out.

• Our issues were always acknowledged and support and assistance was always provided.

(FCMS, Managers)

8. How much clinical support did your agency receive for implementing the Family Checkup 

Model and working with clients? 
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How much clinical support did your agency 

receive for implementing the Family Checkup 

Model and working with clients? Manager (N=7) FCMS (N=13)

More than enough support 2 (29%) 3 (23%)

Just the right amount of support 4 (57%) 8 (62%)

Not enough support 1 (14%) 2 (15%)

8a. Please explain your answer and provide any comments about any additional support 

that would have been helpful.

Manager

• Both FCMS's felt very supported by Chris. Whenever we had questions, he was quick to 

respond and very helpful. I had a difficult time with uploading the staff's videos during the 

certification process, and Chris & the tech support at ASU were very supportive in resolving 

the problem.

• Chris was a good support to staff.

• More than enough in person and virtual training was provided for this project. Additionally, 

clinical support was available whenever needed - whether by phone, email or in person.

• The Learning Communities were helpful. Being able to discuss a case was helpful for a lot 

of our staff, but because we worked with a very specific community, some of the cases 

didn't relate as well to who we may have been working with at the time. That doesn't mean 

that the information and working with the rest of the network wasn't helpful and beneficial. I 

remember us having to do some of our own detective work to come up with resources and 

materials that fit our clients specific needs. While I feel that the FCMS did get enough 

support, I do not feel as though the DCS were supported as well as they should've been. I 

know there was a lot of discussion around how the DCS should interact with clients and 

what resources they should be providing families. I believe that the DCS should've been 

more involved in our learning communities from the very beginning as they were still 

supposed to give appropriate resources and referrals, just without the follow-up using the 

FCM model. Many times our DCS would end up connecting with our FCMS on a needed 

resource.

• Trainings on the clinical side of things came very late in the game. Attending for example 

the motivational interviewing training only in the third year of the project seems really late. 

In order to make it a robust part of the routine interactions with the clients, trainings such as 

these should've been implemented before the start of the project or at least before starting 

to work with clients.

• Chris was great

FCMS

• Additional clinical support is always something I would never say would hurt a program. I 

think between other agencies and our learning communities, we had a lot of support during 

this program.

• All assistance needed was provided

• I was involved for such a short time that I am not really sure.

• I would implement the family checkup model by following the steps it showed, during 

interviews, I would use it, and then I would enter the data in ETO. By doing so it would give 

me a graph that shows me which areas I needed to focus the most on.

• My supervisor has been very helpful in working with me during preparation of case 

conceptualizations and finding resources for clients, and giving me tips for doing feedbacks 

with intervention participants.

• Our SIF meetings once a month are very beneficial and Chris has been more than open to 

answer questions (and continue to check for our understanding) of the model. I feel that we 
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were appropriately prepared and taught about any changes prior to them occurring. Kim 

has been great at helping trickle this information to us as well.

• Our agency's main focus is substance abuse prevention services. Our Early Learning 

Communities (ELC) department makes up less than 5% of our entire staff. Although there 

was plenty of support WITHIN the department, I feel that there was very minimal support 

from the agency in general.

• Sometimes I was made to feel that nothing I ever did for my families was the correct thing. 

That I should have done better. In my heart I know I worked hard for all of my families.

• Though our team had the benefit of getting support through monthly learning communities 

and our own agency's monthly Reflective Supervision meetings; I felt that my team and I 

could've used one-on-one clinical support with our more difficult clients. I found that my 

colleagues and I often ended up turning to each other for support, which was fine enough, 

but having a trained clinical professional available would have been very helpful. For future 

programs like this, it would be helpful to have a larger focus on discussing, training, and 

supporting the clinical nature of our work to prepare home visitors.

• We had many learning opportunities during the learning community meetings and outside of 

them that supported our work such as the mental health first aid, motivational interviewing 

skills, ASQ-training and attending many infants toddlers conferences.

9. How much evaluation support did your agency receive?

How much evaluation support did your 

agency receive? Manager (N=7) FCMS (N=13)

More than enough support 0 (0%) 3 (23%)

Just the right amount of support 7 (100%) 9 (69%)

Not enough support 0 (0%) 1 (8%)

9a. Please explain your answer and provide any comments about any additional support 

that would have been helpful.

Manager

• Evaluation support available quarterly and when needed by email was just enough. The 

team appreciated being included in discussions with evaluators.

• I didn't quite understand the need for the reports with agency data removed, but maybe that 

was helpful more in the beginning or middle of the study, before I came on board?

• I'm not exactly sure as to what "evaluation support" entails, but I do believe that support 

was provided if it was really needed. More support was needed at the beginning of the 

project than at the end. If we had questions about a specific survey, the question 

sometimes was put off until we could meet together as a network to discuss it. That wasn't 

always helpful right away. Towards the end of the project we still weren't clear on if certain 

touchpoints in ETO were needed to be completed by FCMS, DCS, or both.

• The Philliber team was available as needed to answer questions.

• The evaluation team has always been quick to respond to questions and concerns. During 

our periodic calls or meetings the staff has always felt heard & understood by everyone. 

The reports that we get are very helpful for monitoring. When we experienced the situation 

where we needed to use the Certificate of Confidentiality, the evaluation team & UWSEM 

staff were incredibly supportive and provided us with the answers we needed within a short 

amount of time.

• We did not have many issues, and most circled around miss communication

FCMS

• All assistance needed was provided.
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• During this period we would have evaluators from Phillibers come and evaluate our work 

and give us the result and number of our work and see where our weaknesses and 

strengths are.

• I think a manager would be able to better answer this question, but I do know that we would 

receive updates on how we were doing and where we needed to work within this program.

• I was involved for such a short time that I am not really sure.

• It's been a while, but I don't remember having inadequate support in learning how to 

evaluate.

• See response to 8a. (Our agency's main focus is substance abuse prevention services. Our 

Early Learning Communities (ELC) department makes up less than 5% of our entire staff. 

Although there was plenty of support WITHIN the department, I feel that there was very 

minimal support from the agency in general.) 

• no comment.

ETO (FCMS, DCS (add N/A to Q 10 for DCS only), and Managers)

10. Rate how useful ETO was for:

Rate how useful ETO was for

preparing feedback Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 0 (0%) 2 (15%) 0 (0%)

Somewhat useful 3 (43%) 2 (15%) 2 (40%)

Not very useful 3 (43%) 4 (31%) 0 (0%)

Not at all useful 1 (14%) 5 (39%) 3 (60%)

Rate how useful ETO was for

monitoring progress of families Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 0 (0%) 2 (15%) 0 (0%)

Somewhat useful 4 (57%) 4 (31%) 3 (60%)

Not very useful 3 (43%) 3 (23%) 1 (20%)

Not at all useful 0 (0%) 4 (31%) 1 (20%)

Rate how useful ETO was for looking 

at agency level data Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 0 (0%) 2 (15%) 1 (20%)

Somewhat useful 2 (29%) 4 (31%) 2 (40%)

Not very useful 4 (57%) 3 (23%) 1 (20%)

Not at all useful 1 (14%) 4 (31%) 1 (20%)

Rate how useful ETO was for tracking 

follow-up dates Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 0 (0%) 3 (23%) 1 (20%)

Somewhat useful 2 (29%) 2 (15%) 2 (40%)

Not very useful 5 (71%) 3 (23%) 1 (20%)

Not at all useful 0 (0%) 5 (39%) 1 (20%)

10e. What were your agency’s biggest challenges with ETO?

Manager

• As a manager, I didn't prepare feedback, monitor progress of families, or track follow-up 

dates so those answers (above) are based on what I heard from our team. In the beginning, 

the scores were oftentimes incorrect on the feedback form, so handscoring was essential 

and therefore ETO was basically useless. This was probably our biggest challenge as it 
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added time spent on each case. I personally never looked at agency level-data from ETO 

because of the way it ended-up being formatted in Excel and half the time it never 

downloaded correctly anyways. I had created my own spread sheet before the information 

was available on ETO, so I just kept using my own personal spreadsheet to type in notes, 

collect dates and check incentive information.

• ETO entries would disappear or show up connected with other families. Various mixing up 

of results and family members. Incorrect results based on answers (caseworkers will I'm 

sure speak more to this). We didn't really use it for any data analysis or tracking; we kept a 

separate excel internally that was much more user-friendly.

• ETO had many issues over the years, but not being able to see data that had been entered 

or easily run reports would be two of the bigger issues.

• Our biggest challenge was with utilizing the feedback forms in ETO. We continuously had 

difficulties with be able to run them, and when we could they were frequently wrong. Our 

FCMS's switched to hand scoring very early on in the project, which took a great deal of 

time away from their work with families.

• Reports did not adequately produce the intended data.

• Reports not populating meaningful data.

• Inaccurate data.

FCMS

• Always found that hand scoring was most beneficial due to ETO having issues with scoring 

correctly in the beginning.

• As a DCS, I've often run into the issue of ETO running blank feedback forms for 

comparison participants.

• Everything

• I know there were issues with information not saving in ETO, there were assessment 

counting issues, feedback preparation form issues, and issues with needing to skip 

assessments but not being able to.

• I rated not at all useful because I did not count on ETO. I used ETO only to enter 

assessments. the ETO was not able to generate a feedback form for FCMS. I used an 

excel sheet that I created in the beginning of the study that helped me tracking my families 

timelines.

• It was not user friendly at all. It was not useful for preparing feedbacks, monitoring 

progress, nor looking at data because I never found the scoring to be accurate. All prep 

and progress monitoring has had to be by hand to ensure accuracy, which makes ETO 

essentially useless. And it was never useful for tracking follow-up dates because you have 

to sign on and search where those were listed anyway- my calendar was much more useful 

for that. The way that many of the touch-points were built in, there was a big lack of easeof-entry which encourages human error; repeated incorrect numbering, missing options, 

repeated questions. Also, the lack of ability to edit touch-points myself has been a major 

hassle in correcting errors correctly. The frequent glitching has of course, added to the 

challenges we've been facing; error messages, swapping client data, and showing our data 

entry pages so differently than those built so our ETO support is unable to help us without 

screenshots provided to them so they know what we're talking about. And these are just the 

few I can think of now.

• It wasn't accurate. Everything had to be hand scored too, so I thought it was useless.

• Our agency's biggest challenge with ETO was the issue of deleting mistakes. It would take 

time to delete as you have to go to supervisors or team leaders for it to be deleted.

• Preparing Feedback: For DCS there were several issues with generating the feedback 

which was crucial for preparation and delivery of the information. Maya has helped us with 

this, but it has occurred often. For FCMS, we did not use the ETO feedback form because 

the answers did not appear accurate compared to the hand scored version.
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• The time-outs while entering data, the fact that we couldn't enter assessments directly into 

the software (we had to write in on a hard copy and then transfer it at another time), the fact 

that it only operates on Internet Explorer (which is slow on most newer computers)

• We never used it to prepare for feedbacks because it either did not work or was incorrect. 

We never trusted the scoring in ETO and did it on our own. I think I can remember three or 

four times ETO scored correctly on one of my client's assessments. ETO had glitches like 

taking the emergency contact on one client's participant intake and putting it on other 

client's participant intakes after they had previously been entered correctly (that terrifies 

me- not only could a lot of our data be incorrect after it was entered correctly, but also in 

terms of client confidentiality). ETO was not user friendly- often very slow and unable to 

handle our big assessments in one touchpoint. For example, there is a lot of extra room for 

error for the ASQ-3s because we have to enter the date, month of ASQ and interval for 

each section instead of just once. Also, having to enter the date multiple times for each 

touchpoint has left more room for error.

DCS

• How it often changes. The forms sometimes can be complicated with information that is not 

needed.

• Preparing feedbacks

• The data has been switching- the program is creating internal validity issues.

• The efficiency of the site as far as entering in data and making changes, there were multiple 

steps and access points to do one task.

• We didn’t really have any.
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11. How often did you use the reports in ETO to better understand the families being served 

by your agency? 

How often did you use the reports in 

ETO to better understand the families 

being served by your agency? Manager (N=7) FCMS (N=13) DCS (N=5)

Very often 0 (0%) 2 (15%) 2 (40%)

Often 0 (0%) 0 (0%) 1 (20%)

Occasionally 4 (57%) 4 (31%) 1 (20%)

Never 3 (43%) 7 (54%) 1 (20%)

11a. Please explain your answer: 

Manager

• I personally never used this information and liked to manually check each touch point in 

ETO because I would have to go in and check the touch points any way to ensure that the 

scores were correct and that the questions were all entered correctly. I relied heavily on my 

team to keep my up-to-date on our families and any trends we saw in family needs.

• I tried occasionally.

• I would talk to my caseworkers to better understand the families.

• We had difficulty with running reports and getting accurate data, so this is not something I 

chose to utilize.

• We only pulled reports when looking for a very specific piece or when requested

FCMS

• Don't recall how to use this function

• I appreciated the data being reviewed and sent to us by Philliber for a condensed 

understanding of the needs. I relayed more on these reports more than ETO itself.

• I have personally not utilized these reports and obtain my data by hand scoring.

• I only used ETO reports for comparison participants in completing their feedbacks.

• I work with many clients and need to gain data and reports from ETO which shows me the 

family's progress, issues, and where to approach their goals. This means I use it a lot in 

order to fully understand where my clients are so I can help them the best I can.

• The reports almost never generated an accurate score so I never bothered to use it.

• The scoring isn't consistently accurate, so running reports seems like a waste of time.

DCS

• Due to being a DCS worker I was not able to access specifics of the families and interpret 

there results I was more so involved with the basics.

• I am not sure about the question- I never generated reports using any special functions. I 

just would go back and look at previous family profiles and assessments to see what 

changes had occurred between visits and to anticipate needs for upcoming visits.

• It was not an easy process to learn and navigate and understand the data inputted.
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Assessments

(FCMS, DCS (take g. PICCOLO off Q12 for DCS only), and Managers)

12. Rate how useful each assessment was in understanding the needs of the families you 

served: 

Rate how useful each assessment was 

in understanding the needs of the 

families you served: 

Family Profile Form Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 3 (43%) 12 (92%) 4 (80%)

Somewhat useful 4 (57%) 1 (8%) 1 (20%)

Not very useful 0 (0%) 0 (0%) 0 (0%)

Not at all useful 0 (0%) 0 (0%) 0 (0%)

ASSM Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 3 (43%) 7 (54%) 1 (20%)

Somewhat useful 4 (57%) 2 (15%) 2 (40%)

Not very useful 0 (0%) 3 (23%) 0 (0%)

Not at all useful 0 (0%) 1 (8%) 2 (40%)

Temperament Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 0 (0%) 3 (23%) 2 (40%)

Somewhat useful 1 (14%) 3 (23%) 1 (20%)

Not very useful 5 (72%) 5 (39%) 2 (40%)

Not at all useful 1 (14%) 2 (15%) 0 (0%)

ASQ-3 Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 4 (57%) 12 (92%) 3 (60%)

Somewhat useful 3 (43%) 1 (8%) 2 (40%)

Not very useful 0 (0%) 0 (0%) 0 (0%)

Not at all useful 0 (0%) 0 (0%) 0 (0%)

ASQ: Social Emotional Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 4 (57%) 11 (85%) 3 (60%)

Somewhat useful 2 (29%) 2 (15%) 2 (40%)

Not very useful 1 (14%) 0 (0%) 0 (0%)

Not at all useful 0 (0%) 0 (0%) 0 (0%)

Feeding Your Child Manager (N=7) FCMS (N=13) DCS (N=5)

Very useful 1 (14%) 4 (31%) 2 (40%)

Somewhat useful 1 (14%) 3 (23%) 1 (20%)

Not very useful 5 (72%) 3 (23%) 2 (40%)

Not at all useful 0 (0%) 3 (23%) 0 (0%)

PICCOLO Manager (N=7) FCMS (N=13) -- 

Very useful 1 (14%) 8 (61%) -- 

Somewhat useful 6 (86%) 4 (31%) -- 

Not very useful 0 (0%) 1 (8%) -- 

Not at all useful 0 (0%) 0 (0%) -- 
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13. Are there areas of family functioning or child development that were not assessed that 

you think should have been assessed? (FCMS and Managers)

Are there areas of family functioning or child 

development that were not assessed that you 

think should have been assessed? Manager (N=7) FCMS (N=13)

No 6 (86%) 6 (46%)

Yes 1 (14%) 7 (54%)

13a. If yes, please elaborate: 

Manager

• I believe that we captured a lot of good data using the surveys listed above. The FPF was 

redundant most of the time for follow-ups.

FCMS

• Although I think the ASQ's were a great resources, I do not think it went in depth enough to 

truly evaluate the child development in sections such as communication or personal social.

• If there were multiple children under age 5, it was almost as if their needs were ignored. 

Quite often the youngest child wasn't the one the parents were struggling with (in all areas, 

child development, social emotional skills, eating habits, physical or mental health 

concerns, etc).

• More in depth assessments on parent mental health and stress levels and its impact on 

child development.

• Safe Sleep and Car Seat Safety

• Self care of parents. I know many of the families I worked with were single-parent 

households. I think that adding a brief questionnaire about self care may be useful because 

it allows that conversation to naturally flow. Many single parents are just burned out 

because they don't do anything for themselves. I would also have liked to see a topic on 

credit history. One of the barriers I saw for some families was the inability to get better 

housing and/or transportation due to poor credit. Asking these questions may be able to 

allow the FCMS to explore some credit counseling with them.

• Some sort of past trauma history could've been helpful; but of course there can be major 

limitations in asking someone to discuss such topics with a stranger. Maybe in future 

programs, that could be done after a handful of visits, just to help the provider get a better 

idea of their clients' life experience.

• There are tons of aspects of family life that are not addressed in the family profile. Often 

times explanations from families about why they answered a certain way (outside factors in 

their lives) totally changed my scoring. However, the family profile covers a lot of bases and 

easily opens the conversation with clients to talk about some of these situations that are 

often very specific to them and their family.

14. How would you describe the length of the assessment process? (FCMS, DCS, and 

Managers)

How would you describe the length of 

the assessment process? Manager (N=7) FCMS (N=13) DCS (N=5)

Too long 5 (71%) 8 (62%) 3 (60%)

About right 2 (29%) 5 (38%) 2 (40%)

Too short 0 (0%) 0 (0%) 0 (0%)
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Implementation of the Family Checkup Model

15. How often did you use the motivational interviewing techniques that were taught in 

training? (FCMS) 

 Very often 3 (23%)

 Often 10 (77%)

 Occasionally 0 (0%)

 Never 0 (0%)

15a. Please give an example of how you used them:

• Emphasis on families' strengths

• Everytime I would talk to parents about potential help needed with child development or tips 

on parenting skills.

• In helping clients explore setting their goals and during goals check-ins, in addition to using 

some MI during many other interactions.

• It was very hard in the beginning to elicit some change talk but with practice and 

understanding the characteristics of the community we work with gave us some insights 

how we want to use the MI. for example, some parents believe it’s normal for a child to 

sleep at midnight, why not, the child does not go school. So, using MI helped them 

acknowledge how important to change and made feel they empowered, supported, 

understood, and respected.

• Many of the parents I worked with were resistant to change or didn't believe they were 

capable of changing. I used many of the MI techniques in these two scenarios specifically.

• Motivational interviewing occurred most frequently for me with clients when they made 

opposing statements about their want to achieve something. Motivational interviewing was 

also very beneficial to gage a client's motivation that I may not have otherwise gaged 

correctly (and I definitely think it helped to make their motivations or lack of more clear to 

themselves)

• The Motivational Interviewing training was extremely helpful for our team! We used them in 

every FCMS feedback and I use them in supervision with staff.

• Using Empathy and Reflective Listening through my visits.

• When parents have an area of need that they are not ready to change (i.e. such as getting 

help for a health-related issue, making repairs in the home, continuing education, etc.) I use 

reflective listening and open ended questions taught during the MI Training in order to 

engage parents and talk about needed areas of change, and then set goals with them.

• When talking to my clients in interviews in order for them to be more comfortable I would 

use motivational techniques. One I would use most is expressing empathy when listening to 

my clients, rather than imposing and joining the conversation, I would allow my clients to 

speak and I would listen. This encouraged them to speak more in the interview and thus, 

would allow me to work better towards them.

16. How often did families set goals during the feedback session? (FCMS) 

 Very often 10 (77%)

 Often 2 (15%)

 Occasionally 1 (8%)

 Never 0 (0%)

17. How often did families make progress towards reaching those goals? (FCMS) 

 Very often 0 (0%)

 Often 9 (69%)
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 Occasionally 4 (31%)

 Never 0 (0%)

17a. What were the biggest barriers that families experienced in trying to reach their goals?

• Creating goals that are too broad and not specific enough to be able to complete in that 

period of time.

• Finances, income, lack of transportation and stress.

• I think many of them set too high of a goal that was just impossible to complete in such a 

short period of time. For instance, I had one parent that set a goal of getting her PhD and 

she didn't even have a high school diploma or GED....

• Lack of time, support, transportation, confidence, etc. Also, sometimes the goals that they 

had thought were attainable turned into something that felt intimidating and unrealistic; or 

they just lost steam or changed their mind.

• Not being motivated to do so. More often than not, clients who did not complete their goals 

did not seem very interested in setting them from the start.

• Some of the goals were too broad. It got better once we did the SMART goal training and 

changed the goals to be done in steps, counting progress in the goal as steps verses the 

entire goal itself. An example is: Enroll in a CNA program. The step would be to call, talk to 

an advisor, and apply. They were more likely to reach a step that the entire enrollment in 6 

months when they have several other commitments. The biggest barrier is a lack of 

transportation, child care, and confidence. When participants met their goals, they were 

very proud of themselves. When unable, they felt like they needed to provide a reason for it, 

though not requested by the FCMS. I believe that the majority of the barrier is a lack of 

confidence in their own support network, that others are willing to help them, and that they 

can do what it takes to accomplish their goals. Perhaps having a bit more follow up from the 

FMCS would have been beneficial, however with the caseload, it was near impossible to 

provide that type of case management.

• The biggest barriers that families experienced in trying to reach their goals were time 

management on their goals, such as how long does it take to potty train, how long should 

one nurse a child.

• Transportation English language

• Transportation, financial difficulty, lack of support

• Transportation, motivation, education

18. How difficult was it to find referrals for families in the following categories? (FCMS)

How difficult was it to find 

referrals for families in the 

following categories?

Very 

difficult

Somewhat 

difficult

Not very 

difficult

Not at all 

difficult

a. Housing 6 (46%) 5 (39%) 2 (15%) 0 (0%)

b. Income 4 (31%) 7 (54%) 2 (15%) 0 (0%)

c. Food 0 (0%) 2 (15%) 4 (31%) 7 (54%)

d. Adult Education 0 (0%) 6 (46%) 2 (15%) 5 (39%)

e. Employment 0 (0%) 0 (77%) 2 (15%) 1 (8%)

f. Transportation 9 (69%) 2 (15%) 1 (8%) 1 (8%)

g. Healthcare 1 (8%) 3 (23%) 5 (38%) 4 (31%)

h. Safety 2 (15%) 4 (31%) 3 (23%) 4 (31%)

i. Life skills 2(15%) 2 (15%) 2 (15%) 7 (55%)

j. Childcare 4 (31%) 6 (46%) 1 (8%) 2 (15%)

k. Parenting skills 0 (0%) 2 (15%) 4 (31%) 7 (54%)
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l. Children’s education 0 (0%) 1 (8%) 6 (46%) 6 (46%)

m. Family/social relations 1 (8%) 5 (38%) 6 (46%) 1 (8%)

n. Community involvement 1 (8%) 2 (15%) 6 (46%) 4 (31%)

o. Mental health 0 (0%) 1 (8%) 8 (62%) 4 (30%)

p. Substance abuse 0 (0%) 1 (8%) 4 (30%) 8 (62%)

q. Disabilities 1 (8%) 2 (15%) 6 (46%) 4 (31%)

r. Legal 0 (0%) 4 (31%) 6 (46%) 3 (23%)
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19. Were there any services that families needed for which you did not have a referral 

source? (FCMS) 

 No 7(54%)

 Yes 6 (46%)

19a. If yes, please describe: 

• Car insurance/car repair

• Childcare, health care, and transportation were the hardest sections to find referrals for.

• Free or discounted dental referral. Even if I find a referral for them the copay is very 

expensive for participants. Car seats, we encountered that even if there’s a training about 

car seats and they will distribute a car seat for parents, our parents were not allowed to 

attend those meeting because of their English language. They were allowed to bring an 

interpreter with them although our organization offered to provide interpretation services so 

parents can get a car seat. Transportation: They don’t have problem with obtaining the 

permit, we gave them the materials to study, they apply, and then they obtain the permit but 

then they face the challenge that cannot afford to pay the fee $35 per hour to practice 

driving in the road. They need at least 12 hours to practice so, some permits end up 

expired.

• There is some help out there for housing, transportation, income, employment, childcare, 

etc- BUT many of those resources are very limited or very difficult to navigate and therefore 

not useful to many of my clients.

• Transportation and immigration

20. What do you think families liked most about the program?(FCMS and Managers)

Manager

• I believe families liked the relationships aspect of the program the best. They trusted 

someone enough to divulge their family's information and their worries. The majority of our 

families reached out to their FCMS between the scheduled 6 month assessment time 

period to ask questions and get additional resources and referrals. Without that relationship, 

families wouldn't have felt comfortable doing so.

• I'm not the best person to answer this, but I would think they liked learning about the 

features of their family and child and then getting resources and referrals to address 

anything necessary. Everyone has a general understanding of their family and kids, I'm 

sure, but I doubt anyone delves this deep into it independently. Having that outside 

perspective and support to make changes I would think was nice.

• It seemed to be that families really enjoyed the relationships that they were able to develop 

with staff. We frequently had families calling staff to check in and even stopping in the office 

just to say hello. Families also seemed to take pride in showing the progress they made on 

their goals. Even the little accomplishments were shared between assessment sessions.

• The feedback we received from families was that they felt very supported by their 

specialists and appreciated the help in finding resources that met their needs.

• The incentive and having an engaged FCMS.

• The interaction with a service provider.

• Money, useful items, and useful and accessible resources

FCMS

• Being able to track their progress in terms of self-sufficiency and goals they have set from 

their initial feedback to their 6 month (and sometimes 12 month), as well as learning about 

helpful resources in their community that they otherwise not would have known about. 
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Additionally, I think setting goals for families that were in the intervention group gave them a 

sense of something to look forward to and increased their motivation to become more selfsufficient.

• Compensation for some. Others enjoyed the support provided by the worker

• Getting their gift cards, definitely. But many families also expressed appreciation for the 

one-on-one support provided by having a FCMS focused on your needs. Many parents 

expressed that they enjoyed just having someone to talk to for a bit, as well.

• Having a supportive, listening ear and a $50 gift card.

• Having someone come in and provide the family with tips, tricks, and resources to help the 

family in a variety of ways. Families also liked to see the child development changes from 

the baseline to the 6 months.

• I think families liked most about the program is that they became more aware of themselves 

and their position in their own lives, whether that be as parents, sisters, brother, or more. 

Allowing them to see their weaknesses, or where they need to pay more attention to 

themselves and everyone around them. They understandably became better and more 

educated versions of themselves thanks to this program.

• Of course, the gift card. But other than that, most of my families said that they enjoyed 

having me as their worker. They said that I "opened their eyes" to a lot of different things in 

regards to their child's development and their parenting skills. Most families found the 

resources and referrals I provided to them very helpful.

• Resources

• Resources

• Setting goals and seeing their progress

• The gift card.

• The reflective and strength based approach.

• The relationship we built in this project with them . The open communication. The referral to 

go to ask for help, to raise a concern, or share a success.

21. What do you think families liked least about the program?(FCMS and Managers) 

Manager

• Hearing some results if they weren't so great, especially about their child. Sometimes 

parents tend to be in denial. Also another thing that was always tricky was the culturally 

sensitive questions like about addiction and mental illness. Those are taboo in the 

community, so asking and answering those was probably uncomfortable.

• I believe the families felt that a lot of the information was rather personal. This was the most 

difficult part about the 1st session - having parents understand the need for ALL of the 

information in order to help their child. It was also a long process. Assessment sessions 

happened over multiple periods some of the time.

• Length between check ins. FCMS not having much time to support family. During the 

recruitment and enrollment period the focus was on meeting numbers more than anything.

• The length of assessments.

• The length of the surveys.

• The most common complaint that we received about the program was the frequency of 

assessment sessions and duration of the program. The majority of our families wanted to 

see their FCMS in person more often. Almost all of our families were sad to have to stop 

working with their FCMS once they completed their final session.

• The time commitment, length of feedback
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FCMS

• Depends on the family. Some families were doing well and were over talking about 

assessments (and completing them). Other families were merely participating for the $50 

and did not like spending the time to honestly complete assessments. I would assume a lot 

of "not liking the program" came from the length of assessments and the inability for us to 

always provide a helpful resource for their needs.

• Having to answer questions about sensitive/personal topics

• I think some families would have benefitted from completing their feedback the same way 

participants in the comparison group receive feedback, while some parents liked the 

thoroughness of the FCMS model, I felt like there were families that disliked it and found it 

to be too time-consuming.

• If they reached out for a referral and there were not very many that we could provide or 

referrals that were just not helpful enough in that section. Also during the 6 months of not as 

much contact, I had families who would have rathered keep physical in person check in 

visits to keep them on track and keep it easier to not lose contact.

• Length/amount of assessments

• Nothing

• Takings with family

• The length of the questions for sure. Some families also didn't like the time frame between 

the visits. I've also had a few participants say that the questions are sort of annoying 

because they're repetitive.

• The time commitment, definitely. For many parents, it seemed that scheduling and 

completing visits was sometimes very burdensome to their already full schedule and it was 

also the most common reason provided for those clients who dropped out. Also, some 

families expressed being uneasy with the personal nature of some of the assessments.

• There were situations where they had to be uncomfortable in order to give us answers, 

such as problems with abuse, their income, and more. Although we did not press them for 

these answers they are in a situation where they are uncomfortable and awkward, that is 

what I think they did not like about this program

• They were promised services they would never receive. Each case manager was so busy 

trying to meet their deadlines and recruiting participants in order to meet their numbers that 

they were unable to provide any case management services. The initial assessment took 

way too long. We were basically harassing anyone who didn't answer their phone for 6 or 

12 month check ups. People told us they no longer wanted to participate but we were told 

to still call them.

• Time Commitment

• When they have the referral but still they cannot benefit from it because other challenges 

arise such transportation or extra fee to pay.

Lessons learned about the FCU and its usefulness for families

22. What do you think were the three biggest needs of the families that your agency served 

through this project? (FCMS and Managers) (Check the top three)

What do you think were the three biggest 

needs of the families that your agency served 

through this project? Manager (N=7) FCMS (N=13)

Housing 3 (43%) 6 (46%)

Income 4 (57%) 7 (54%)
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Food 3 (43%) 4 (31%)

Adult Education 1 (14%) 5 (38%)

Employment 1 (14%) 1 (8%)

Transportation 2 (29%) 6 (46%)

Healthcare 0 (0%) 0 (0%)

Safety 0 (0%) 0 (0%)

Life skills 0 (0%) 0 (0%)

Childcare 1 (14%) 6 (46%)

Parenting skills 4 (57%) 2 (15%)

Children’s education 1 (14%) 1 (8%)

Family/social relations 1 (14%) 1 (8%)

Community involvement 0 (0%) 0 (0%)

Mental health 0 (0%) 0 (0%)

Substance abuse 0 (0%) 0 (0%)

Disabilities 0 (0%) 0 (0%)

Legal 0 (0%) 0 (0%)

23. What were the most beneficial things from the Manager/FCMS/DCS meetings? (FCMS, 

DCS, and Managers)

(check all that apply)

What were the most beneficial things 

from the Manager/FCMS/DCS 

meetings? Manager (N=7) FCMS (N=13) DCS (N=5)

Clinical support and guidance 3 (43%) 9 (69%) 3 (60%)

Training 1 (14%) 8 (62%) 3 (60%)

Case Presentations 3 (43%) 10 (77%) 1 (20%)

Technical Assistance 2 (29%) 4 (31%) 2 (40%)

Hearing from other agencies 7 (100%) 8 (62%) 4 (80%)

Updates from UWSEM 5 (71%) 6 (46%) 4 (80%)

Other 0 (0%) 0 (0%) 1 (20%)

Note: Other - Always willing to listen and find better alternatives, easier solutions, find a plan.

23a. Please list specific trainings or other specific meeting activities that were especially 

helpful and explain why they were helpful. 

Manager 

• I think that the discussions in general during the Manager's Meetings were incredibly helpful. 

The staff & clients at each agency are so diverse, so being able to hear what was successful or 

not at different agencies was beneficial.

• Managers meetings were beneficial to check in with partnering agencies to ensure all agencies 

were delivering programming consistently, and if not, it would be highlighted at these 

meetings.

• Motivational Interviewing

• Motivational Interviewing training because of the direct impact it had on the caseworkers' 

ability to engage participants. It should've been done earlier in the study. Also the case 

presentations were really helpful for sharing ideas and resources. Talking through what 

different assessments and questions really are getting a was also helpful.

• Motivational interviewing training at U of M was very helpful.
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• The case presentations were very helpful for the team as explained previously. I wish the DCS 

were also a part of this process.

• motivational interviewing

FCMS

• All case presentations I believe were helpful because it allowed for many different perspectives 

to come together to help someone in that case. It also almost always ended with resources 

given to one another that someone else might not have had before that presentation. Trainings 

on human trafficking, car seat safety, and many others allowed for me not only to learn more 

about the topic, but get specific resources given to me that I could keep and know of for future 

situations. All trauma trainings that were done were always helpful as well because of the 

clientele that we work with.

• All the training

• Being able to reflect on the challenges of the program and how others phrase certain topics 

was very helpful. For example, how to explain when someone is in RED because of their CPS 

involvement, but scored well in their other answers surrounding parenting. Topics of MI and 

SMART Goals were very beneficial.

• Case presentations- ideas for resources/referrals for issues which some of my families might 

be facing too

• FCMS community learning meeting each month with the entire SIF team. During these 

meetings, we were able to listen to others and we come together to solve an issue and give 

feedback and resources in order to be ready for feedback.

• I do not remember the specific trainings.

• I found the MI training to be helpful and I felt that the case presentations done at the meetings 

were helpful in learning about new resources for families as well as how to approach certain 

topics with families. I also felt that the FCMS and DCS meetings had good discussions for things 

that we may have had issues with during the course of the study.

• I think the case presentations were extremely helpful. When I presented my case, I was 

honestly lost and confused about what to do. But the whole team had so many additional 

support and resources available. It was really nice to be able to put our heads together and 

come up with solutions for families. I also loved hearing about other people's case 

presentations and helping out when I could.

• I took a mental health first aid training and it was fantastic. Would help anyone that works with 

people be more aware of mental health and questions to ask.

• Motivational Interviewing

• One of the most beneficial training that I got is the Motivational interviewing skills. it was very 

useful to me as I mentioned before, my credential background is education and I don’t use MI 

skills in depth like in therapy sessions or social work meetings, so MI skills helped me identify 

ambivalence and elicit change talk.

• The child abuse and neglect conference was very interesting and I feel that I learned a great 

deal.

• The motivational Interviewing trainings were helpful in providing useful clinical skills; it 

would've been more helpful to continue with the other MI trainings provided by U of M. The 

FCU trainings were of course helpful in setting a blue print for the FCU. 

DCS 

• Professional Development trainings that were applicable to the work we do, that we attended 

were very helpful. For example, the motivational interviewing trainings were very beneficial.

• The car seat training had a lot of information that I didn't know and had wondered about for a 

long time, and had actually searched for and wasn't able to find the answers.

• The trainings that were geared towards professional development such as the mental health 

first aid training were helpful.
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• N/A

• N/A

23b. What could have made the Manager/FCMS/DCS meetings more useful?

Manager 

• DCS meetings were never really useful. Putting the DCS with the FCMS would've been a much 

better use of time and more growth would've occurred as well.

• For awhile it felt like we were discussing the same issues repeatedly during the Manager's 

Meetings. It got discouraging that a decision was not being made and we were going in circles 

about the issues during the meetings. It would have been much more beneficial if there could 

have been a clear process on how to resolve certian issues and been given clear answers.

• Perhaps ask managers to complete a running list of items that are discussed during the month 

at there agency and share out in advance of the monthly SIF meeting.

• The manager meetings could have been more helpful if there was more concise direction.

• Less focus on case presentation towards the end, more focus on whats next, maybe more talk 

about proper methods of termination or transition for clients

• N/A

FCMS

• Cannot think of anything.

• I don’t know

• I enjoyed when the Manager Meetings were after the FCMS and DCS meetings, as those two 

meetings often gave us more to talk about. If there were big changes to announce to all 

FCMS/DCS, United Way could have sent out a quick email to managers to notify them prior to 

the meeting, allowing us to think through questions ahead of time. I believe the FCMS meetings 

should have been extended to 1 1/2 hour, as we were often short on time and had to rush 

through. For some, it takes an entire hour to get to the site of meeting, so to have a meeting the 

same length as a one way drive feels a bit wasteful of time. The DCS did not need to meet 

monthly, perhaps every other month, DCS often did not much to discuss and it often seemed 

unorganized, which allowed the meetings to revisit the same issues every time, causing 

confusion, which led to the DCS feeling unsupported. I appreciated the combination of groups 

when appropriate.

• I think more trainings would have been more helpful. I came towards the end of the project 

though so I could have missed a good amount of trainings. I also think that case presentations 

are super helpful, but when we do not have a case to present focusing on trainings or things 

going on in the world right now would have been helpful.

• I was not part of them.

• In my opinion, FCMS meetings were great and Chris always was a resourceful professional in 

those meetings.

• Maybe incorporating more "re-training" about topics that were taught about at the beginning 

of the project. Maybe a 10 mins discussion each meeting as a refresher about topics like setting 

goals, presenting feedbacks and correctly administering assessments. Tasks as simple as how 

to correctly determine whether a client has achieved a goal or is in progress at follow-ups 

would be beneficial. For example, as a project is it our protocol to continuing checking up on 

goals that are already achieved? If a client sets a goal to do something weekly and they do so at 

the first check-in is that considered achieved or in progress? These topics can seem relatively 

simple, but I think it is always great to continue checking in as a project to insure data is being 

obtained and entered the same across agencies.

• More efficient training could have made the Manager/FCMS/DCS meetings more useful.

• No comment.

• Not having separate meetings for FCMS and DCS
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• Nothing

• The Learning communities are already very helpful, but maybe adding in some more reflective, 

clinical support could be make them even better.

• Timing. I always thought it was weird that the FCMS meeting was only one hour long. 1.5-2 

hours would have been a little better in order to feel a little less rushed. Also, why do DCS 

have their own meeting????

DCS 

• Faster solutions to technology problems. Felt like we circled around similar problems a lot at 

meetings.

• For a couple of meetings, we spent some time going over the same issues, and the group had a 

difficult time moving on to the next topic for too long.

• Having one on one training with each other.

• Having the meetings more specific to the tasks at hand. I believe because every agency was 

handling the study in a slightly different manner the meetings often became repetitive and 

confusing because issues and concerns would be brought up and discussed at great length but 

without any solution.

• N/A

24. What were the major challenges of the project?(FCMS, DCS, Managers) 

Manager

• ETO was a challenge and all the changes that were made along the way to the project. 

Every couple of months I feel that there was something new we had to complete, or a 

different way of completing our tasks. The project was never consistent. It was definitely 

good to tailor the project as we see need to do so, but maybe those changes could've taken 

place in stages instead of making changes and adding tasks all the time. An example of this 

is staff training. It changed from the beginning of the project to the end (And I'm not sure 

why). Another challenge was dealing with the staff turnover. While this wasn't as big of a 

challenge for our agency in particular, as a network, it made the success of the project 

more difficult. Especially when trying to reach numbers, attrition rates, etc.

• Formatting of assessments in ETO and paper copies not aligned. Feedback forms and 

reports did not populate correctly.

• Recruitment was challenging at the beginning of the project. I think that because myself & 

the staff weren't comfortable with how to describe the program to families or how to 

highlight the benefits of participating, it really caused us to have slow recruitment for awhile. 

As we all came to have a better understanding of the project, this became less of a 

challenge. Another challenge we dealt with throughout the project was working with 

participants who spoke little or no English and not always having the staff to support that 

need. Translating some of the forms was difficult and assessment & feedback sessions 

were quite lengthy. It was very challenging with some families to gain their trust & get them 

to feel comfortable with letting us into their homes when we didn't speak their language. 

• Retention for most agencies; ACCESS is lucky to have such a tightly knit community and 

thus not much attrition. In the assessments, there was a lot of repetition and assessments 

took a long time, and I feel that reducing the repetition would've helped participants remain 

more easily engaged through the assessments at each round. Something specific for our 

clientele is that many of the goals of this study (engaging in kids' development and being an 

agent in one's life) are culturally foreign or removed for many immigrants in our area 

compared to the typical white American mindset. Changing that mindset for our clients was 

a lot of work.
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• There were too many moving pieces and guidance was constantly changing, which made it 

difficult to implement with fidelity. 

• Timeline changes ETO database

• Building the frame work as we ran it was particularly difficult. poor communication in the 

beginning. lack to UWSEM team members with clinical or front line experience.

FCMS

• Keeping clients engaged who have walls up or are feeling overburdened by the time 

commitment. - ETO. - The very large caseloads were not always manageable. Balancing 

our very large caseloads with the large amounts of paperwork, resource research, and data 

entry that was needed to support our very large caseloads was very difficult and at times 

overwhelming. - The lack of clinical training and support.

• ETO 

• Employee turn over rate, participants dropping out of the program.

• Helping families

• Losing contact with clients

• Mainly just getting in touch with participants, either to schedule 6 and 12 month follow ups 

or having them keep appointments. Many participants were difficult to get ahold of, 

especially as people change their address and phone number in the program quite often.

• Motivating some families to take action for their own independence (only a few of them 

though)

• Not having enough resources to meet the needs of clients. ETO. Feeling defeated when the 

only thing I could provide to a client is a listening ear.

• Overall, having direct answers would have been appreciated. Often, in any of the meetings 

held, our opinion on next steps of preference was requested, and then direction on a 

decision was not provided for at least another month. This caused a lot of frustrations by 

our staff. We appreciate that the study valued our opinions, but when there was such a 

variety of opinions, we just needed an answer on what the expectation was in order to 

proceed in a way that would be beneficial for our participants, and for the purpose of 

consistency of the study.

• Scheduling appointments, making first interviews, and signing the consent form were the 

major challenges of the project

• The project became so much about numbers that there wasn't time or energy left to put into 

actual services. The supervisor provided training in a different manner than was required 

for certification so it was difficult for people to know which way to do things. Participants 

and potential participants were essentially being harassed with phone calls from their 

assigned case manager. During the brief period I worked on the project, I felt more like a 

survey-taker than a case manager. I lost motivation to even do the surveys because all I 

was doing was collecting data. I didn't have the time to provide actual services to the 

people on my caseload because I had to try tracking down participants that weren't 

answering and going to recruiting events.

• Trying to schedule participants that live in the same area was difficult. Driving most of the 

day to see 3 or 4 people doesn't seem efficient. Maybe the county could have been broken 

up into areas so drive time could be less?

• With the project being broken up in 6 month intervals, it made it very easy for clients to fall 

out of contact with the worker. Something that myself and my clients thought would be a 

good idea is to still schedule in person check ins during those 6 months of not doing 

assessments. This keeps a good rapport with clients, as well as making it easier to keep in 
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contact and not lose touch. Another challenge was some of the assessments either asking 

too specific questions, or not having enough that would depict the true level of development 

for the child. I had families that the child was lacking in a certain aspect of child 

development, but because of the small amount of questions scored in the strength area.

DCS

• ETO was so inefficient that it put a lot of stress on me because of course, I spent a lot of 

time driving and seeing clients, and that program added so much time to the data entry 

that I didn't have enough time to complete my work. Another thing that added too much 

time too the workload was the detail of the communication logs requested at one point. I 

realize there was a study of those logs, but if I remember correctly I was having to 

document number of texts at each exchange, number of minutes each text took, what 

was said, amount of time driven to each home, number of miles, how long it took, both 

written and entered into ETO, and it was too much on top of what a DCS has to do.

• Having a better understanding of the population we was serving. Not enough resources 

to provide for families. Dividing the incentive payments. The ages of the children.

• Keeping a hold of some families.

• The comfort level of the parents responding to the Family Profile Form.

• The constant changes and inconsistency of the project towards the end, the difficultly it 

took to get ahold of the participants due to the longevity of the project.

25. What were the major successes of the project? ( FCMS, DCS, Managers) 

Manager

• All the families we met with were positively impacted in some way. Our team also learned a 

new and more beneficial way of completing case work and encouraging families. We 

learned how to work as a team.

• I think the biggest success of the project was the relationships that were developed 

between participants and staff. The project really allowed staff to take on a new role with 

the families in our community and develop more meaningful relationships with them. 

Watching the relationships develop over time and then seeing how that often translated into 

the families taking steps towards their goals or making improvements in their family wellbeing was so really exciting and said a lot about the importance of the project and the work 

we were doing.

• Meeting our enrollment goals and follow up completion, and seeing clients make real gains 

in progress towards life changing, beneficial advancements, providing a better of quality of 

life for their family.

• Supporting the families we served.

• Serving high number of families. Growth within families served.

• Witnessing increasing engagement from the clients and families in their kids' education and 

the family's personal goals. We were able to widen the world-view of many of our clients 

who took more control in their lives and were empowered to make their own decisions.

• Helping families and seeing them grow.

FCMS

• When clients were able to utilize a resource that I provided. - When clients expressed 

they're enjoyment/appreciation of the support provided by the FCU. - Providing clients with 

useful things that actually made a positive impact on their lives: gift cards, books, etc.

• A lot of data was collected.
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• Being able to connect families with resources in their community that were able to help 

them; resources that they may have otherwise not known about. Also just being a listening 

ear and support for families dealing with a lot of stress and that had a lot of needs.

• Being able to provide these clients with a wide range of resource options. Also seeing the 

differences between baseline to 6 months for the families was really helpful to allow them to 

see where they needed to work or where needed more resources to help make that a 

strength.

• Enrollment, it has been very exciting to work with so many different families throughout 

Wayne County. The experience gained is invaluable.

• Gaining good relationships with the families and follow up appointments were the major 

successes of the project.

• Give family resources

• Participants feeling supported and able to identify their own strengths when going through 

the Family Check Up Model.

• Seeing families set goals and reach them

• The awareness of referrals and resources available in the community for them when they 

need. Participants are advocating for children’s learning and more involved in children’s 

school activities. The great relationship between FCMS and participants. The relationship 

that never phased out even when they phased out the study, the connection stayed to 

share other successes participants make. Our retention rates. Participants trusted us to 

the extent that they helped us in recruiting their relatives and friends.

• The resources we provide to the families (the books and gift card especially).

• Watching clients become self-sufficient in obtaining their own resources. Breaking through 

boundaries and having clients open up to me. Feeling like a great support for clients. 

Watching clients find the motivation or opportunity to make small changes in their lives (i.e. 

getting a new job, going to see a counselor) and how these small changes affected them 

and the development of their children greatly.

• Watching clients grow.

DCS

• Completing assessments and meeting with families.

• Getting to know families and connect them with resources and having what I felt were a 

large number of families finishing and being happy with the project.

• Helping families, understanding the dynamic of the family, learning and educating yourself 

on the assessments, being able to go all the way through the program and the end process.

• Seeing the families flourish throughout and benefit from community resources.

• The resources, connections and aid we were able to provide with people in the community.

26. Please give us an example of a family you felt was really helped by the program. Please 

provide details about what needs the family had, how you worked with the family to meet 

those needs, and how the Family Checkup Model in particular was well suited to the family: 

(FCMS) 

• A family I worked with during the beginning of the Pandemic, needed food, food delivery, 

home medication delivery, assistance with obtaining food as the single parent was 

immunocompromised. I was able to assist her with all of the above needs. She was very 

thankful and grateful for the assistance and as far as I know is still receiving the assistance 

that I assisted in setting up.
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• A family that really benefited from the program was Client S. The reason why we dismissed 

the client S was due to the fact that she quit ELA due to not having any transportation which 

led to quitting SIF. Last week, I was calling all my clients dismissed or not due to Covid-19 

and me asking for their well-being and wanted to remind them of Access and how we are 

always there willing to help them during this hard time. This is when it all began- during the 

middle of the night, she called on WhatsApp and left me a voicemail which I only saw the 

next morning. Upon hearing her message I realized that Client S was in a terrible situation. 

Her husband lost her job, she has no bridge card that currently working since March. She 

was unable to pay rent and all other expenses. So right away after hearing this, I called her 

to try to fully understand the situation and how to help her. Right away I told her to reupload 

all the documents Social Services was asking for online and to call her caseworker right 

away. I also sent her the link to the unemployment resources so her husband could apply 

for unemployment and receive its benefits. I also reminded her to call United Way at 211 to 

get more resources or help in order so she could manage her monthly expenses more 

cordially. The reason why I helped her even though she was dismissed from SIF is that as a 

community I believe it is our duty to help everyone and anyone- especially during the 

pandemic crisis right now. So on Friday morning I received news that her food stamp is 

reopened and that her husband called the unemployment facilities and applied. I am very 

happy that I helped my client to the best of my abilities.

• A huge contribution of this project is the empowerment outcomes. Throughout feedback 

sessions, open communication, sharing success stories of other participants in the same 

community. Some participants took as if they can do, why I can’t do it despite the oldfashioned beliefs that are embedded in them. One of my participants saw success starts 

with determination. She was very determined to be self-sufficient by setting goals that lead 

to it. She was clear what exactly she wants despite of some beliefs and old-fashioneded 

thoughts towards work, driving, and be self-sufficiency. Participant is a mom, married, 

lives with her family because her husband is still overseas. In her baseline feedback, 

participant set a goal to study the driving materials and obtain the permit. I provided the 

study materials. She studied them, took the test and passed it. This was her first goal that 

she accomplished. Within the first six months, she kept practicing driving with her permit 

any time her father’s car was available. Six months feedback session, she set another goal 

to obtain a driving license, she applied, took the road test, and passed it. Now that she has 

her driver license, which was the first barrier to self-sufficiency, she set a third goal to work 

to be able to save money and buy a car. I referred her to ACCESS employment and 

training to find a job but one of the our participants told her about a bakery business that is 

hiring. she went, applied and, got hired. Now, she’s working and started saving money to 

buy her own car.

• Help family to CPS for her kids

• Honestly, not one specific family comes to mind when thinking about how the Family 

Checkup Model was particularly helpful. In many ways, I felt that providing support was 

more helpful to most families than the Model itself. I had many families that make great 

strides throughout the program but of all of those families I am thinking of right now, I 

strongly believe they would have made these strides without the program. However, this 

may be specific to me as I came onto the project late and had only a few clients that I 

started the project with.

• I do not think any of the families I worked with felt like they were helped. I do think the pilot 

families benefited. I worked with some of them in a different program and these families 

received services as they were intended.
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• I had a family in the intervention group that was homeless at the time of their initial 

assessment and living at a hotel. I was able to connect them with housing resources and 

they eventually worked with Salvation Army to help them find housing, as well as 

connecting them to resources for education, mental health, food, clothing and child 

development needs. The mother was also referred to my agencies in home parenting 

program where mom was able to set goals and a routine for her children once they had 

secured a home about a month after her initial assessment. I think just being a sense of 

emotional support, getting mom to set goals so that she would have something to work on 

and look forward to, as well as connecting her to resources to help her and her family get 

back on their feet were the most helpful parts of the model, pertaining to her participation in 

the program.

• I had a family that I presented in our FCMS team meeting. Mother was a 42 year old single 

mother with 6 children. The focus child was 2 years old. Mom was relatively self sufficient. 

Although she reported receiving financial assistance such as food stamps and reduced 

lunch for her children, she claimed that she was able to meet her family's basic needs. The 

parent's biggest barrier was poor parent/child interaction evident by her low parenting 

survey score and her low PICCOLO scores. During the feedback session, the parent 

admitted that she's heard all of these things before and felt as if people were personally 

attacking her and telling her everything she was doing wrong as a parent. Overall, the 

model allowed me to highlight her strengths as a parent (i.e. being a great provider to her 

kids even as a single parent) and briefly explore some of the challenges she faced. I think 

this model was specifically helpful to this family because it looks at the bigger picture 

instead of just focusing on the negatives, which many programs do. I was able to connect 

the parent with resources in her community such as parenting classes, mental health 

counseling for postpartum depression, and play and learn groups. One of the things I liked 

most was being able to talk about this family to the group because other agencies were 

able to relate and offer different perspectives to me. This family was able to achieve most of 

their goals (mainly the barriers had to do with COVID19) and mom expressed that she 

really liked the program overall.

• I have a client that was able to make a goal of getting her high school diploma and with the 

resource I provided her she was able to sign up for online classes and obtained her high 

school diploma last month.

• Many of my families benefited from this program in very different ways, but one family sticks 

out because of all of the different ways this program was able to help her and her family. 

When I first came into the home, the focus child was very very silent and shy. She had 

struggled with using her words because she always depended on her older sisters to talk 

for her. She also was very clingy to the mom, almost baby like even though she was around 

5 years old. After talking with the mom a few times we started to build a really good 

relationship where she was able to open up more about the past. We talked through the 

past and figured out some reasons of why her daughter could have been acting these way 

and having these developmental delays. After working with this family I was able to get not 

only the focus child in counseling, but all of the daughters and the mother herself. There 

were many other resources and areas that we worked on together to help, but getting the 

mom to discuss the past and really see how that could have shaped the way the girls act 

was a huge step. This family was a fantastic family to be involved in a program like this, and 

also pushed her to get more involved in other programs similar to be able to continue to 

help the family and hold her accountable.
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• One mom had all the tools she needed to succeed but was in a bad relationship and lived 

with her mother who is very controlling, and when we chatted at length about her strengths, 

she took it to heart and became more confident to do what she needed to do for herself and 

her kids

• One mother I worked with had some big mental health issues that she's been struggling 

with her whole life, as well as her child having some development delays. After several 

months of working with Mom and Dad's concerns about getting help, we were able to get 

their son enrolled in Early On and then connected with the school district for support to get 

him back on track. He he began to show improvements within the first month of services. 

And then, after completing all of their timepoints and finishing her 12m feedback, I got an 

update from Mom that our conversations about counseling helped motivate her to connect 

with a therapist. This step toward addressing her mental health needs is very likely to have 

a positive impact on her parenting, her family's wellbeing, and of course her own wellbeing. 

The one-on-one support provided by the FCU was essential for helping this family become 

comfortable in seeking help for things they were not able to address on their own.

• One particular family had children with special needs and was in the process of a divorce 

out of a domestically violent marriage, when she enrolled in the program. She was very 

self-sufficient, carrying two jobs, doing online school, and supporting the needs of her kids. 

Through SIF, we were able to connect her to another parenting home visiting program at 

CARE for further support of her and her kids. Through the support of both SIF and SOF, 

she got connected to early intervention services for her children and connected support 

groups for parents of special needs. These programs were also able to assist her with 

holiday needs by connecting her to resources to financially help during troubling times. The 

Family Checkup Model was well suited for her because she was very open to reflect on her 

responsibilities and emotions, and took pride in being able to make progress towards goals 

pertaining to the development of her children and to improve herself I ways that would 

benefit her family long-term.

27. Do you feel that participating in SIF 2016 benefitted you professionally ? (FCMS) 

 No 1 (8%)

 Yes 12 (92%)

27a. If yes, please explain: 

• Because we can help the family

• Being part of a study

• Coming into this position, I had very limited professional experience. The only relative 

experience that I had was with case management. I loved that that this position didn't 

require too much experience and the on-the-job training I received was really helpful in my 

professional development because I've always wanted to work with children and families.

• Home visiting has been a hugely beneficial experience for me.

• I already knew how to do assessments and motivational interviewing.

• I am more comfortable working and communicating effectively with all different types of 

clients after my experience with these families

• I feel I grew professionally in this project, using MI skills not just at work but even at the 

personal level especially that I had a teen in the house tremendously helped me.

• I feel more competent in my clinical skills based on the experiences I've had doing SIF as 

well as the trainings and meetings that I have attended and participated in.

• I had no idea of what resources were available for Wayne County and now I have a much 

better idea of the resources out there and how to go about finding them. Also working with 
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families in Wayne County has given me a much better perspective of what the needs are in 

Wayne County. Being able to gain the trust of the family and have them welcome me into 

there home is humbling.

• I learned a lot personally and professionally. This project was a wonderful opportunity to 

practice my clinical skills and home-visit without a Master's degree. I was recently accepted 

to Wayne State to pursue a MSW and I feel that my learning throughout this program will be 

much different/more personal due to my experiences and knowledge from working in SIF 

2016.

• Motivational Interviewing as been a blessing to my professional development.

• Within the social services field, I think any home visiting work is beneficial. For me 

personally, working with younger kids was very beneficial because it was an age range I 

had not worked a ton with and really wanted to work more with. Also this program allowed 

for me to find and hear about resources that I never knew existed. I also enjoyed all of the 

trainings that we were able to do during this project especially based on how to deal with 

trauma within families and children.

• Yes, it allowed me to know the rules, how to manage clients, how to efficiently solve their 

problems, how to solve hard cases.

28. Did you communicate with families in languages other than English? (FCMS, DCS)

Did you communicate with families in 

languages other than English? FCMS (N=13) DCS (N=5) 

No 8 (62%) 3 (60%)

Yes 5 (38%) 2 (40%)

28a. If so, what language(s)? (check all that apply)

If so, what language(s)? (check all that apply) FCMS (N=5) DCS (N=2) 

Arabic 4 (80%) 2 (100%)

Bengali 1 (20%) 1 (50%)

Spanish 1 (20%) 0 (0%)

Other 0 (0%) 0 (0%)

If yes to question 28:

29. How difficult was it to conduct the assessments in a language other than English? 

(FCMS, DCS) 

How difficult was it to conduct the 

assessments in a language other than 

English? FCMS (N=5) DCS (N=2)

Very difficult 1 (20%) 0 (0%)

Difficult 0 (0%) 0 (0%)

Not very difficult 1 (20%) 2 (100%)

Not difficult at all 3 (60%) 0 (0%)

29a. Please explain your answer: 

FCMS

• I am bilingual, I speak Arabic and English fluently.

• I know how to read and write Arabic 

• It depends on the level of the other language. Arabic is my mother tongue and I understand 

most of the dialects of the Arabic language.
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• Motivational interviewing in the feedback sessions required more conscious effort, but 

assessment sessions were easy

• Since I only speak English myself I had to utilize a translator which I found very difficult at 

times.

DCS

• Having experience, and Arabic language background, being a native speaking in Arabic, 

reading and writing the language, it was very helpful.

30. How difficult was it to find appropriate referrals for families who spoke languages other than 

English? (FCMS)

 Very difficult 0 (0%)

 Difficult 1 (20%)

 Not very difficult 2 (40%)

 Not difficult at all 2 (40%)

30a. Please explain your answer: 

• I am bilingual, I read and write Arabic and English fluently.

• I read for them and translate

• It just sometimes that they don't benefit from the referral because the language. when the 

make the call, there's no one speak their language.

• Making sure the referrals they could utilize given language barriers.

• There are so many organizations nearby that serve Spanish-speakers, since we're so close 

to SW Detroit

31. How good of a fit do you think the GOALS project was for families who spoke languages 

other than English? (FCMS)

 Very good fit 3 (60%)

 Good fit 2 (40%)

 Not a good fit 0 (0%)

 Not a fit at all 0 (0%)

31a. Please explain your 

answer:_______________________________________________________________________

32. What suggestions would you make for adapting the GOALS project so that it works 

better for families that speak languages other than English? (FCMS) 

• Allow more resources and referrals to have language translations, not only Arabic and 

Spanish.

• I will get rid of the temperament questionnaire, unless I change the phrases into simple 

sentences not including a clause phrase because it confuses participants and it affected 

their answers. In the family profile form, I will add more questions related to child’s 

education because this a priority for participants. The scale in the assessments, make it 

simple, visual not more than 5-points scale. Assessments, referrals and resources should 

be available in Arabic and Spanish from the beginning of the study. 2-1-1 should imidiatly 

take participants to languages selections when they call. They were many times where I 

had to be with participants when they called 2-1-1. Provide books in different language to 

promote reading skill.

• N/A- I think it worked well

• Not really sure. 

• Nothing

Thank you!
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Appendix W: Characteristics of GOALS Families by Agency

Table 1: Characteristics of GOALS Families – ACCESS (N=86)

Variable N %/ 

Average SD

Parent’s age 86 31.2 6.336

 18-25 17 20%

 26-34 50 58%

 35 and older 19 22%

Child’s age 86 2.3 1.420

Parent’s gender

 Female 86 100% 0 

Child’s gender

 Female 86 40% .492

Race/ethnicity1 86

 American Indian 2 2% .152

 Asian 1 1% .108

 African American 11 13% .336

 Hispanic 6 7% .256

 Middle Eastern/North African 64 74% .439

 Pacific Islander 0 0% 0 

 White 3 3% .185

 Other 1 1% .108

Language Spoken 86

 English 12 14% .349

 Spanish 6 7% .256

 Arabic 67 78% .417

 Other 1 1% .108

Household Composition

 Number in household 86 6 1.988

 Living with spouse 86 80% .401

 Receiving public assistance 86 79% .409

 Less than high school education 86 63% .486

 1 More than one option could be selected.

Table 2: Characteristics of GOALS Families - CARE (N=100)

Variable N %/ 

Average SD

Parent’s age 99 31.4 7.547

 18-25 23 23%

 26-34 50 51%

 35 and older 26 26%

Child’s age 99 2.0 1.605

Parent’s gender
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 Female 99 96% .198

Child’s gender

 Female 99 51% .503

Race/ethnicity1 99

 American Indian 4 4% .198

 Asian 4 4% .198

 African American 47 47% .502

 Hispanic 6 6% .240

 Middle Eastern/North African 10 10% .303

 Pacific Islander 0 0% 0 

 White 33 33% .474

 Other 4 4% .198

Language Spoken 99

 English 93 94% .240

 Spanish 1 1% .101

 Arabic 1 1% .101

 Other 4 4% .198

Household Composition

 Number in household 93 4.5 1.632

 Living with spouse 99 45% .500

 Receiving public assistance 99 83% .379

 Less than high school education 93 13% .337

1 More than one option could be selected.

Table 3: Characteristics of GOALS Families – LBFS (N=88)

Variable N %/ 

Average SD

Parent’s age 88 32.0 6.931

 18-25 20 23%

 26-34 37 42%

 35 and older 31 35%

Child’s age 88 2.0 1.436

Parent’s gender

 Female 88 97% .183

Child’s gender

 Female 88 58% .496

Race/ethnicity1 88

 American Indian 1 1% .107

 Asian 1 1% .107

 African American 39 44% .500

 Hispanic 88 2% .150

 Middle Eastern/North African 32 36% .484

 Pacific Islander 0 0% 0 

 White 14 16% .368
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 Other 4 5% .209

Language Spoken 88

 English 55 63% .487

 Spanish 0 0% 0 

 Arabic 29 33% .473

 Other 4 4% .209

Household Composition

 Number in household 82 4.6 1.601

 Living with spouse 88 51% .503

 Receiving public assistance 88 86% .345

 Less than high school education 81 14% .345

 1 More than one option could be selected.

Table 4: Characteristics of GOALS Families - NKFM (N=131)

Variable N %/Average SD

Parent’s age 125 31.5 7.791

 18-25 31 25%

 26-34 57 45%

 35 and older 37 30%

Child’s age 131 2.3 1.750

Parent’s gender

 Female 128 98% .152

Child’s gender

 Female 131 50% .502

Race/ethnicity1 128

 American Indian 4 3% .175

 Asian 2 2% .125

 African American 90 70% .459

 Hispanic 9 7% .257

 Middle Eastern/North African 7 5% .228

 Pacific Islander 0 0% 0 

 White 23 18% .385

 Other 5 4% .195

Language Spoken 127

 English 125 98% .125

 Spanish 1 1% .089

 Arabic 1 1% .089

 Other 0 0% 0 

Household Composition

 Number in household 128 4.5 1.874

 Living with spouse 130 20% .402

 Receiving public assistance 130 77% .423

 Less than high school education 128 20% .398

 1 More than one option could be selected.
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Table 5: Characteristics of GOALS Families - OFS (N=113)

Variable N %/Average SD

Parent’s age 113 34.0 7.704

 18-25 19 17%

 26-34 46 41%

 35 and older 48 42%

Child’s age 113 2.5 1.655

Parent’s gender

 Female 113 96% .186

Child’s gender

 Female 113 46% .501

Race/ethnicity1 113

 American Indian 7 6% .242

 Asian 6 5% .225

 African American 54 48% .502

 Hispanic 12 11% .309

 Middle Eastern/North African 3 3% .161

 Pacific Islander 0 0% 0 

 White 47 42% .495

 Other 7 6% .242

Language Spoken 113

 English 109 96% .186

 Spanish 2 2% .132

 Arabic 1 1% .094

 Other 1 1% .094

Household Composition

 Number in household 107 4.1 1.513

 Living with spouse 113 42% .497

 Receiving public assistance 113 65% .480

 Less than high school education 106 12% .330

 1 More than one option could be selected.
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Appendix X: Coronavirus Impact Scale
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Appendix Y: COVID-19 Symptoms and Social Distancing Web Survey
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Appendix Z: Participant Consent Form
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Appendix AA: Study Logistics and Updates

Protection of Human Subjects

The study protocol was submitted to Advarra IRB for review and approval. Evaluation staff 

maintained regular communication with the IRB to obtain updated approvals as the pilot 

unfolded, implementation forms were updated and/or translated, instruments were revised 

and/or translated, protocols were updated, and other changes, such as adding the six-month 

cohort and the COVID-19 measures, were made to the study. 

Participants were asked to sign a consent form to participate during their first session with an 

FCMS or DCS (see Appendix Z). The consent form was available in English, Spanish, and Arabic. 

The study enrollment period was extended from April 30, 2019 to December 31, 2019 in order 

to enroll more families. A revised version of the consent form was approved by the IRB in 

December of 2018 to reflect the increase of the evaluation support from $25 to $50. Families 

enrolled after December 31, 2019 received only one follow up assessment after six months in 

the program. A revised consent form, available in English, Spanish, and Arabic, was developed 

for this group of families and approved by the IRB to account for this change.

The consent form provided an overview of the study including a description of what would be 

asked of participants, the potential risks and benefits, a description of how confidentiality would 

be protected, and information about the evaluation support payment. In addition, families were 

presented with a set of supplemental consents that requested permission to contact them via 

text messaging, reach out to them through social media, release their contact information to the 

evaluation team in order to monitor evaluation support payments, and to video tape some 

portions of the assessment process. Families were still able to participate if they did not agree 

to any or all of the items in the supplemental consents.

In June of 2020, the project team decided to add two new assessments that asked questions 

about families’ experiences related to COVID-19. At that time, face to face visits with families 

had been suspended in order to prevent both staff and participants from being exposed to 

COVID-19. The study team developed a verbal consent form to be read to families (in English, 

Spanish or Arabic) seeking their consent to complete these new measures over the phone and 

receive an additional $10 evaluation support. The verbal consent form was reviewed and 

approved by the IRB.

The project team also obtained a Certificate of Confidentiality from the National Institutes of 

Health. The Certificate of Confidentiality provided an additional layer of protection for 

participants by enabling the project team to withhold the identities of participants from all 

persons not connected to the research. The project team believed the Certificate of 

Confidentiality was necessary due to the sensitive nature of some of the assessments included in 

the project.

Budget and Timeline 

This project began at the now closed Corporation for National and Community Service 
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(CNCS) and is now housed with AmeriCorps. It was part of the 2016 Social Innovation 

Fund portfolio and was United Way’s second Social Innovation Fund Award (also 

awarded in 2011, for detail on that project 

see: https://www.nationalservice.gov/impact-our-nation/evidence-exchange/uwsemportfolio-evaluation-implementation-and-outcomes-united). In 2016, United Way was 

awarded $6 million with a required one to one match on every dollar. There was also a 

majority pass through stipulation meaning that at least 51% of the federal award had 

to go to subgrantees (referred to in this report as partner agencies) who were also 

required to match their awards dollar for dollar. With the shortened period of 

performance, United Way’s total budget was just over $4 million with a pass-through

rate of approximately 76 percent. 

United Way was awarded the SIF grant for this project in September 2016. Between 

then and the April 1, 2017 start date, the United Way team worked to hire staff and 

conduct a Request for Qualifications process to identify partner agencies for subgrants 

as well as a Request for Proposals process to identify the external evaluator. Partners 

were brought under contract beginning April 1, 2017. When the timeframe for the 

study was reduced by a year, a second RFP process was employed to award a fifth 

agency. And the 18-month visit with families was eliminated. Data collection was 

originally to end April 30, 2020 but continued until August 2020. The final evaluation 

report was to be completed in the Fall of 2020. United Way’s contract with CNCS ends 

December 31, 2020. 

Evaluation and Program Staff Involvement

United Way for Southeastern Michigan

This is the final project team from United Way:

• Chief Impact Officer: Tonya Adair

• Senior Director: Jeffrey D. Miles, MSW

• Project Manager: Melanie Gill, MPA 

• Data Specialist: Maya Satterwhite 

Philliber Research and Evaluation

Upon embarking on the GOALS evaluation with United Way, Philliber established a five-member 

team to manage the evaluation. These team members included:

● Lead Evaluator: Randi Burlew, PhD 

● Senior Evaluator: Stacie Powers, PhD 

● Senior Advisor: William Philliber, PhD

● Data Analyst: Ed Parker, MA

● Evaluation Coordinator: Heather Hirsch, MS
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Drs. Burlew and Powers provided general oversight of the project, managed all evaluation 

activities, and supervised the Data Analyst and Evaluation Coordinator. Dr. Philliber provided 

technical assistance and consultation at all stages of the project. The Data Analyst cleaned and 

analyzed all data associated with the project and conducted routine reporting for the Monthly 

Summaries provided to United Way. The Evaluation Coordinator managed communication with 

and provided evaluation technical assistance and support to the five partners implementing the 

project. 

The Philliber evaluation team remained consistent over the course of the project which helped 

with retaining institutional memory. Midway through the project, Philliber underwent 

organizational restructuring which included shifting of projects and responsibilities throughout 

the company. As a result, Dr. Powers transitioned off of the GOALS project. However, she 

remained available throughout the course of the project for consultation and often reviewed 

documents and reports associated with the GOALS project deliverables.

Partner Agencies

At the start of the GOALS program each partner agency was staffed with one Program Manager 

and at least two Family Check-Up Model Specialists. Due to a language barrier, one agency was 

allowed to have a third FCMS who worked with Spanish speaking families and eventually moved 

into a dual capacity of both FCMS and DCS. After the extensive FCMS training had been 

completed, each agency added one Data Collection Specialist to work with comparison families. 

Throughout the course of the GOALS program the ability to maintain a consistent staff varied 

drastically between the agencies. While one agency replaced one FCMS early in the program 

and maintained staffing thereafter, another went through a plethora of staffing changes 

including three managers, nine FCMS’s, and two DCS staff. 

While turnover at any position was difficult, losing an FCMS had the most impact on the 

program. This can partially be connected with the difference in training FCM specialists 

received throughout the program. Original members of the FCMS staff received training on the 

Family Check-Up Model (directly from Arizona State University), conducting assessments, 

connecting families with resources, using the pathways, and utilizing the Efforts to Outcomes 

database. New FCMSs coming in after the start of implementation participated in a Family 

Check-Up training with a certified FCU trainer and were educated by their agencies on 

conducting assessments, community resources and pathways, and entering data into ETO. 

Since newer staff members did not have consistent training across agencies, slight variations in 

implementation as well as data entry occurred. Differences were often addressed during 

monthly Learning Communities. 

The loss of either an FCMS or a DCS was also felt among the participating families. Specialists 

were able to build trusting relationships with their clients throughout the program. When a 

specialist left, it was often difficult for families to recreate that relationship with a new case 

worker. Partner agencies suggested this was due to the deeply personal nature of the 
United Way for Southeastern Michigan 230

assessments. This was especially true for participants that had more than one change in FCMS 

or DCS. It is hypothesized that some families dropped out of the program due to inconsistent 

staffing.