Addressing Psychosocial Risk Factors Among Families Enrolled in Home Visitation: Issues and Opportunities

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Psychosocial risk factors—in particular, maternal depression, substance abuse, and intimate partner violence—are prevalent among women enrolled in home visitation (HV) programs. Although HV programs have been shown to improve various maternal and child health outcomes, they have had more limited success in responding to clients’ psychosocial risk factors. This chapter has three objectives. First, this chapter provides recommendations for HV programs to identify psychosocial risks among their clients. To detect the presence of psychosocial risk factors, HV programs are encouraged to conduct systematic screening on an ongoing basis using well-validated instruments. Second, this chapter provides specific examples of approaches to enhance home visitors’ capacity to address psychosocial risks among their clients. HV programs should be explicit in defining when and how psychosocial risks are to be addressed by home visitors and ongoing support should be provided using approaches such as reflective supervision and coaching. Third, this chapter provides recommendations on ways to augment existing HV program models to address psychosocial risk factors. Multiple aspects of HV programs need to be focused upon (e.g., program models, training, and supervision protocols) to enact the recommendations put forth in this chapter. Also, critical to the successful implementation of these recommendations is the buy-in from HV program staff. Given the prevalence of psychosocial risks facing HV clients and the deleterious effects of these risk factors, it is imperative that HV programs strive to address these areas in a multifaceted and ongoing manner.