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Break the cycle: Stopping intergenerational poverty through families and schools

Improving the economic stability of the family is not enough: Evidence-based family and school prevention programs can help interrupt the cycle of intergeneration poverty. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2018, Vol. 24, No. 1, 128–143

The Promise of Prevention Science for Addressing Intergenerational Poverty

Authors

Mark J. Van Ryzin, Oregon Research Institute, Eugene, Oregon
Diana Fishbein, The Pennsylvania State University
Anthony Biglan, Oregon Research Institute, Eugene, Oregon

Abstract

This article reviews research suggesting that the prevention of intergenerational poverty will be enhanced if we add evidence-based family and school prevention programs to address the adverse social environments that often accompany poverty. Government policies such as the Earned Income Tax Credit can reduce family poverty, but simply improving the economic stability of the family will not necessarily prevent the development of child and adolescent problems such as academic failure, antisocial behavior, drug abuse, and depression, all of which can undermine future economic wellbeing. The authors briefly review the evidence linking family poverty to adverse social environments, which can have deleterious effects on children’s behavioral, emotional, cognitive, and neurophysiological development. They then document the value of evidence-based family- and school-based prevention programs in effectively addressing these behavioral, emotional, cognitive, and neurophysiological factors that can put children at risk for continued poverty in adulthood. They also describe 3 family-based prevention programs that have been found to have a direct effect on families’ future economic wellbeing. The evidence indicates that widely disseminating effective and efficient family- and school-based prevention programs can help to address both poverty itself and the effects of adverse social environments, making future poverty less likely. The authors conclude with specific recommendations for federal and state policymakers, researchers, and practitioners.

Keywords

prevention science, intergenerational poverty, family, school

Summary of the Research

“Poverty is a known risk factor for a variety of negative behavioral and emotional outcomes for children and adolescents, including academic failure, alcoholism, antisocial behavior, depression, drug use, and teenage pregnancy. The effect of poverty on these outcomes appears to be mediated to a great extent by adverse social environments, particularly in the family. Specifically, families that are living in poverty are more likely to have social interactions that are marked by high levels of conflict in which family members use aversive behavior to influence one another. […] Children learn to escalate conflict to reduce parents’ efforts to set limits on their behavior. Over time, parents gradually withdraw from monitoring their children’s behavior, thereby allowing opportunities for the child to engage in antisocial behavior and become involved with deviant peers, who further promote antisocial behavior and drug use. […] Other aspects of the family, such as parental neglect and maltreatment, can also influence child outcomes later in life.” (p. 128–129)

“The findings regarding child behavioral and emotional problems are consistent with a burgeoning body of new research that is establishing the effects of poverty and adverse social environments on neural development in ways that impact cognitive abilities. Specifically, poverty and adverse social environments have been found to have a direct impact on the development of the brain; in particular, connections between the front of the brain (e.g., prefrontal cortex) and structures in lower regions (e.g., amygdala, striatum, anterior cingulate) are likely not to develop as fully or function as effectively. […] Insecure attachment in childhood, which arises from inadequate caregiving, is associated with alterations in brain development and neurophysiological stress responses that manifest as long-term deficits in social responsiveness, attention, and other self-regulatory functions that would otherwise enhance resilience and reduce risk for behavioral and emotional problems. Poverty has also been found to have negative effects on IQ, vocabulary, memory, and problem-solving skills.” (p. 129)

“Research has found that the family environment modulates the functioning of biological systems, particularly the human stress response system, and the early overactivation of this system in the context of chronic adversity leads to alterations in functioning. Specifically, early exposure to excessive stress can oversensitize the human stress-response system, leading to chronic “wear and tear” effects on multiple organ systems, including the brain. This stress-induced burden on the body has been referred to as “allostatic load,” and research has linked allostatic load to increased risk for cardiovascular disease, inflammation, impaired immunity, atherosclerosis, obesity, and mood disorders such as depression. Thus, stressful or adverse childhood experiences can lead to enduring changes in biological systems that render individuals more vulnerable to serious, costly, and potentially debilitating health problems in adulthood. […] “Researchers found that attaining economic security later in life did not completely attenuate this link between early poverty and health problems, suggesting that poverty and adverse social experiences early in life made the strongest contribution to negative long-term health effects.” (p. 129–130)

“Although the family is central to child development, schools can also serve as sources of either risk or protection. […] Importantly, supportive school environments can moderate the established association between poverty and negative educational outcomes; specifically, students from poor families who perceive a positive school environment can exhibit similar outcomes to their peers from higher income families. Adverse or maladaptive social interactions between students often manifest themselves as bullying and victimization, which is remarkably widespread. […] Cross-sectional and longitudinal research documents that children and adolescents who are bullies and/or victims are at an elevated risk of depression, anxiety, lower academic performance, substance use, delinquent and criminal behavior, and suicidal thoughts and behaviors. In addition, students from impoverished families report disproportionately high rates of victimization, suggesting that negative social interactions may mediate the link between poverty and negative student outcomes.” (p. 130)

“Most of the common behavioral, emotional, cognitive, and neurophysiological problems that develop in childhood and adolescence make it more likely that a young person will be in poverty as an adult, either by directly impacting economic wellbeing or by creating additional risk for life-altering negative events. […] Life-course research finds that the relationship between adverse social environments in adolescence and reduced economic wellbeing in adulthood is mediated by poor mental health and reduced educational attainment […] Cognitive abilities such as self-regulation also play a key role in the intergenerational cycle of poverty. […] Life-course research suggests that self-regulatory problems can contribute to a host of negative outcomes in adulthood (e.g., substance dependence, criminal offending) including reduced economic well-being.” (p. 130)

“There is only limited research on the link between maladaptive human neurophysiology (or “allostatic load”) and economic wellbeing, but the literature is very clear that allostatic load can contribute to poor health, and poor health can restrict an individual’s job prospects or earnings and/or create significant medical expenses. Here again, life-course research can provide useful insight; recent studies suggest that adverse social environments in childhood negatively impact human stress neurophysiology and health, which in turn limit educational and workforce outcomes. Thus, as with behavioral, emotional, and cognitive problems, allostatic load and its impact on individual health can play a significant role in the intergenerational transmission of poverty.” (p. 131)

“Efforts to prevent intergenerational poverty depend on their ability to sustainably increase family economic security and/or to prevent or ameliorate the adverse social conditions that make it more likely that children from impoverished homes will remain poor as adults. Research and policymaking relevant to poverty have so far focused on increasing family economic security, and among the policies demonstrating some benefit are a robust minimum wage, earned income tax credit, housing vouchers, food stamps, and conditional cash transfers. However, simply raising their income may not alter the family interactions that are critical for successful development, nor will it necessarily improve the quality of school environments that also have a significant impact on development. To enhance family and school environments as contexts for healthy development will require a more widespread implementation of evidence-based prevention programs.” (p. 131)

“The present article is intended to clarify for researchers how intergenerational poverty can be prevented while simultaneously articulating specific policy initiative that policymakers can adopt. In addition to having a direct impact on policymakers, we hope that this paper will also influence researchers and advocates to articulate the policies that are needed in formats that are digestible for policymakers.” (p. 133)

“The programs we highlight are among the most widely known and thoroughly studied in their respective fields and thus can be considered exemplars of particular approaches to prevention. […] These programs focus on providing education to families, improving the quality of family relationships, and teaching key family management skills. Their goal is to transform how parents manage and monitor child behavior, how the family negotiates conflicts and solves problems, and the affective quality of the family environment. They treat the family as the most influential and malleable context from which to promote long-lasting behavioral and emotional adjustment among children and youth.” (p. 131)

The overviewed family-based prevention programs included Parent Management Training—Oregon (PMTO), Strengthening Families for Parents and Youth 10–14 (SFP 10–14), and Nurse Family Partnership (NFP). School-based programs included Positive Action (PA), Good Behavior Game (GBG), cooperative learning (CL), and Positive Behavioral Interventions and Supports (PBIS).

“Family-based prevention programs have demonstrated significant effects on a range of behavioral, emotional, cognitive, and neurophysiological risk factors for poverty. […] The quality of the home environment appears to be particularly impactful on a range of child development outcomes due to the proximal influences of family functioning, disciplinary tactics, order (vs. disorder), and enriching experiences on children’s ability to self-regulate behavior and emotion. In the absence of nurturing parenting, children are more likely to manifest poorly developed social skills, cognitive deficits, poor coping and stress regulation, and behavioral problems. Although a relatively new area, some studies are showing effects of family and parenting programs on brain systems that support cognition and self-regulation. Finally, there is also evidence that parenting programs can significantly alter cortisol rhythms in a way that is reflective of improved stress regulation.” (p. 131)

“Cost-benefit analyses indicate that family-based programs among the most cost-effective at addressing a range of problem behaviors. […] Among the benefits achieved are reductions in future societal costs for crime and health care as well as gains in future labor market earnings by individuals as a result of staying in school.” (p. 131–132)

“In addition, at least three family-based programs have exhibited direct effects on family economic security […] Patterson et al. (2010) suggested that PMTO’s economic benefits may be due to mothers becoming more flexible and prosocial, enabling them to obtain and keep jobs and/or acquire more education. […] Another family program demonstrating direct economic benefit to families is the Nurse Family Partnership (NFP). […] NFP led to lower use of welfare and other government assistance, more employment for mothers, and fewer closely spaced pregnancies. […] The third program originated in Jamaica. Published results reported that parental efforts to stimulate young children’s cognitive skills and social competence significantly enhanced a child’s adult income 20 years later. […] Results indicated that the program increased the average earnings of participants by 42%.” (p. 132)

“School-based programs target specific aspects of child development in order to remediate the effects of poverty and/or suboptimal home environments. Importantly, some studies have included measures indicative of change in neurobiological indices such as executive function and found evidence for their partial mediation of school-based program effects on behavioral outcomes. As such, there is potential for evidence-based school interventions to modify the course of neurodevelopment and ultimately to alter individual risk status.” (p. 132)

“Some school-based programs have teachers, school counselors, or mental health professionals deliver a psychosocial curriculum aimed at changing attitudes, normative beliefs, behaviors, and/or resistance skills related to negative peer influence, such as peer pressure to use substances. A related group of curriculum-based prevention programs focus on promoting socioemotional learning. These programs teach skills in recognizing and managing emotions, making responsible decisions, handling challenging situations, and establishing positive relationships. […] Although curriculum-based programs have been found to be effective, with small to moderate effects on a range of behavioral and social-emotional outcomes, they often require a substantial time commitment. […] In contrast to curriculum-based programs, another set of approaches focus on promoting prosocial behavior and social skills in the context of instructional activities. Examples include the Good Behavior Game (GBG), cooperative learning (CL), and Positive Behavioral Interventions and Supports (PBIS).” (p. 132)

“Overall, substantial evidence indicates that family and school prevention programs can ameliorate the problems that are well-established risk factors for children’s subsequent or continuing poverty. Further, some evidence suggests that family-based programs can directly improve families’ economic security. In general, these programs have demonstrated an ability to (a) reduce coercive interactions, (b) increase positive reinforcement for diverse forms of pro-social behavior, and/or (c) reduce opportunities to engage in problem behavior. Taken together, these effects can contribute to better outcomes for children raised in poverty.” (p. 133)

“Evidence-based family and school prevention programs have significant potential to reduce risk for negative outcomes associated with poverty and adverse social environments and, in turn, interrupt the cycle of intergenerational poverty. The effort to disseminate and implement these programs should accompany a concerted research effort to reduce the monetary and time investments these programs require and to reconfigure them as needed for new service delivery systems and target populations. The ultimate goal of these efforts should be to ensure that every family and school has the skills necessary to prevent the growth of problems such as antisocial behavior and drug abuse and to nurture development of children’s self-regulation, social skills, and academic success, enabling them to become contributing members of society.” (p. 136)

Translating Research into Practice

“In brief, we believe that there are three areas in which policy is needed: (a) The dissemination and implementation of evidence-based programs on a wider scale to reach families in need; (b) supporting research to identify ways to reconfigure and/or streamline existing family-based programs to enhance their ability to integrate with existing service contexts; and (c) taking an evidence-based approach to teacher professional development and educational practice to ensure that schools can support at-risk students.” (p. 133)

Recommendations to federal policymakers: “Promote the dissemination and implementation of evidence-based family interventions within federal programs targeting poverty (e.g., Head Start, Women, Infants, and Children)”; “Support research on how dissemination and implementation can be accelerated (e.g., research on barriers in existing systems, streamlining of existing family-based prevention programs) through the National Institutes of Health and/or the Institute of Education Services.” (p. 133)

Recommendations to state policymakers: “Implement policies that require dissemination and implementation of evidence-based family interventions, both in healthcare (e.g., Accountable Care Organizations) and in education (K–12).” (p. 133)

Recommendations to researchers/practitioners: “Work to educate citizens and state and local policymakers regarding the programs and policies that are available to prevent the most common and costly problems of youth”; “Engage the media to be responsible reporters about the long-term consequences of our actions for children’s development.” (p. 133)

“The first and most obvious implication of the research discussed here is that we need to integrate evidence-based prevention programs into the antipoverty efforts of the federal government. Specifically, Head Start and Women, Infants, and Children (WIC) include efforts to support effective parenting, so federal policymakers should begin by funding systematic implementation and evaluation of evidence-based family programs within each of these systems to strengthen their impact on families in poverty. Effective scale-up of these programs will require refinement and testing on a smaller scale prior to wider dissemination. Such a strategy will allow the demonstration of impact, which will generate further public support for widespread dissemination.” (p. 134)

“Families in need can also be reached through public health care systems. Recent federal policy has spawned the creation of Accountable Care Organizations (ACOs), which hold a group of health care providers accountable for the cost and quality of care delivered to a defined (e.g., at-risk) population using a value-based payment model designed to promote population health while reducing costs. The focus on population health favors integrated medical and behavioral health care and promotes the prevention of behavioral and psychological problems before they become costly from a medical perspective. This new model of integrated pediatric and family care has been found to be effective; further, it increases access to and engagement in behavioral health services and is economically beneficial. Though the number of ACOs is growing rapidly, however, little evidence exists concerning the strategies needed to support and improve the implementation of evidence-based prevention programs within ACOs. Research is needed to better understand the specific policy, structural, and financial barriers that preclude the uptake of these programs in order to enable development and testing of dissemination and implementation strategies for bringing about greater investment by ACOs in taking evidence-based prevention programs to scale. Such research could be supported by either the federal government (e.g., National Institutes of Health) or state governments (through state funding to ACOs).” (p. 134)

“A chronic issue with existing family based prevention programs is the failure to reach families in need, as those families seeking support are often unaware of available programs or even of their need for assistance. The stigma of attending a parenting program may reduce a family’s willingness to attend and even when families engage, structural challenges (e.g., cost and complexity) can reduce a program’s impact. There are also barriers to family participation among families willing to engage, including work schedules, childcare, and the substantial time commitment many programs require. Thus, even when family-based programs are universally available through well-trained community settings, family engagement may dip below 20% of the targeted/eligible families.” (p. 134)

“Innovation in the delivery of family-based programs will facilitate their reaching families in need. Federal policymakers should fund research on more efficient and effective ways to deliver these services. We suggest that this effort focus on adaptive programs, in which the composition and/or intensity of the prevention programming is adapted to family characteristics and then adjusted in response to the family’s ongoing performance. With an adaptive approach, service providers streamline program delivery to include only the material relevant to a given family, reducing delivery costs and barriers to family engagement. With this strategy, families can be provided with a customized level of support, whether that is universal (Tier 1), selective (Tier 2), or indicated (Tier 3); as a result, prevention programming is both relevant to the family and efficient to deliver.” (p. 134)

“Barriers related to family work schedules and the stigma of parenting programs can be reduced through the application of technology. Specifically, family-based programs can be enhanced to support a tele-health model, whereby Web-based videoconferencing technology is used to deliver prevention programming to a family in their home, in the family’s native language, on a schedule that meets the family’s needs. […] As a tele-health service, family-based programs can be embedded in systems that have frequent contact with children and families, such as primary care. The tele-health approach also removes provider-level barriers to more widespread adoption of family based services, including (a) finding time for overworked care personnel to implement additional services, (b) reducing the extensive training requirements that commonly accompany family based programs, and (c) reducing demand on resources for implementation.” (p. 134)

“Technology can also support more automated and detailed family assessment, which can eliminate burdens related to service provider workload that currently serve as a barrier to the adoption and implementation of these programs. […] By moving to adaptive models of family based prevention and by integrating technology to automate the most labor-intensive aspects of service delivery and overcome barriers to family participation, family-based programs can (a) have a greater likelihood of reaching families in need; (b) have more detailed, accurate, and targeted information to customize service delivery; (c) more quickly and effectively engage families; and (d) be less labor-intensive to deliver, enabling these programs to achieve a scalable public health impact.” (p. 134)

“We suggest that state and federal policies strongly encourage the use of evidence-based practices in schools and provide training and support to enable more widespread dissemination and implementation of evidence-based programs in schools. […] Research on dissemination barriers and/or mechanisms to accelerate dissemination of evidence-based programs and practices in educational systems can be supported at the federal level by the Institute of Education Sciences.” (p. 135)

Other Interesting Tidbits for Researchers and Clinicians

“Researchers who want further support in advocating for effective policies can learn more at the National Prevention Science Coalition website, http://www.npscoalition.org/” (p. 133)

“Truly achieving significant reductions in poverty in the U.S. may require a movement that brings people together around a shared set of communitarian values. Prevention science has tended to focus on the development and implementation of evidence-based programs and, to a lesser extent, the impact of policy. However, significant undertakings of this nature often involve social movements that produce widespread changes in attitudes and in people’s shared understandings and commitments. […] Each of the initiatives that we suggest here seem more likely to be instituted if such a broad coalition can educate the public and policymakers about (a) the problem of poverty and the harm that it does, not only to children living in poverty, but also to the society as a whole (e.g., reduced innovation and productivity) and (b) the potential for evidence-based policies and programs to significantly improve America’s wellbeing.” (p. 135–136)

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add! To read the full article, click here.

Authored by Kseniya Katsman

Kseniya Katsman is a Master’s student in Forensic Psychology program at John Jay College of Criminal Justice. Her interests include forensic application of dialectical behavior therapy, cultural competence in forensic assessment, and risk assessment, specifically suicide risk. She plans to continue her education and pursue a doctoral degree in clinical psychology.

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