Date of Award


Document Type


Degree Name




First Advisor

Sarah E. Watamura

Second Advisor

Julia Dmitrieva

Third Advisor

Angela Narayan

Fourth Advisor

Jennifer Bellamy


Families experiencing high stress, Family support programs, Implementation of evidence-based interventions, Maltreatment prevention, Prevention interventions


Family support programs (FSPs) are designed to stabilize and strengthen families on a range of outcomes to promote well-being. Paradoxically, families with the greatest need are more likely to drop out or experience reduced benefit on average. This study examines patterns of differential benefit for families experiencing elevated stress through a cross-program evaluation of “what works for whom” in FSPs.

Family Resource Center Family Development Services (FDSs), Colorado Community Response (CCR), Promoting Safe and Stable Families (PSSF), Head Start (HS), and SafeCare Case Management Pilot (Safe CMP) contributed data on 15,771 participants enrolled in services from 2014-2020. Program samples were weighted to correct for dropout. Improvements in self-sufficiency, health, and family protective factors were measured using ANCOVA. Main effects and interactions between program and predictors were examined, including cumulative stress score, single-parenthood, poverty, household size, fatherhood, primary language, parent age, race, and ethnicity. Importantly, the study design is pre-post assessments without randomization to program or reference to a comparison group. Thus, pre-post change could not be calibrated against change that would have occurred without program participation.

Dropout ranged from a low of 20% in HS to a high of 75% in PSSF. Latinx caregivers and families with higher stress varied in their pattern of attrition by program. Families enrolled in HS, a center-based model, and CCR, a community-based model, showed the greatest number of differential pre-post improvements. ESL families exhibited greater improvements in their health and child education across program participation. BIPOC families showed greater gains in child education and fewer improvements in family functioning and resilience than white families across program participation. Families with higher stress exhibited greater improvements in maintaining control when disciplining, but fewer pre-post gains in substance abuse, family functioning, child education, and beliefs about the intent of child misbehavior. Homevisiting and community-based programs were linked with the greatest number of differential subgroup benefits. Families with higher stress had the greatest variation in differential benefits by program. This study suggests that no single approach benefited all subgroups equivalently. Findings from this project may increase the equity with which families are supported in FSPs.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.


Received from ProQuest

Rights holder

Elly M. Miles

File size

192 pgs

File format





Developmental psychology

Available for download on Thursday, September 26, 2024