A total of 80 research participants took part in the study: 57 group participants completed pre- and post- data; 12 provided pre-test and follow-up data after a short-term counselling and therapy intervention; 4 families consented to be interviewed for the purpose of developing case studies about the Developmental Clinic participation, and 7 completed pre- and post- test interviews after receiving advocacy services. Data was collected between March, 1997 and August, 1998 and consisted of interviews with clients using both standardized measures and specially developed questionnaires and interview protocols. Data collection tools were designed to measure the objective of each of the interventions being evaluated. Data analysis included descriptive statistics to summarize the responses of participants and paired sample t-tests were used to test for significant differences between pre- and post- test data when it was available for ten or more participants. Content analysis of open-ended interview responses was carried out in order to identify dominant themes.

      Results showed that for the six groups evaluated (parenting, therapeutic and skill-based), group objectives were being met and desired improvements in the identified areas were occurring for participants. As well, participants reported satisfaction with their experience and particularly with the support they felt from meeting with other mothers. The Developmental Clinic services were extremely important for each of the families whose case studies were discussed. The cases presented illustrated the importance of the Developmental Clinic resources for children identified with biological difficulties and for parents who are anxious about the feeding and sleeping patterns of a normal infant. Mothers who received counselling/therapy services for four months, during the immediate post-partum period, demonstrated improved psychological functioning, and showed improved capacity to engage in a therapeutic relationship and to begin to be able to process and gain insight from discussion with their workers. In many instances it was possible to link up mothers to necessary services in the community. Perhaps most significant, the level of risk for the compromised development of their children was reduced. A large number of families received advocacy services, and pre- and post- test impact on the difficult life circumstances that the families had to deal with. Again, satisfaction with and appreciation of the service was high. Combining these findings with information obtained through the Process Evaluation study, research from early intervention studies, and the views of the Co-Directors and staff, the following program components were seen as being critical:       Early screening of mothers and newborns needs to be provided using a risk factor assessment and that immediate nursing and other services should be provided immediately in the neonatal period, as needed.

• Early screening of mothers and newborns needs to be provided using a risk factor assessment and that immediate nursing and other services should be provided immediately in the neonatal period, as needed.
• Ongoing and regular monitoring and assessment of children and families should be available and referral to intervention services within and outside the program occurs as necessary.
• Services should be provided directly to the child.
• Services need to be provided to enhance the parent-child interaction and relationship.
• Family support programs need to be provided to families.
• A community development component should be provided.

The following recommendations are made:

1. A budget is put in place to assure the continuity of the essential components of the program.
2. Efforts are made to expand services that are provided directly to children.
3. The program must continue to develop a number of approaches to meet the needs of the most multi-challenged families.
4. Caution be used around trying 'to be all things to all people' and instead efforts should concentrate on providing services which have proved to be effective or are consistent with the essential components outlined in this study.
5. Additional funds be provided if further research is to take place as the program's current resources cannot be used to carry out research without severely compromising the integrity of service delivery.