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Parent-Child Connectedness Think Tank

Introduction

This article describes the process of designing and convening a "think tank" meeting on parent-child connectedness (PCC). It describes the objectives we had for the meeting, the influences on our design and approach to the meeting, the meeting activities, and conclusions.

For an account of the outcomes and findings from the meeting, refer to Major Findings.

Overview of the PCC BRIDGE Project

Parent-child connectedness, or PCC, describes a high-quality bond between a parent and a child that is both mutual and sustained over time. The presence of parent-child connectedness in families has been shown to be a protective factor for children against a variety of negative outcomes including teen pregnancy, substance abuse, tobacco use and delinquency.

However, to date, information and research on PCC has been scattered across multiple disciplines and prevention fields. Staff from the Training and Research Departments from ETR Associates saw a need to collect and interpret the available information about PCC from across these various disciplines and fields, and in early 2003, we received funding from the Annie E. Casey Foundation to compose a clear and concise written understanding of PCC and its importance in preventing teen pregnancy and other negative outcomes for youth and families.

ETR initiated the "Parent-Child Connectedness: Bridging Research to Practice" (PCC BRIDGE) project and undertook three major activities in the first year. These activities were a review of more than 600 articles on PCC, a write-up of that literature review, a survey of health practitioners to assess their understanding of PCC, and a "think tank" with national PCC experts.

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Think Tank Objectives

The primary purpose of convening the Think Tank on PCC was to review and critique our written summary of the available literature on PCC.

A second purpose was for think tank participants to help project staff assess the current levels of understanding and awareness of PCC among practitioners and consider ways to effectively disseminate information about PCC to that audience.

The third purpose was for participants to make recommendations around methods, strategies and other considerations important to designing interventions intended to increase PCC in families.

These purposes translated into five specific objectives. By the end of the think tank, we aimed to:

  1. Reach general agreement about the body of knowledge presented on parent-child connectedness in ETR's literature review;
  2. Review and modify the list of risk and protective factors/determinants related to PCC presented in the literature review;
  3. Evaluate the relative impact of each of the risk and protective factors/determinants on increasing PCC;
  4. Prioritize the list of risk and protective factors/determinants on the basis of their individual viability for intervention activities; and
  5. Develop recommendations for general and specific intervention activities that could potentially affect prioritized risk and protective factors/determinants.

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Influences on Design

Our think tank design was influenced primarily by three sources:

  1. prior project staff experience in leading meetings;
  2. interviews with "veterans" of similar meetings; and
  3. select literature on group process.

Staff Experience and Interviews
Project staff conducted informational interviews with two staff members within ETR Associates who each had extensive experience or expertise with professional meetings. The contents of two half-hour interviews were narrowed down to two lists presented in Figure 1: factors contributing to good meetings and factors contributing to poor meetings.

Figure 1:
Characteristics of "Good" and "Poor" Meetings

Good Meetings Result From:
Poor Meetings Result From:
  • Participants coming together over similarities

  • Derailments over "odd" disagreements

  • Fun

  • Too "touchy-feely"

  • Everyone having a chance to participate

  • Schisms between research and practice

  • Participants feeling they have learned

  • Fights over differences

  • Participants having a sense they contributed

  • Absence of a good way to record information

  • Clear, measurable objectives

  • Lack of organization/ pre-preparation

  • A competent chairperson (facilitator)

  • Absence of authority

  • Personal needs being met (good food, comfortable lodging)
  • Overly large group sizes

Literature on the Group Process
Written literature also influenced our thinking on the design for the meeting. The first example of this literature is the body of work that explores the well-known Delphi process for group decision-making. ETR staff had previously used the Delphi process for similar meetings, and a modified version of the process seemed appropriate for the PCC think tank meeting. The basics of Delphi became an underlying influence on the format, structure and organization of both our pre-meeting activities and our think tank agenda.

A diagram outlining the Delphi process is presented in Figure 2:

Figure 2:
An Outline of the Delphi Process

A second written influence on the think tank design was an article that surfaced during our search for literature on PCC called "Permanency Planning: Creating Lifelong Connections" (Charles and Nelson, 2000). The article is about the efforts of the National Resource Center for Youth Development (NRCYD) to infuse the child welfare system with effective strategies for creating permanent, caring relationships with adults for children under its charge.

NRCYD used a system of paired-weighting, which they called a "force-field analysis," to try to illuminate factors within the child welfare system that were pushing reform ahead and factors that were holding reform back. The use of the force-field analysis influenced us to think about the opportunities and barriers to designing interventions to increase PCC. This resulted in our developing the "viability matrix" described among the think tank activities below.


Think Tank Participants
We identified potential think tank participants on the basis of the research, programs or training they had conducted around PCC-related topics. In selecting individuals to invite to the think tank, we felt that it was important to balance expertise in PCC with a representation of both practitioners and researchers. This balance was important to our interest in moving toward effective ways of promoting understanding and developing interventions in PCC even in the face of known gaps in the research. We felt that a think tank weighted too heavily with researchers would have a difficult time in moving past the gaps in the research base.

Our final think tank roster included seven researchers and eight practitioners, plus ETR facilitators and support staff. The final roster of participants, in alphabetical order is listed in Figure 3:

Figure 3: Final Think Tank Roster

Think Tank Participant
Organization
Steve Bean, MAT (think tank designer and facilitator) ETR Associates, CA
Robert Wm. Blum, MD, MPH, PhD University of Minnesota, MN
Judith S. Brook, EdD Mount Sinai School of Medicine, NY
Catherine Coughland, MA ETR Associates, CA
Debra Delgado, BA Annie E. Casey Foundation, MD
Linda Nightingale Greenwood, MA Rhode Island Department of Education, RI
Robin L. Jarrett, PhD University of Illinois at Urbana-Champaign, IL
Douglas Kirby, PhD ETR Associates, CA
Nicole Lezin, MS (think tank staff, literature review lead writer) ETR Associates, CA
Brent Miller, PhD Utah State University, UT
Helen Roemhild, Med Minnesota Department of Children, Families & Learning, MN
Lori Rolleri, MPH, MSW (think tank facilitator, literature review writer) ETR Associates, CA
Rebecca Rubin, BA (think tank support staff) ETR Associates, CA
Sue Simonson, ICCE Sutter Medical Center, CA
Barbara Sugland, MPH, ScD Center for Applied Research and Technical Assistance, MD
Nancy Tartt, MS University of Illinois at Chicago, IL
Julie Taylor, BA (think tank facilitator) ETR Associates, CA
Trish Moyland Torruella, MPH Independent Consultant, CT
Raphael Travis, Jr., MSW UCLA School of Public Health, CA
Pamela Wilson, MSW Independent Consultant, MD
Patty Wipfler, BA Parents Leadership Institute, CA


Overall Design
From a process standpoint, our goal was to keep the meeting productive, respectful, balanced and fun. Adult learning principles guided the development of the overall agenda and specific activities. These principles suggested the use of a mix of small group work and large group discussion. We believe that the mix we achieved was unconventional for a meeting of this type but contributed to its successes.

These same principles suggested that we should rearrange our small group rosters frequently to build a "learning community" that would contribute to a productive and enjoyable meeting.

The formats used for the four main think tank activities reflected both adult learning principles and the recommendations for successful meetings that had come out of informational interviews with meeting "veterans." Our think tank design emphasized highly structured activities with good supporting materials and strong facilitation.

Strong facilitation was intended to balance three potentially competing forces in our think tank:

  • the need to obtain "buy-in" from participants;
  • our desire to find general agreement on important issues; and
  • ETR's position as the final arbiter of what would be included or emphasized in the published literature review.

Finally, our meeting activities were designed to be interactive and product-focused through an emphasis on concrete outcomes such as written recommendations, prioritization lists and intervention designs.

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Meeting Activities

Pre-Meeting Activity
Prior to the think tank, participants were send draft copies of the literature review and the results from the ReCAPP survey. They were asked to evaluate the two documents in writing using a list of questions provided. The questions to which participants responded were:

  1. Is there a body of literature that we did not explore in the literature review that we should explore? Are there key research articles or authors that are missing from the literature review? Please advise.
  2. Given your expertise and experience, are we missing any key risk and protective factors related to parent-child connectedness in our literature review? Please describe.
  3. Given your expertise and experience, which risk and protective factors are most critical in establishing parent-child connectedness? In other words, which risk and protective factors are likely to be the most powerful at impacting parent-child connectedness. List no more than ten.
  4. Of the risk and protective factors that matter most, which ones do you think are most feasible for intervention? Think about feasibility in regard to financial resources, staff expertise, administrative capability, and political acceptance.
  5. Are there existing interventions/programs that should be included in the literature review, but currently are not? Please describe. How would we find out more about any interventions you suggest?
  6. Given your experience and expertise, and your answers to questions #3 and #4, what would effective intervention strategies/approaches to strengthen parent-child connectedness look like? In your response to this question, mention any health behavior/psychological theories that should guide the development of these interventions.
  7. How does culture, socioeconomic status (SES) and education level affect the development of these interventions, if at all?
  8. After reading the literature review, what are the three main ideas that you are taking away from it?
  9. What research study questions or knowledge gaps come up for you (in addition to the ones listed at the end of the document) after reviewing this literature review, if any?
  10. What other feedback would you like to give us about the literature review?

Participants' written responses were read by project staff and keyed to the section or sections of the literature review to which they related. All comments pertaining to each section of the literature review were compiled and printed for participants' use in re-evaluating the literature review during the first major activity of the think tank.


Think Tank Agenda
The two-day agenda for the meeting is presented in Figure 4:

Figure 4: Agenda for Two-Day Think Tank

Day One: July 21, 2003

8:15am-9:00am Breakfast  
9:00am-9:30am Welcome & Introductions 30 min.
9:30am-10:00am Overview of the Think Tank 30 min.
10:00am-11:00am Initial Consideration of Literature Review 60 min.
11:00am-11:15am Break 15 min.
11:15am-12:00pm Evaluating and Prioritizing Risk & Protective Factors, Part 1 45 min.
12:00pm-1:00pm Lunch 60 min.
1:00pm-2:30pm Evaluating and Prioritizing Risk & Protective Factors, Part 2 90 min.
2:30pm-2:45pm Break 15 min.
2:45pm-3:30pm Reports on Evaluation and Prioritization of Risk & Protective Factors 45 min.
3:30pm-4:30pm Presentation and Discussion of ReCAPP Survey Data 60 min.
4:30pm-4:45pm Closure 15 min.

Day Two: July 22, 2003

8:15am-9:00am Breakfast  
9:00am-9:30am Check-in/Overview of Day Two 30 min.
9:30am-10:15am Designing Interventions, Part 1 45 min.
10:15am-10:30am Break 15 min.
10:30am-11:00am Designing Interventions, Part 2 45 min.
11:00am-12:00pm Reports on Intervention Design 60 min.
12:00pm-1:00pm Lunch 60 min.
1:00pm-2:00pm Summary Discussion 60 min.
2:00pm-3:00pm Think Tank Feedback & Closure 60 min.

Meeting Activities
The finalized think tank design spanned two days and featured four major activities:

1. Re-evaluation of the Literature Review
Participants joined small groups. Each group re-evaluated one section of the literature review using written comments from the individual evaluations conducted by participants prior to the think tank. This re-evaluation identified strengths, gaps and special considerations pertaining to each section of the document.

2. Analysis of Risk and Protective Factors
Participants analyzed the 98 risk and protective factors that affect the presence of parent-child connectedness in families. Related risk and protective factors were grouped into nine categories, and small groups of participants were each given several categories to consider, totaling approximately two dozen risk and protective factors for each group.

In the first step of their analysis, participants considered whether any risk and protective factors were absent from their categories.

Next, individuals within groups did an "impact analysis" picking the ten risk or protective factors from their list that they thought would have the greatest effect on PCC. Individual lists were compared, and a "top ten" list was selected in each group.

In the final step of their analysis, each small group used a "viability matrix" to look at their top ten factors and decide which of these factors were most accessible via intervention activities. Their goal in using the viability matrix was to further pare their list down to the top five risk and protective factors that the group felt were most viable to target in an intervention.

3. Analysis of the ReCAPP Survey of Practitioners
After completing their re-evaluation of the literature review and analyzing risk and protective factors, participants were presented with data from a survey of 599 health practitioners. The survey had been designed to assess respondents' awareness and understanding of PCC.

Participants analyzed the survey data as a way of checking their understanding of PCC and their prioritization of 25 risk and protective factors against the "common sense wisdom" of people in the field currently working with families.

Participants' analysis of the survey data also identified the information about PCC most needed by practitioners in the field. Participants discussed how best to disseminate the information from the think tank and literature review to these practitioners.

4. Intervention Design
Finally, participants joined colleagues with similar expertise, training and background to design PCC intervention activities targeted at priority risk and protective factors and priority populations. This activity included making general recommendations for intervention design based on efforts to design activities, conclusions drawn from previous discussions, and analysis of the practitioner survey.

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Conclusions

Generally, participants had strong, positive reactions to the importance of the PCC BRIDGE project and the design and outcomes of the think tank. They collectively expressed the opinion that the draft of the literature review was a solid start toward our goal of presenting a concise account of the existing body of knowledge about PCC.

The results from the think tank have subsequently shaped ETR Associates' thinking about how to disseminate key information about parent-child connectedness and how to increase the general awareness and understanding of this important concept. The think tank identified critical gaps in our understanding of PCC. These are gaps that need to be filled before we can proceed to develop interventions that will be effective at increasing parent-child connectedness within families.

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