Early Childhood Home Visiting Research Articles

Visualizing Complex Adaptive Systems: A Case Study of the Missouri Maternal, Infant, and Early Childhood Home Visiting Program

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was created by the 2010 Patient Protection and Affordable Care Act. MIECHV provides comprehensive services to at-risk families through evidence-based home visiting programs. Purpose: The following question is addressed: Does the Missouri MIECHV system meet the definition of a complex adaptive system (CAS)? Methods: A systematic review was conducted of documents related to MIECHV programs (federal, state, and local levels), and to affiliated programs with a home visiting and early childhood (aged birth to 5 years) scope. The organizations’ fit was identified for the scope of early childhood home visiting programs, and then its relationship extracted to MIECHV and its affiliates. Results: MIECHV meets the definition of a CAS, being dynamic, massively entangled, scale independent, transformative, and emergent. Over 250 organizations were identified; 19 federal and 79 state organizations; 24 nonprofits at the federal level, 31 at the state; over 150 community-level agencies; and 13 home visiting models implemented in Missouri. Implications: A considerable amount of organizational complexity exists within the MIECHV system and among its affiliates with a home visiting and early childhood scope. The complexity of the system challenges its potential for effective and efficient implementation, coordination, sustainability, and evaluation, and increases the potential for redundancy, overlap, and fragmentation. Evaluating a CAS requires acknowledgement of its complexity, beyond traditional approaches to evaluation. Creating visualization tools of federal, state, and local stakeholders and their relationships is a practical approach for aligning, organizing, and communicating the work flow.

Federal Investments in Evidence‐Based Early Childhood Home Visiting: A Multiple Streams Analysis

AbstractChild poverty, child maltreatment, and child health and development are major public policy issues. By the end of the Great Recession in 2009, as many as one in four children under the age of five were living in poverty and six million children were subject to child maltreatment reports in America. For decades, evidence‐based home visiting (EBHV) programs have provided effective early interventions for preventing child maltreatment and promoting child and family outcomes to pregnant women and families with children age birth to five years old. Despite this, no widespread federal policies or funding supported home visiting before 2010. Through the Patient Protection and Affordable Care Act (ACA), the federal government invested $1.5 billion in home visiting with the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) initiative. While many articles examine the effectiveness of home visiting and call attention to the unprecedented features of MIECHV, this article applies the multiple streams framework to illuminate the unique social and political contexts culminating in the inclusion of MIECHV in ACA. The findings in this article are significant for policy analysts, advocates, and program developers and for establishing policies requiring evidence‐based practices.

Retention and attrition in a home visiting programme: looking back and moving forward

ABSTRACTObjective: The purpose of this study was to investigate retention and attrition in First Teacher, Alabama’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. Methods: Secondary data analysis was used to identify families that were most likely to leave through attrition; focus groups were conducted to discuss potential reasons for choosing to leave or stay in the programme. Results: Participants who were pregnant and under the age of 21 years were nearly eight times more likely to leave the programme than their peers. Focus group participants confirmed that it was frequently the relationship with their home visitor that influenced their decision to stay in the programme rather than leave. Conclusion: Based on social exchange theory, investigators observed that home visitors who seemed most successful at building and maintaining relationships with their clientele were women who expanded participant networks through an exchange of information and access to community resources.

Personal Characteristics of Effective Home Visitors

ABSTRACTHome visitation continues to be a common social service delivery strategy. In recent years, early childhood home visitation is experiencing a boon in popularity. Home visitors empower parents and are the lynchpin of home visitation programs but little research is available on these helpers. This qualitative study, conducted in the Midwest, examines a small (n = 11) purposive sample of home visitors who stood out to their administrators as excelling in their practice. Data include a) open-ended interviews with home visitors; b) home visiting situational vignettes; and c) a quantitative empathy scale. Results indicate that the home visitors possessed some important similarities, including the ability to form and maintain empathic relationships, a self-awareness allowing for reflective practice, an attitude of lifelong learning, and a belief in the ability of their clients to change by relying on their strengths and recognizing the importance of the environment in change efforts. The description of the personal characteristics of these home visitors provides a constructive foundation for future research, new information to home visitation programs that could be valuable in the staffing process, and insights for the training of home visitors or other professionals working with families through fieldwork.

Violence in the United States: Status, Challenges, and Opportunities.

Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence. To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities. We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation's Uniform Crime Reports, the US Justice Department's National Crime Victimization Survey, the National Survey of Children's Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System-All Injury Program. Homicide rates have decreased from a peak of 10.7 per 100,000 persons in 1980 to 5.1 per 100,000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100,000 in 1992 to 242 per 100,000 in 2012. Nevertheless, annually, there are more than 16,000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants. Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution.

Developing a fidelity assessment instrument for nurse home visitors.

Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs.

A Nationally Representative Study of Early Childhood Home Visiting Service Use in the United States.

Early childhood home visiting (HV) services are expanding broadly across the United States. Supported by federal policy, HV is now an integral part of maternal and child health services. However, no nationally representative estimate of HV use is available and no research has compared HV use across states. The 2011/12 National Survey on Children's Health was used to estimate the national and state prevalence of HV use for children 0-3 years. Generalized linear mixed modeling was used to predict HV use. An estimated 2,137,044 US children and families received HV during pregnancy and up to child age of 3 years. State HV prevalence range was 3.7-30.6 %. Nationally, 19.1 % of children below the federal poverty line received HV services. Although family poverty increased the odds of receiving HV services, higher rates of child poverty at the state level predicted less use of HV services. Important predictors of HV use include infant/child need factors (health risk, adverse experiences), predisposing factors (family size), and enabling factors (insurance type). This study provides the first estimates of national and state HV service use. Although findings indicate HV services are targeted to children at elevated risk for poor physical or developmental outcomes, our estimates show the vast majority of at-risk children did not receive HV services, including more than 80 % of low-income children, 76 % of preterm infants, and 57 % of very low birth weight infants. Increasing HV service availability could decrease negative health outcomes for young children.

Overview of the Federal Home Visiting Program

On March 23, 2010, the President signed into law the Affordable Care Act (Public Law 111-148), which included an amendment of Title V of the Social Security Act authorizing the creation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Authorized and funded at $1.5 billion for 5 years, the MIECHV represents a large investment in health and development outcomes for at-risk children through evidence-based home visiting programs. The MIECHV presents unprecedented opportunities to integrate early childhood services systems, not only on the federal level but also within states and local communities. The MIECHV is funded in escalating amounts over 5-year period authorized, as follows: $100 million in fiscal year (FY) 2010, $250 million in FY 2011, $350 million in FY 2012, $400 million in FY 2013, and $400 million in FY 2014. Most of the funding is being provided to states and territories to provide home visiting services in their at-risk communities. In addition, the legislation included a 3% set-aside for tribes, tribal organizations, and urban Indian organizations and a 3% set-aside for research and evaluation. This investment has spurred the creation of more comprehensive and coordinated early childhood service systems across the United States. This article provides an overview of the MIECHV program, including descriptions of the various requirements under the Affordable Care Act. These include partnering with states to provide evidence-based home visiting services to at-risk families, working with tribal communities to implement culturally competent home visiting programs, and developing a mechanism to systematically review the evidence of effectiveness for home visiting program models and to conduct a national evaluation of the MIECHV program.

Effectiveness of Home Visiting in Improving Child Health and Reducing Child Maltreatment

The Patient Protection and Affordable Care Act established the Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion to states over 5 years for home visiting program models serving at-risk pregnant women and children from birth to age 5. The act stipulates that 75% of the funds must be used for programs with evidence of effectiveness based on rigorous evaluation research. Home Visiting Evidence of Effectiveness reviewed the home visiting research literature and provided an assessment of the evidence of effectiveness for program models that serve families with pregnant women and children from birth to age 5. Home Visiting Evidence of Effectiveness included a systematic search and screening process, a review of the research quality, and an assessment of program effectiveness. Reviewers rated studies' capacity to provide unbiased estimates of program impacts and determined whether a program met the Department of Health and Human Services' criteria for an evidence-based model. As of July 2012, 32 models were reviewed, of which 12 met the Department of Health and Human Services criteria. Most of these models were shown to have favorable effects on child development. Other common favorable effects included health care usage and reductions in child maltreatment. Less common were favorable effects on birth outcomes. Home visiting is a promising way to serve families who may be difficult to engage in supportive services. Existing rigorous research indicates that home visiting has the potential for positive results among high-risk families, particularly on health care usage and child development.

Parents' participation in taking care of hospitalized children: a

AbstractBackground and objectiveAlthough “parents' participation in taking care of hospitalized children” is considered as anindispensible principle today, it is still among the concepts with no consensus about it. The mainobjective of this study is to define “parents' participation in taking care of hospitalized children”using hybrid model.Materials and methodsIn this research analysis of “parental participation in parents' participation in taking care ofhospitalized children” was performed using a hybrid model in three steps: literature review(theoretical step), field work, and combination of literature review and field work.FindingsBased on the step of literature review, the best definition for the concept of “parental participation intaking care of hospitalized children” was selected. In the field work step, dimensions of mentionedconcept were extracted; and finally definition of this concept by mixing theoretical and field workstep was proposed as: mutual relationship and gaining parents’ trust, giving required informationand educations to the parents about care and treatment process, asking parents for doing neededhome care jobs, involving the parents in care processes, and finally defining participation/decisionmaking authorities (clarifying the parents role).ConclusionThe findings of this study elucidated dimensions of parental participation in NICU where givingattention to them can lead to their putting to practice.Key Words: Parental participation, Hospital, Nursing, Hybrid model*Corresponding Author:Mahvash Salsali, Faculty of Nursing & Midwifery, Tehran University ofMedical Sciences, Tehran, IranE-mail : m_salsali@hotmail.comREFERENCES-Aein F Alhani F Mohammadi E et al (2009). Parental participation and mismanagement: A qualitative study of childcare in Iran. Nursing Health Science. 11(3) 221-227.-Aein F Alhani F Mohammadi E et al (2011). Struggling to create new boundaries: A grounded theory study ofcollaboration between nurses and parents in the care process in Iran. Journal of Advanced Nursing. 67 (4) 841–853.-Balling K Mccubbin M (2001). Hospitalized children with chronic illness: Parental care giving needs and valuingparental expertise. Journal of Pediatric Nursing. 16 (2) 110-119.-Chapados C Pineault R Tourigny J et al. (2002). Perceptions of parents’ participation in the care of their childundergoing day surgery: Pilot-study. Issues in Comprehensive Pediatric Nursing. 25(1) 59–70.-Corlett J Twycross A (2006). Negotiation of parental roles within family – centered care: A review of the research.Journal of Clinical Nursing. 15 (10) 1308-1316.-Coyne I (1996). Parent participation: A concept analysis. Journal of Advance Nursing. 23 (4) 733–740.-Coyne I Cowley S (2007). Challenging the philosophy of partnership with parents: A grounded theory study.International Journal of Nursing Studies. 44(6) 893–904.-Diaz-Caneja A Gledhill J Weaver T et al (2005). A child’s admission to hospital: A qualitative study examining theexperiences of parents. Intensive Care Medicine. 31(9) 1248–1254.-Doss S DePascal P Hadley K (2011). Patient nurse partnership. Nephrology Nursing Journal. 38(2) 115-125.-Elo S Kyngas H (2008). The qualitative content analysis process.The Journal of Advanced Nursing. 62(1) 107-115.-Espezel H Canam CJ (2003) Parent–Nurse Interactions: Care of Hospitalized Children. Journal of Advanced Nursing.44(1) 34–41.-Gamell A Corniero P Palazon P et al (2011). Parental presence during invasive procedures in Spanish pediatricemergency department: Incidence, perspective, and related anxiety. European Journal of Emergency Medicine. 18 (4)202-207.-Homer C Marino B Cleary P et al (1999). Quality of care at a children`s hospital. Archive Pediatrics and AdolescentMedicine. 153 (11) 1123-1129.-Hopia H Tomlinson P Paavilainen E et al (2005). Child in hospital: Family experiences and expectations of how nursescan promote family health. Journal of Clinical Nursing 14 (2) 212-222.-Huchfield K (1999). Family-centered care: A concept analysis. Journal of Advanced Nursing.29 (5) 1178-1187.-Hupcey J Penrod J (2005). Concept analysis: Examining the state of science. Research for Theory and Nursing Practice19 (2) 197-208.-Jolley J Shields L (2009). The evolution of family-centered care. Journal of pediatric nursing. 24 (2) 164-170.-Korfmacher J Green B Staerkel F et al. (2008) Parent Involvement in Early Childhood Home Visiting. Child Youth Care Forum. 37 (4) 171-196.-Kristensson-Hallstrom I (1999). Strategies for feeling secure influence parents' participation in care. Journal of ClinicalNursing. 8(5) 586-592.-Kristensson-Hallstrom I (2000). Parental participation in pediatric surgical care. American Operating Room NurseJournal. 71 (5) 1021–10241, 1026-1029.-McEwan M Wills E (2010). Theoretical Basis for nursing [3rd edition]. Philadelphia, Lippincott Williams &WilkinsCo.-Meleis A (2011). Theoretical Nursing, Development and Progress [5th edition]. Lippincott Williams & Wilkins co.-O`Haire S Blackford J (2005). Nurse’s moral agency in negotiation parental participation in care. International Journalof Nursing Practice. 11(6) 250-256.-Power N Frank L (2008). Parent participation in the care of hospitalized children: A systematic review. Journal ofAdvanced Nursing. 62 (6) 622-641.-Shields L Nixon J (2004). Hospital care of children in four countries. Journals of Advanced Nursing. 45(5) 475–486.-Tourigny J Chapados C Pineault R (2005). Determinants of parental behavior when children undergo day-care surgery.Journal of Advanced Nursing. 52(5)490–497.-Ygge B Arnetz J (2004). A study of parental involvement in pediatric hospital care: Implications for clinical practice.Journal of Pediatric Nursing. 19 (3) 217-223.-Ygge B (2007).Nurses' perceptions of parental involvement in hospital care. Pediatric Nursing. 19(5) 38-40

Revised Design for the Mother and Infant Home Visiting Program Evaluation

Home visiting programs in the United States seek to improve maternal and child health, child development, and family economic self-sufficiency by supporting and educating families with young children. Today, home visiting is seen as an important strategy for high-risk families who may be difficult to engage in other services. The Patient Protection and Affordable Care Act (ACA) of 2010 included $1.5 billion over five years for states to operate the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. It also required a national evaluation of the programs. This document describes the design of that evaluation — the Mother and Infant Home Visiting Program Evaluation (MIHOPE). MIHOPE was launched in 2011 by the Administration for Children and Families and the Health Resources and Services Administration within the U.S. Department of Health and Human Services. The evaluation is being conducted by MDRC in partnership with Mathematica Policy Research, James Bell Associates, Johns Hopkins University, the University of Georgia, and Columbia University.MIHOPE will include the following components:-An analysis of state needs assessments will describe the communities that states chose to target with MIECHV program services.-An implementation study will collect information on the services provided by local programs as well as the factors that helped shape those programs.-An impact analysis will estimate the effects of home visiting programs on family outcomes, both overall and for key subgroups of families.-An economic analysis will assess program costs and savings.The study will include approximately 5,100 families with a pregnant woman or a child under 6 months old. Families who enroll in the study will be randomly assigned to a home visiting group or to a comparison group that can use other services available in their community. Families will be spread across about 85 local programs in about 12 states. Sites must be operating one of four national models of home visiting: Early Head Start-Home Visiting Option, Healthy Families America, Nurse-Family Partnership, or Parents as Teachers. These four models were chosen because they are being implemented using MIECHV program funds in at least 10 states.Data for the implementation and impact studies will be collected from a variety of sources, including interviews with parents; observations of the home environment; observed interactions of parents and children; direct assessments of children’s development; observations of home visitors in their work with families during home visits; logs, observations, and interviews with home visitors, supervisors, and program administrators; program model documentation from program developers, grantees, and local sites; and administrative data on child abuse, health care use, maternal health, birth outcomes, and employment and earnings.The study will produce a report to Congress in 2015 that includes information on families and sites included in the evaluation as well as information on how states made decisions about how to spend home visiting funds. Later reports will provide more information on program implementation, the effects of home visiting programs for families, and the features of programs that are associated with larger effects.

Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation

In 2004, the U.S. Preventive Services Task Force determined that evidence was insufficient to recommend behavioral interventions and counseling to prevent child abuse and neglect. To review new evidence on the effectiveness of behavioral interventions and counseling in health care settings for reducing child abuse and neglect and related health outcomes, as well as adverse effects of interventions. MEDLINE and PsycINFO (January 2002 to June 2012), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the second quarter of 2012), Scopus, and reference lists. English-language trials of the effectiveness of behavioral interventions and counseling and studies of any design about adverse effects. Investigators extracted data about study populations, designs, and outcomes and rated study quality using established criteria. Eleven fair-quality randomized trials of interventions and no studies of adverse effects met inclusion criteria. A trial of risk assessment and interventions for abuse and neglect in pediatric clinics for families with children aged 5 years or younger indicated reduced physical assault, Child Protective Services (CPS) reports, nonadherence to medical care, and immunization delay among screened children. Ten trials of early childhood home visitation reported reduced CPS reports, emergency department visits, hospitalizations, and self-reports of abuse and improved adherence to immunizations and well-child care, although results were inconsistent. Trials were limited by heterogeneity, low adherence, high loss to follow-up, and lack of standardized measures. Risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. Additional research on interventions to prevent child abuse and neglect is needed. Agency for Healthcare Research and Quality.

Using Evidence to Influence Health Policy

At a recent evidence-based practice nursing research conference, Dr. Mary Wakefield (2011), the highest-ranking nurse in the U.S. government, stated that evidence-based health policy is as important as evidenced-based practice. As administrator of the Health Services and Resources Administration (HRSA), Dr. Wakefield oversees a $9.7 billion budget intended to improve access to health care services for people who are uninsured, medically vulnerable, and geographically distant. How can she and other government officials make the best decisions about which of potentially infinite health care policies to fund and implement?In her remarks at the conference, Dr. Wakefield (2011) described several important health initiatives that were based on evidence generated by the work of nurse researchers. For a moment, let us ponder two important questions: (a) What role does the level of evidence of health care recommendations play in a decision to institute a particular health policy initiative and (b) How can we teach our students, particularly DNP students, to incorporate health policy recommendations in their work?Regarding the first question, nursing evidence impacts health policy only when it is publicized and multiple disciplines outside of nursing become interested in how the evidence offers possible cost-effective solutions to the complex problems of public health (Hinshaw, 2011). In other words, a potential solution with a demonstrated high level of evidence to support its effectiveness in resolving a complex public health problem must also be publicized to influence health policy makers' decision to adopt the evidence-based solution.Although the level of evidence of information is important, the supporting evidence also needs to be of high quality, contain an economic analysis, and be politically viable. As a historical but important example, in 1997, nurse researcher Harriet Kitzman in collaboration with researchers from other disciplines pro- duced important evidence demonstrating the dramatic improvements in health outcomes achieved by teaching low-income pregnant women about prenatal health and childhood development (Kitzman et ah, 1997). Intervention outcomes included healthier pregnancies, less child abuse and neglect, and fewer trips to emergency rooms for accidents and poisonings (Kitzman et ah, 1997). As part of her remarks, Dr. Wakefield (2011) announced that $1.5 billion was authorized under the Affordable Care Act to create and implement a new Maternal, Infant, and Early Childhood Home Visiting Program. This $1.5 billion program was developed on the basis of well-publicized evidence generated by Kitzman and colleagues (1997).The Maternal, Infant, and Early Childhood Home Visiting Program proposes a solution to a complex public health issue. The visitation program improves the health outcomes of pregnant women and their children while at the same time sav- ing health care dollars. This program offers us an example of how a combination of high-level evidence and political savvy can influence national policy.According to the Robert Wood Johnson Foundation (2010), the program costs $4,500 per year per family. Thirty years of evidence including three randomized controlled trials and 9 years of intervention follow-up studies in multiple state sites caught the eye of politicians interested in cost-effective maternal-child health programs. In addition, longitudinal studies show that the cost savings to society is long-term (Robert Wood Johnson Foundation, 2010).Quantified, improved, and long-term clinical outcomes and cost savings led President Obama to support the program as a 2008 presidential candidate. As president, he asked the Congress to authorize support for the Maternal, Infant, and Early Childhood Home Visiting Program (Robert Wood Johnson Foundation, 2010).Dr. Kitzman's research demonstrates that a high-level quality of evidence is essential but not sufficient to impact health policy. …

Beyond the Pale of Psychoanalysis: Relational Theory and Generalist Social Work Practice

Many have noted the consonance between contemporary relational theory and classic social work values and practice principles such as person in environment and starting where the client is. However, there have been few efforts to explore relational theory’s utility to the generalist social work framework. This paper takes the position that relational theory’s intersubjective stance lends new coherence to classic social work principles, and therefore elucidates the process aspects of evidence-based social work practice. In order to illustrate this point, the author applies relational theory to implementation issues around early childhood home visitation with Spanish-speaking immigrant clients—a social work service modality that, like so many others, does not fall into the category of individual psychotherapy in the context of private practice.

Impact of a Kentucky Maternal, Infant, and Early Childhood Home-Visitation Program on Parental Risk Factors

As public health organizations continue to implement maternal and child health home-visitation programs, more evaluation of these efforts is needed, particularly as it relates to improving parental behaviors. The purpose of our study was to assess the impact of families’ participation in a home-visitation program offered by a central Kentucky health department on parental risk factors. A family social worker or nurse interviewed parents pre-intervention, completing a Parent Survey which assessed multiple parental risk factors associated with negative health and well-being and to calculate a total risk score. Upon exiting the program, parents are re-interviewed to document improvements, review progress and accomplished goals, plan for transitional services, and calculate a new risk score. As of December 2010, 64 families had completed the home-visitation program and had pre- and post-risk scores available for analysis. Based on paired-sample t tests, there was a statistically significant difference in total mean risk scores among both mothers and fathers from pre to post. The McNemar–Bowker test also revealed statistically different scores for four of the six risk factors for mothers and fathers pre- and post-home-visitation: lifestyle behaviors and mental health, coping skills and support systems, stresses, and anger management skills. Findings suggest that families who were deemed at-risk for adverse pregnancy and child health outcomes benefit from participation in the home-visitation program. Programs designed to promote positive pregnancy outcomes and child development may benefit from providing social support, fostering parental knowledge, skill development and problem solving, insuring proper medical care, and connecting parents with community resources.

Patterns of Intimate Partner Violence in Mothers At-Risk for Child Maltreatment

Using three interviews spanning 3 years, we identified intimate partner violence (IPV) classes and determined how class membership changed over time amongst a sample of 217 mothers at-risk for child maltreatment that were enrolled in an early childhood home visitation evaluation study. Data on perpetration/victimization, IPV type (verbal, physical, and sexual abuse and injury) and severity were used to conduct latent class analyses at each time point. Latent transition analyses established the proportion of mothers who changed classes over time. A three-class solution (minimal, moderate, and high IPV) was indicated at each time point. All classes included mutual IPV. Partners used minor verbal abuse in the minimal class, minor and severe verbal abuse and minor physical abuse in the moderate class, and all IPV categories in the high class. At each transition, 40% or more moved from minimal to moderate or high IPV. This movement emphasizes the need to screen women frequently and develop interventions recognizing the dynamic nature of IPV.

Reducing maternal intimate partner violence after the birth of a child: a randomized controlled trial of the Hawaii Healthy Start Home Visitation Program.

To estimate whether home visitation beginning after childbirth was associated with changes in average rates of mothers' intimate partner violence (IPV) victimization and perpetration as well as rates of specific IPV types (physical assault, verbal abuse, sexual assault, and injury) during the 3 years of program implementation and during 3 years of long-term follow-up. Randomized controlled trial. Oahu, Hawaii. Six hundred forty-three families with an infant at high risk for child maltreatment born between November 1994 and December 1995. Intervention Home visitors provided direct services and linked families to community resources. Home visits were to initially occur weekly and to continue for at least 3 years. Women's self-reports of past-year IPV victimization and perpetration using the Conflict Tactics Scale. Blinded research staff conducted maternal interviews following the child's birth and annually when children were aged 1 to 3 years and then 7 to 9 years. During program implementation, intervention mothers as compared with control mothers reported lower rates of IPV victimization (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.73-1.01) and significantly lower rates of perpetration (IRR, 0.83; 95% CI, 0.72-0.96). Considering specific IPV types, intervention women reported significantly lower rates of physical assault victimization (IRR, 0.85; 95% CI, 0.71-1.00) and perpetration (IRR, 0.82; 95% CI, 0.70-0.96). During long-term follow-up, rates of overall IPV victimization and perpetration decreased, with nonsignificant between-group differences. Verbal abuse victimization rates (IRR, 1.14, 95% CI, 0.97-1.34) may have increased among intervention mothers. Early-childhood home visitation may be a promising strategy for reducing IPV.

Home Visitation and Young Children: An Approach Worth Investing In? and commentaries

Home Visitation and Young Children: An Approach Worth Investing In? and commentaries

Relationship Work in an Early Childhood Home Visiting Program

A significant component of the work of public health nurses and paraprofessional home visitors who provide home visits to families with young children involves establishing relationships to effectively deliver the visiting program. The purpose of this qualitative and descriptive study was to describe the relationships among participants in a home visiting program in one regional health authority in the Canadian province of Manitoba. Interviews were carried out with 24 public health nurses, 14 home visitors, and 20 parents. The findings related to establishing, maintaining, and terminating relationships as well as factors influencing relationship work are described. Public health nurses and home visitors put significant effort into the work of establishing relationships with each other and their clients and require adequate training, sufficient human resources, and support from the program's administration to sustain these relationships.

Issues Related to Delivering an Early Childhood Home-Visiting Program

To describe the issues related to delivering an early childhood home visiting program, BabyFirst, from the perspective of public health nurses and lay home visitors (paraprofessionals). This descriptive, qualitative interpretive study had a sample of 24 public health nurses and 14 lay home visitors. One in-depth, semi-structured, audio-taped interview was conducted with each participant. Transcribed data were analyzed using content analysis techniques. Public health nurses and lay home visitors identified several issues associated specifically with the use of lay home visitors and more broadly with the delivery of the BabyFirst program. These are discussed in the following categories: issues related to (a) the lay home visitors, (b) the BabyFirst families, and (c) the general administration of the program. Findings from this study provide information about the issues related to providing home-visiting services delivered by lay home visitors that can be applied to policy and practice development. The findings suggest that in addition to careful selection of prospective applicants, considerable resources should be provided in preparing public health nurses and home visitors for their respective roles. The concerns identified by nurses and home visitors suggest the need to target the following three areas: (a) training and retention of nurses and home visitors, (b) program delivery, and (c) enrollment of families. Attention to the issues discussed in this article has implications for improving the BabyFirst home-visiting program and other similar early childhood programs.