The Rural Families Program Makes a Difference

Iowa farm and rural families have faced a decade of unprecedented change, largely attributable to the economical restructuring that began in the mid-1980s, commonly referred to as the "farm crisis". The farm crisis resulted in high stress levels among families in rural communities (Heffernan & Heffernan, 1986; Thompson & McCubbin, 1987; Walker & Walker, 1987; U.S. Department of Health and Human Services, 1993). A synthesis of research findings indicated that major stressors were financial concerns, geographical isolation, farm labor resource needs, concern about the future of the farm, family and political issues, and time pressures. The most commonly reported stress symptoms were lack of concentration, sleep disruptions, deteriorating health, frequent bouts of anger, and conflicts with spouse or children.

Based on their findings, Walker and Walker (1987) suggested that stress management programs for farm families should include conflict resolution, work sharing, development of supportive and nurturing networks, cooperative decision making, cooperative problem solving, and time management. The authors also advised that stress-alleviating interventions should include coping strategies already accepted and used by rural people. The research findings of Marotz-Baden and Colvin (1986) indicated that the most frequently used strategies in dealing with stress among farm families were reframing (the ability to view change in relation to confidence in their ability to handle problems), seeking spiritual support, and seeking help from organizations.

Iowa State University (ISU) Extension utilized special funds from the 1985 and the 1990 farm bills to provide one-on-one outreach education to farm and rural families facing severe stress. That initiative, "The Rural Families Empowerment Program," was well received by the Iowa Department of Human Services (DHS), Division of Mental Health. When Floods Recovery Supplemental Grants became available for Iowa in late 1993, DHS- Mental Health funded the ISU "Rural Families Program."

The Rural Families Program, a one-on-one stress prevention intervention, was initiated in December 1994. The program sought to reduce the need for professional mental health services for clients adversely affected by stress in rural Iowa, through preventive education and by building community capacity to meet the needs of citizens. In addition, clients with severe mental illness as well as children with serious emotional disturbances would be identified and referred to professional counseling. These goals were consistent with two of the four goals in the strategic plan suggested by the National Association of State Universities and Land-Grant Colleges (1990) to revitalize rural economy for families and communities. These were to create community capacity through leadership building, and to assist in family and community adjustments to stress and change.

Iowa State University Extension to Families program units were staffed with at least one Rural Family Program Assistant (RFPA) who was a certified Family Development Specialist trained in group facilitation, dispute resolution, community development, diagnosis of mental health disorders, and crisis management. Clients were referred to the program by Extension personnel or by helping services and the financial community.

Needs of participants were determined through a literature review on stress prevention for rural families, informal conversations with farm and rural families, discussions with professionals in the field, and past programming experience. At the first in-home contact, the RFPAs worked with the program participants to identify family strengths and needs. They then helped them set realistic goals and formulate strategies to achieve them. Analytical and critical thinking approaches were utilized to identify family strengths, needs, and goals.

The in-home educational sessions included value orientation, dispute resolution, communication, and relationship skills as tools to develop strategies for resolving problems. The RFPAs used their facilitation expertise to intervene as participants and their families practiced newly acquired skills or strengthened existing skills needed to implement desired change toward goal achievement.

The RFPAs identified and referred family members with serious mental illness or severe emotional disturbances to appropriate support services. The participants exited the program after six-to-nine weeks, when they felt reasonably confident that they could set goals cooperatively and could implement strategies to achieve them. Each of the 15 RFPAs worked with about 60 families annually.

RFPAs also strengthened communities by establishing networks for generating their own resources and services through community capacity building efforts. These included efforts by a community group or organization (public or private) to provide new or enhanced services aimed at strengthening families. RFPAs facilitated group processes in the community capacity building effort.

An evaluation study was conducted to answer the following questions: To what extent did the Rural Families Program participants increase their self-perceived ability to deal with the stresses and strains of family and work life? What were the program benefits as perceived by program participants? A pre-test -post-test evaluation design was used. A pre-test instrument was administered by the RFPA to the program participant (usually the head of the household) at first contact. The post-test instrument was mailed to program participants six weeks after program exit. Participants who did not return the completed post-test instruments were reminded through telephone or personal contact.

The pre-test instrument titled "Family Entry Assessment" contained three open-ended questions designed to elicit data on family strengths, needs, and goals. The instrument also included a self-assessment instrument designed to measure perceived ability to deal with 17 selected aspects of personal and family life. The indicators related to the ability to manage stress, communicate with family members, solve problems, network with formal and informal family support agencies, meet basic needs, manage finances, access basic health care, be good parents, be engaged in productive work, and ensure physical safety. Participants were asked to respond to each of the 17 statements on a five-point scale, reflecting their ability to deal with the stresses and strains of family and work life. The possible responses on the five-point scale were very good, good, satisfactory, needs work, and poor.

The post-test instrument, titled "Family Change Assessment," utilized the same 17 indicators included in the "Family Entry Assessment." The post-test contained two other structured questions designed to assess program benefits and one open-ended question designed to elicit information on the most important behavior change made as a result of program participation. A panel of Families Extension program development specialists at Iowa State University established the content validity of both instruments. The 17 indicators of personal and family life included in the instruments corresponded with the indicators of family well being proposed by Young, Gardner, Coley, Schorr, and Bruner (1994, p. 31)

Paired t-tests were used to assess differences between entry assessments and post assessments on the 17 indicators of family well being. Perceived program impact was assessed using both quantitative and qualitative methods. Descriptive statistics were used to analyze responses to the structured question of perceived impact. Qualitative analysis was done to examine the areas of program benefits by identifying recurring themes from responses to the open-ended question "What was the most important behavior change made as a result of participating in the program?"

Evaluation results were based on the pre-test and post-test data from 934 cases, collected from February 1, 1995 to June 30, 1997. Due to practical difficulties and circumstances beyond the control of the RFPAs, such as relocation of the participants or not keeping appointments, not all families provided post-test data.

The reliability of the instruments administered at entry and exit was assessed using the Cronbach alpha coefficient. The coefficients were .84, based on responses of 614 participants at program entry, and .89, based on the responses of 517 participants at program exit. Thus, the internal consistency of the instruments at entry as well as exit was found to be high.

Table 1 indicates statistically significant pre-test-post- test mean score differences on the 17 indicators of family well being. Post-test scores for all 17 indicators were higher than those of the pre-test.

Data in Table 1 show that at the time of the post-test, participants reported to have felt better able to cope with all 17 areas of family and work life.

To assess impact from a qualitative perspective, participants were asked the open-ended question "What was the most important behavior change made as a result of participating in the program?" The analysis of responses of the participants revealed the following major recurring themes: breaking free from debt and addiction, managing finances, making difficult farm business decisions, improving parenting skills, seeking help to maintain mental health, strengthening family relationships, finding and keeping a job, bringing hope to senior citizens, accessing community resources, improving communication and conflict resolution skills, meeting educational goals, gaining independence, and self-sufficiency.

Participants also reported that their RFPAs referred them to community service and support agencies to help them meet their needs. The agencies included service providers of mental health care, physical health and disability care, food assistance, primary health care, health education and support, continuing education, employment, housing, farm business, legal aid, banking and insurance, domestic abuse and neglect, and alcohol and drug abuse.

Each RFPA was responsible for the implementation of at least two community capacity building projects per year. Descriptive reports submitted by the RFPAs revealed that they implemented a wide range of community capacity building activities. Some of these were programs against domestic abuse, programs that identified at-risk preschool children and linked them with existing services, programs that prevented alcohol and substance abuse, programs for cancer screening, and programs for rehabilitation and support of adults and children receiving mental health care.

Four hundred and seventy-nine (61.3%) of the 781 clients responding felt that the program met their expectations well or very well, and 227 (29.1%) felt that the program greatly exceeded their expectations. An overwhelming majority 748 (95.5%) out of 783 respondents felt that they would probably or definitely recommend the program to others. For the majority of program participants, the program fulfilled or exceeded their expectations.

The evaluation results need to be interpreted with caution in view of the following limitations of the study: (a) Lack of validity--internal and external--of the experiment that may be attributed to the relatively less rigorous nature of the pre-test -post-test design (Borg & Gall, 1989, p. 663); (b) The 17 indicators of personal and family life that were measured were based on self-perceptions of participants. The element of subjectivity is likely to have affected the accuracy of the results; (c) In view of financial constraints and practical considerations, this study did not measure long-term program impact; (d) A follow up assessment after a period of six to nine months would have helped assess long-term program impact; (e) The researchers did not control for extraneous variables which may have been relevant to the results of the study.

The results of the study revealed that the Rural Families Program offered access to much needed resources and support to alleviate stress of rural families and appeared to have filled a gap in education and service in rural areas. Through the interactions with RFPAs, participants learned the skills required for better communication, conflict resolution, problem solving, decision-making, value clarification, goal setting, resource management, and making connections to community based services.

Through community capacity building activities the program helped strengthen small rural communities through establishing collaborations. The community capacity building activities helped inspire a shared vision for the future through the involvement and commitment of diverse groups of citizens. The Rural Families Program ended on June 30, 1997, when funding for the program terminated, leaving a gap in services that are much needed in rural Iowa.

Similar ongoing one-on-one outreach programs are critical to help severely stressed rural families cope with work and family crisis situations. However, when evaluating future programs, researchers should consider using a control group. If resources permit, researchers should consider a follow up with participants to determine long-term program impact.

Borg, W., & Gall, M. (1989). Educational research: An introduction. White Plains, NY: Longman Inc.

Heffernan, G., & Heffernan, J.D. (1986). When families have to give up farming. Rural Development Perspectives, (2)3, 28-31.

Marotz-Baden, R., & Colvin P.L. (1986). Coping strategies: A rural-urban comparison. Family Relations, (35), 281-286.

National Association of State Universities and Land Grant Colleges (1990). Revitalizing the rural economy for families and communities. Descriptive report. (ERIC document No. ED324148).

Thompson, E.A., & McCubbin, H.I. (1987). Farm families in crisis: An overview of resources. Family Relations, 36, 461- 467.

U.S. Department of Health and Human Services (1993). Taking rural into account: Report of the National Public Forum. Washington D.C.: Public Health Service, Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services.

Walker, L.S., & Walker, J.L. (1987). Stressors and symptoms predictive of distress in farmers. Family Relations, 36, 374- 378.

Young, N., Gardner, S., Coley, S., Schorr, L., & Bruner, C. (1994). Making a difference: Moving to outcome-based service reforms. (Resource Brief No. 7). Falls Church, VA: National Center for Service Integration.