The Role of Home Visiting as an Early Intervention Strategy for Prevention of Child Abuse and Neglect

Abstract

Burgeoning numbers of child abuse and neglect reports throughout the developed world has prompted calls for preventive and early intervention measures to support and prepare families for parenting. Nurse home visiting is one form of service delivery gaining acceptance as an appropriate strategy. Although home visiting is not a new concept in service delivery, enthusiasm for home-visitation programmes has re-emerged not only in Australia in recent years, but in many other developed countries with initiatives being launched or recommended at state, national and international levels. This thesis presents a review of the tenets of home visiting and examines a home visiting intervention programme targeting children born into families with child abuse or neglect risk factors. A randomised controlled trial using a cohort of 181 families was undertaken to evaluate the impact of this home visiting programme. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting programme or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. This procedure was shown to have utility in the context of recruitment to a research trial, in that respondents were willing to disclose sensitive personal issues using this form of screening as the basis for targeted intervention. The home visiting programme examined by this study was also shown to have social validity, with mothers willing to accept this form of intervention from the immediate postnatal period. High retention and satisfaction rates strengthened this conclusion. The ability of this study to evaluate the effectiveness of the home visiting intervention programme may have been compromised by a range of contextual factors influencing programme outcomes detailed in this thesis. Nonetheless, the study found that, for a group of families reporting risk factors for child abuse and neglect potential, provision of an intensive home visiting intervention using nurses, social workers, and parent aides was not effective in producing more favourable adjustment to the parenting role over time compared with nonintervention or clinic based service provision. The intervention programme group participants gained knowledge of child development and child management skills during the early postnatal weeks while the comparison group participants developed knowledge and skills later in the first year of their infant's lift. Early adaptation to the parenting role, parenting knowledge, and skill acquisition bodes well for parent-infant attachment and the children's long-term health and developmental outcomes. However, a 12-month assessment of maternal, family, and child development variables did not demonstrate maintenance of a positive intervention impact on parenting stress, parenting competence, or quality of the home environment. Finally, predictive analysis of fictors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. These results not only demonstrate that there is a relationship between maternal, family and enviromnental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenge demographic targeting for child abuse and neglect risk. Findings are discussed and placed within the context of previous research and reference is made to implications for future child health practice, development, and research. Recommendations arising from this discussion relate to both future research and community child health practice.