Family Champions Project

Study Overview
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Brief Summary
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This evaluation uses a formative approach and a descriptive design with repeated measures to assess the efficacy of a Continuous Quality Improvement (CQI) Process to improve services delivered by the Family Champions Project (FCP). The FCP delivers education-based services-TYRO Leadership and Core Communication curricula-with funding from the Office of Family Assistance to low-income fathers and mothers to promote healthy family relationships and economic stability in their households. TYRO Leadership and Core Communication are adapted from the TYRO suite of curricula that were developed by the RIDGE Project, and they are designed to improve the relationships of families affected by the incarceration of a parent and the economic stability of their households. Participants must be at least 18 years of age with a child no older than 24 years and have no open criminal cases (cases can be deferred). Evaluation activities are carried out by Midwest Evaluation and Research (MER) and assess the extent to which our CQI Process is a feasible approach to improve outputs and the outcomes that might be associated with them for an education-based service delivery effort like the FCP. Specifically, study results from formative evaluation will inform practitioners in the field of HMRE about the viability of using a CQI Process like ours to achieve full implementation and provide some evidence about its capacity to improve outcomes. Formative evaluation not only assesses experiences of the CQI Team and front-line service staff while implementing our CQI Process, but also pays attention to the timing and other specifics of any performance interventions that occur over the 5-year project. As a result, performance interventions present opportunities to conduct a series of mini studies to descriptively evaluate CQI Team efforts to improve implementation of the FCP. Performance trends that improve after an intervention indicate the CQI Team was likely successful to more fully implement outputs which should result in a positive effect on retention rates and, in turn, short term outcomes if we assume a sound theory of change for the FCP is depicted in the logic model.

Detailed Description
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Efforts to conduct CQI are in the early stages of development in the field of Healthy Marriage and Relationship Education (HMRE). The Office of Family Assistance (OFA) has required HMRE grantees to conduct CQI as part of project activities since funding began for them in 2006. However, HMRE grantees have likely not bought into the CQI Process given the absence of user-friendly conceptual frameworks to guide CQI efforts and empirical evidence to demonstrate they improve implementation of project activities and, in turn, enhance participant outcomes that might be attributed to them. The CQI Process used in this study was developed by Dr. Theodore C. Jurkiewicz and then enhanced after starting work at MER, and it begins by forming a CQI-Team. The CQI-Team is a collaboration between practitioners with the authority to make implementation decisions about the FCP and evaluators at MER who handle data analyses and reporting. The CQI Team carries out a 5-step plan that is repeated each program year to fully implement FCP educational services over time by using a series of indicators to track performance trends for various outputs from a different perspective in each step. Percentage of target enrollment, percentage of target population that reflect eligibility characteristics, hours of dosage received by participants, response rates to participant surveys that measure outcomes among other indicators and outputs are tracked for monthly and quarterly enrollment cohorts in each program year and presented in CQI Reports that take the perspective associated with each of the 5 steps. Ultimately, successful performance interventions designed and implemented by the CQI Team in collaboration with front-line service staff should improve the outputs associated with FCP services over time, and the most immediate impact should be evident in participant retention rates. Interventions that lead to higher enrollment and then improved attendance should lead to a higher incidence of complete program status (active, complete, not in program), which means FCP services are being delivered to more participants in larger doses. Larger doses of services delivered to participants after performance interventions which means the CQI Team is facilitating progress to meet performance standards because participants receive the amounts of FCP services intended for them. What is more, higher retention rates over time should lead to improved short-term outcomes for participants. Participants who receive larger doses of FCP services after performance interventions should acquire more knowledge in educational sessions than those who receive smaller doses. However, rigorous measures of participant knowledge are not available because it was not possible to get full access to proprietary curricula to develop them. Consequently, participant attitudinal changes will be the only focus for measuring short-term outcomes in this study. Attitudes change more quickly in healthy and productive ways after merely exposing participants to new ways of thinking about parenting, handling finances, or accessing employment with curriculum content in the FCP. Finally, FCP services cannot determine participant outcomes but only contribute to them amongst a host of other factors, which makes it difficult for a descriptive study to link behavioral change to CQI efforts. Healthier and more productive behaviors take time to emerge, develop, and hopefully replace old behaviors because they are subject to a host of other influences on FCP participants. What is more, low-income individuals in the FCP target population, especially those who are parents, experience changing life circumstances more often than those from wealthier households that make them more vulnerable to a host of risk-related factors, such as unstable employment, tenuous housing situations, or limited sources of support that are available from family and friends. Changing life circumstances for low-income individuals make it more difficult for FCP services to have a positive, lasting impact on their behavior. In sum, immediate effects of successful performance interventions that result from the CQI Process should be evident in retention rates for FCP services over time because they are being delivered to more participants in larger doses, as indicated by more hours of attendance in TYRO Leadership and Core Communication workshops and higher workshop completion rates. Higher retention rates mean more participants acquire more knowledge from curriculum content to influence their attitudes about parenting and partner relationships, as well as finances and employment. Table IA.1 below summarizes the rationale for this formative and descriptive evaluation and shows how findings are aimed at demonstrating whether practitioners in the field of HMRE can use the CQI Process developed by MER to improve service delivery by raising retention rates, so more participants are likely to exhibit attitudes indicative of the behaviors promoting healthy family relationships and economic stability. Consequently, retention rates are the primary outcome for this study because it will not be possible to attribute improved outcomes to the CQI Process if they are not preceded by improved outputs associated with successful performance interventions, which results in the sequence below for a theory of change: Ongoing performance interventions that are successful should lead to higher retention rates (i.e., hours of workshop attendance and completion rates for each primary service-TYRO Leadership and Core Communication curricula) Higher retention rates should lead to better attitudinal outcomes for healthy family relationships (i.e., parenting, partner) and economic stability (financial, employment).

Official Title
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Descriptive Study of the Family Champions Project

Conditions
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Fathers, Mothers

Intervention / Treatment
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* Other: Anthem Strong Families TYRO Champion Program Primary Services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult (age 18 and older) Parent No open criminal cases (or deferred) Exclusion Criteria: Minor (under the age of 18) Not a parent Has an open criminal case (or not deferred)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Anthem Strong Families Family Champions Program Primary Services<br>Participants receive TYRO Leadership curriculum in 6 2-hour weekly sessions for a total of 12 hours, and Core Communication curriculum in 1-3 sessions for a total of 6 hours. | Other: Anthem Strong Families TYRO Champion Program Primary Services<br>* Primary Services: participants receive 12 hours of TYRO Leadership curricula, 6 hours of Core Communication curricula. Support Services (optional): participants choose from a menu of classes (1-3 hours) at the walk-in mini clinic to meet a variety of self-identified needs.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Outcome Measure 1: retention rates | Do FCP participants exhibit higher retention rates across monthly enrollment cohorts after cycles of CQI? • Measured by program status (% active, complete, or not in program) and attendance as recorded on the nFORM online data collection system whose use is required by the funder to track programmatic data, such as enrollment and participation levels. | change from baseline through study completion, on average 12 weeks from enrollment | 
| Primary Outcome Measure 1: retention rates | Do FCP participants exhibit higher retention rates across quarterly enrollment cohorts after cycles of CQI? • Measured by program status (% active, complete, or not in program) and attendance as recorded on the nFORM online data collection system whose use is required by the funder to track programmatic data, such as enrollment and participation levels. | change from baseline through study completion, on average 12 weeks from enrollment | 
| Primary Outcome Measure 1: retention rates | Do FCP participants exhibit higher retention rates across yearly enrollment cohorts after cycles of CQI? • Measured by program status (% active, complete, or not in program) and attendance as recorded on the nFORM online data collection system whose use is required by the funder to track programmatic data, such as enrollment and participation levels. | change from baseline through study completion, on average 12 weeks from enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secondary Outcome Measure 1: healthy parenting attitudes (a) | Do FCP participant exhibit healthier parenting attitudes 1 year after enrollment? • 2 survey items measure the reported frequency of healthy parenting attitudes using categories on a 4-point healthy parenting attitudes scale (1 'Never', 2 'Hardly Ever', 3 'Sometimes', 4 'Often'). o Higher scores on all items are positive (ex. - I am happy being with my youngest child). | change from baseline to 12-month follow-up | 
| Secondary Outcome Measure 1: healthy parenting attitudes (b) | • 1 survey item measures level of agreement for relationship status best for child on a 4-point healthy parenting attitudes scale (1 'Strongly Agree', 2 'Agree', 3 'Disagree', 4, 'Strongly Disagree', NA 'Not Applicable'). o Higher scores on all items are positive (ex. - I trust my partner/spouse completely). | change from baseline to 12-month follow-up | 
| Secondary Outcome Measure 2: partner relationship attitudes | Do FCP participants exhibit healthier partner relationship attitudes 1 year after enrollment? 5 survey items measure the reported frequency of agreement with healthy partner relationship attitudes on a 4-point partner relationship attitudes scale (1 'Strongly Agree', 2 'Agree', 3 'Disagree', 4, 'Strongly Disagree', NA 'Not Applicable'). Lower scores on all items are positive (ex. - I want to grow old with my partner.) | change from baseline to 12-month follow-up | 
| Secondary Outcome Measure 3: healthy financial attitudes | Do FCP participants exhibit healthier financial attitudes 1 year after enrollment? 4 survey items measure the reported agreement for key financial attitudes using categories on a 5-point healthy financial attitudes scale (1 'Strongly Disagree', 2 'Disagree', 3 'Neither Agree Nor Disagree', 4 'Agree', 5 'Strongly Agree'). Higher scores on 1 item are positive (ex. - I will have financial stability in the future.) Higher scores on 3 items are negative (ex. - I am overwhelmed when I think about my financial situation.) | change from baseline to 12-month follow-up | 
| Secondary Outcome Measure 4: employment attitudes | Do FCP participants exhibit healthier employment attitudes 1 year after enrollment? 4 survey items measure the reported frequency of agreement with key co-parenting behaviors using categories on a 5-point employment attitudes scale (1 'Strongly Disagree', 2 'Disagree', 3 'Neither Agree Nor Disagree', 4 'Agree', 5 'Strongly Agree'). Higher scores on 5 items are positive (ex. - I can overcome almost any challenge to get a decent job.) | change from baseline to 12-month follow-up |