In October, 1997, EMT Associates,
Inc., and its subcontractor, Policy Research Incorporated, were awarded a cooperative
agreement to design and implement a Data Coordinating Center for Starting Early Starting
Smart (SESS). The SESS project is a unique collaborative knowledge development project
jointly funded by the three Centers of the Substance Abuse and Mental Health Services
Administration (Center for Substance Abuse Prevention, Center for Substance Abuse
Treatment, Center for Mental Health Services) and the Casey Family Program, a private
foundation promoting better outcomes for young children at risk, particularly foster
children. SESS includes 12 grantees nationwide implementing and studying programs designed
to integrate behavioral and other services for families of young children at risk, and
collaborating with the DCC in a national study of the implementation and effectiveness of
these programs. The study period is from 1997 to 2001, with two additional years of follow
up research in selected sites funded by the Casey Family Program.SESS Program Description
The SESS programs are designed to improve the environment and outcomes for young children at risk in three major areas. First, they deliver services to strengthen family environment through a) identifying need and ensuring access to mental health and substance abuse treatment services for care givers, b) strengthening the home environment through improving care giver awareness, knowledge, and behavior concerning child development and parenting, c) assisting in meeting additional service needs of the family, and d) improving care giver ability to recognize service needs and make positive linkages to helping institutions for their children and themselves. Second, they work with care givers and children to improve attachment, bonding, and care giver-child interaction. Third, they work with other aspects of the child's environment (e.g, the early childhood education class room) to support the positive impacts of family environment and interaction on child outcomes such as social-emotional development and school readiness.
Six SESS grantees work in pediatric primary health care settings, and six work in early childhood education settings (usually Head Start). The primary health care settings focus on very young children (infancy to 3 years) while the early childhood education settings focus on the pre-school years (3 to 5). All programs use a two level approach to improving assessment and delivery of needed services to children and families. First, they work directly with children and families through family-centered case management, support, and service approaches. Second, they work with other organizations in the service system to improve collaboration in assessment, service perspective, service access, and service delivery. Family-centered case management and support is provided in differing ways across sites, including home visit approaches. Working with other organizations involves a variety of collaborative mechanisms including collocating staff and services, the use of multi-organizational interdisciplinary teams.
SESS Study Design
The goal of the SESS collaborative research project is to provide rigorous scientific evidence concerning whether children and families participating in SESS programs achieve better access to needed services and better social, emotional, cognitive, and behavioral health outcomes than do the children and families not receiving these services. SESS programs may also generate information about opportunities, practices, and barriers to sought-after outcomes. This information is critical to achieving effective public policies.
The SESS research design includes six random assignment treatment / control group sites, and six quasi-experimental treatment / comparison group designs. Outcome data is collected at three or four points in time for family and child outcomes, more frequently for service utilization information. Information is collected through in person interviews, telephone interviews, contact logs that record program "dosage," and observational instruments. A sub-study assesses improvement in care giver-child interaction through video-taped observations. Site level data on program design, program implementation, and comparison group service levels is gathered through site visit interviews, observation and document review. This data is collected using a common protocol developed by the DCC and the Steering Committee. Data analysis uses experimental analysis designs with appropriate adjustments (e.g., covariance analysis) for quasi-experimental sites. Structural equation modeling, hierarchical linear modeling, and growth curve techniques are applied as appropriate.
DCC Role
As DCC grantee, EMT has major responsibility for the SESS research project in several major areas. The funding organizations, the 12 collaborating sites, and a Data Coordinating Center (DCC) form a Steering Committee that has responsibility for designing and implementing a multiple-site study of the implementation and effectiveness of SESS interventions. The DCC facilitates and supports the functioning of the Committee through logistical arrangements, communications and staff support. The DCC prints and distributes scannable instruments, scans data centrally, performs accuracy checks and corrects errors, distributes data back to sites in fully labeled files ready for analysis, and maintains the cross-site data files. The DCC conducts process data site visits, prepares protocols, and enters site visit data into a central data base. The DCC is responsible for preparing interim reports to the Steering Committee and preparing interim and final reports on the cross-site analysis. Finally, the DCC will support the preparation and dissemination of study materials that convey SESS findings that will contribute to the improvement of service delivery to very young children and their families.
U.S. Department of Health and
Human Services,
Substance Abuse and Mental Health Services Administration
http://www.samhsa.gov
The Casey Family
Foundation
http://www.casey.org
Mental Health Policy
Information Exchange
http://www.pie.org
Starting Early
Starting Smart (SESS) Study Publications
http://ncadi.samhsa.gov/promos/sess/research.asp