Home Visitation Program Research Articles

Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study

ObjectivesThe aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations.MethodsOur study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests.ResultsData were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example).ConclusionWhen using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers.Protocol registrationISRCTN 58273216.

Parental Stress and Mental Health Symptoms in the NICU: Recognition and Interventions

Parental experiences in the NICU are often characterized by psychological stress and anxiety following the birth of a critically ill or premature infant. Such stress can have a negative impact on parents and their vulnerable infants during NICU hospitalization as well as after discharge. These infants are also at increased risk for adverse developmental, cognitive, academic, and mental health outcomes. Identifying parents at risk for psychological distress is important and feasible with the use of well-validated screening instruments. Screening for psychological distress is essential for identifying families in need of referral for psychological support and resources. Numerous interventions have been implemented in the NICU to support parents. These include staff-based support such as wellness rounds and education in developmental care as well as parental-based support that includes cognitive behavioral therapy and home visitation programs. Comprehensive interventions should use a multidisciplinary approach that involves not only NICU staff but also key stakeholders such as social workers, spiritual/religious representatives, specialists in developmental care, and psychiatrists/psychologists to help support families and facilitate the transition to the home. Future efforts should include raising awareness of the psychological stresses of NICU parents and encouraging the development of programs to provide parents with psychological support.

A randomized controlled trial testing the efficacy of a Nurse Home Visiting Program for Pregnant Adolescents

To test the efficacy of a nurse home visiting program (HVP) on child development, maternal and environmental outcomes in the first years of life. We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse HVP for adolescent mothers living in a poor urban area of São Paulo, Brazil. Eighty adolescent mothers were included and randomized to receive either Primeiros Laços (intervention group, n = 40) or healthcare as usual (control group, n = 40). Primeiros Laços is a home visiting intervention delivered by trained nurses that starts during the first 16 weeks of pregnancy and continues to the child’s age of 24 months. Participants were assessed by blind interviewers at 8–16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and 3, 6, 12, and 24 months of child’s age. We assessed oscillatory power in the mid-range alpha frequency via electroencephalography when the children were aged 6 months. Child development was measured by the Bayley Scales of Infant Development Third Edition (BSID-III). Weight and length were measured by trained professionals and anthropometric indexes were calculated. The home environment and maternal interaction with the child was measured by the Home Observation and Measurement of the Environment. Generalized estimating equation models were used to examine intervention effects on the trajectories of outcomes. Standardized effect sizes (Cohen’s d) were calculated using marginal means from endpoint assessments of all outcomes. The trial was registered at clinicaltrial.gov: NCT02807818. Our analyses showed significant positive effects of the intervention on child expressive language development (coefficient = 0.89, 95% CI [0.18, 1.61], p = 0.014), maternal emotional/verbal responsivity (coefficient = 0.97, 95% CI [0.37, 1.58], p = 0.002), and opportunities for variety in daily stimulation (coefficient = 0.37, 95% CI [0.09, 0.66], p = 0.009). Standardized effect sizes of the intervention were small to moderate. Primeiros Laços is a promising intervention to promote child development and to improve the home environment of low-income adolescent mothers. However, considering the limitations of our study, future studies should be conducted to assess Primeiros Laços potential to benefit this population.Clinical Trial Registration: The study was registered at clinicaltrial.gov (Registration date: 21/06/2016 and Registration number: NCT02807818).

Development and Validation of the Asthma Exacerbation Risk Score Using Claims Data

ObjectivePediatric asthma is a costly and complex disease with proven interventions to prevent exacerbations. Finding the patients at highest risk of exacerbations is paramount given limited resources. Insurance claims identify all outpatient, inpatient, emergency, pharmacy, and diagnostic services. The objective was to develop a risk score indicating the likelihood of asthma exacerbation within the next year based on prior utilization. MethodsA retrospective analysis of insurance claims for patients 2 to 18 years in a network in Massachusetts with 3 years of continuous enrollment in a commercial plan. Thirty-six potential predictors of exacerbation in the third year were assessed with a stepwise regression. Retained predictors were weighted relative to their contribution to asthma exacerbation risk and summed to create the Asthma Exacerbation Risk (AER) score. ResultsIn a cohort of 28,196 patients, there were 10 predictors associated with the outcome of having an asthma exacerbation in the next year that depend on age, meeting the Healthcare Effectiveness Data and Information Set persistent asthma criteria, fill patterns of asthma medications and oral steroids, counts of nonexacerbation outpatient visits, an exacerbation in the last 6 months, and whether spirometry was performed. The AER score is calculated monthly from a claims database to identify potential patients for an asthma home-visiting program. ConclusionsThe AER score assigns a risk of exacerbation within the next 12 months using claims data to identify patients in need of preventive services.

A Delphi study to identify intervention priorities to prevent the occurrence and reduce the impact of adverse childhood experiences.

There is a lack of a systematic, coordinated approach to reducing the occurrence and impact of adverse childhood experiences. Hence, identifying feasible intervention priorities in this field will help inform policy and reformation of ongoing service delivery. The objective of this study was to identify expert consensus-driven priority interventions for reducing the occurrence and impact of adverse childhood experiences in children under 8 years of age in the Australian context. A three-round online Delphi survey was conducted to establish consensus on 34 interventions for adverse childhood experiences identified through a literature search. Six were general categories of interventions, 6 were broad intervention programmes and 22 were specific interventions. Participants were 17 health practitioners, 15 researchers, 9 policy experts, 7 educators and 3 consumer advocates with expertise in adverse childhood experiences or child mental health. Consensus was defined as an intervention being rated as 'very high priority' or 'high priority' according to its importance and feasibility by ⩾75% of all experts. Seven of the 34 interventions were endorsed as priority interventions for adverse childhood experiences. These included four general categories of intervention: community-wide interventions, parenting programmes, home-visiting programmes and psychological interventions. Two broad intervention programmes were also endorsed: school-based anti-bullying interventions and psychological therapies for children exposed to trauma. Positive Parenting Program was the only specific intervention that achieved consensus. This is the first study to identify stakeholder perspectives on intervention priorities to prevent the occurrence and impact of adverse childhood experiences. Prioritisation of effective, feasible and implementable intervention programmes is an important step towards better integration and coordination of ongoing service delivery to effectively prevent and respond to adverse childhood experiences.

Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age

The Family Connects (FC) program, a community-wide nurse home visiting program for newborns, has been shown to provide benefits for children and families through the first 2 years of life. Potential longer-term outcomes for child well-being remain unknown. To determine the effect of randomization to FC on child maltreatment investigations and emergency medical care through 5 years of age. In this randomized clinical trial, families of all 4777 resident births in Durham County, North Carolina, from July 1, 2009, to December 31, 2010, were randomly assigned to receive the FC program or treatment as usual. Impact evaluation was on an intent-to-treat basis and focused on a subsample of 549 families randomly selected from the full population and included review of hospital and Child Protective Services (CPS) administrative records. Statistical analysis was conducted from November 6, 2020, to April 25, 2021. The FC programs includes 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs, deliver education and intervention, and connect families with community resources matched to their needs. Ongoing program engagement with service professionals and an electronic resource directory facilitate effective family connections to the community. Two primary trial outcomes were CPS-recorded child maltreatment investigations and emergency medical care use based on hospital records. Of the 4777 randomized families, 2327 were allocated to the intervention, and 2440 were allocated to services as usual. Among the children in the full study population, 2380 (49.8%) were female, 2397 (50.2%) were male, and 3359 (70.3%) were from racial/ethnic minority groups; of the 531 children included in the impact evaluation follow-up, 284 (53.5%) were female, 247 (46.5%) were male, and 390 (73.4%) were from racial/ethnic minority groups. Negative binomial models indicated that families assigned to FC had 39% fewer CPS investigations for suspected child maltreatment through 5 years of age (95% CI, -0.80 to 0.06; 90% CI, -0.73 to -0.01; control = 44 total investigations per 100 children and intervention = 27 total investigations per 100 children); intervention effects did not differ across subgroups. Families assigned to FC also had 33% less total child emergency medical care use (95% CI, -0.59 to -0.14; 90% CI, -0.55 to -0.18; control = 338 visits and overnight hospital stays per 100 children and intervention = 227 visits and overnight hospital stays per 100 children). Positive effects held across birth risk, child health insurance, child sex, single-parent status, and racial/ethnic groups. Effects were larger for nonminority families compared with minority families. The findings of this randomized clinical trial suggest that, when implemented with high quality and broad reach, a brief postpartum nurse home visiting program can reduce population rates of child maltreatment and emergency medical care use in early childhood. ClinicalTrials.gov Identifier: NCT01406184.

Understanding Risk and Protective Factors for Maternal Maltreatment: A Population-Based Comparative Analysis

This prospective population-based study explored whether mothers who maltreat had different risk and protective factors than mothers who don’t including the mother’s age when they had their first child, the number of births, marital status, whether the mothers were maltreated as a child and race. This study used data from the Queensland Cross-sector Research Collaboration (QCRC) repository, which included 18,019 mothers born in Queensland during 1983 or 1984 who were aged between 30 or 31 years at the time of data extraction. Mothers were categorised as maltreating (n = 998) or non-maltreating (n = 17,021) based on whether they had substantiated contact with the child protection system, and differences in risk/protective factors were explored. Results indicated that mothers who maltreat were more likely than mothers who don’t to have their first child at a younger age, significantly more children, less likely to be married, more likely to be Indigenous, and more likely to have experienced childhood maltreatment. Implications for policy and practice are discussed, including the need for culturally appropriate home visitation programmes and parenting programmes to reduce the likelihood of child maltreatment perpetration.

An Infant Carrier Intervention and Breastfeeding Duration: A Randomized Controlled Trial.

Parent-infant skin-to-skin contact immediately after birth increases initiation and duration of bodyfeeding. We hypothesized that providing ergonomic carriers to parents during pregnancy would increase the likelihood of breastfeeding and expressed human milk feeding through the first 6 months of life. A randomized two-arm, parallel-group trial was conducted between February 2018 and June 2019 in collaboration with a home-visiting program in a low-income community. At 30 weeks' gestation, 50 parents were randomly assigned to receive an ergonomic infant carrier and instruction on proper use to facilitate increased physical contact with infants (intervention group), and 50 parents were assigned to a waitlist control group. Feeding outcomes were assessed with online surveys at 6 weeks, 3 months, and 6 months postpartum. Parents in the intervention group were more likely to be breastfeeding or feeding expressed human milk at 6 months (68%) than control group parents (40%; P = .02). No significant differences were detected in feeding outcomes at 6 weeks (intervention: 78% versus control: 81%, P = .76) or 3 months (intervention: 66% versus control: 57%, P = .34). Exclusive human milk feeding did not differ between groups (intervention versus control at 6 weeks: 66% vs 49%, P = .20; 3 months: 45% vs 40%, P = .59; 6 months: 49% vs 26%, P = .06). Infant carriers increased rates of breastfeeding and expressed human milk feeding at 6 months postpartum. Large-scale studies are warranted to further examine the efficacy and cost-effectiveness of providing carriers as an intervention to increase access to human milk.

Improving the Life Chances of NICU Graduates.

* Abbreviations: FBBH — : Following Baby Back Home RCT — : randomized clinical trial Although the rates of mortality among extremely preterm and/or low birth weight newborns have been declining for decades, addressing the ongoing health and developmental needs of NICU graduates continues to be of considerable importance, given their increased susceptibility to neurodevelopmental impairments, other health problems, and mortality over the life course.1 In the current issue of Pediatrics , McKelvey et al2 report on a propensity-matched study of a home-visiting program designed to support parents in addressing their infants’ needs after NICU discharge. The program, known as Following Baby Back Home (FBBH), is delivered by nurse–social-worker teams who focus on helping parents meet their children’s medical and developmental needs, including supporting adherence to medical appointments, linking families with other health and human services, and promoting infants’ growth and development. The program continues through child age 3. Using a carefully crafted propensity-matched design, the authors found that compared with those in the control group ( n = 485), infants enrolled in FBBH ( n = 485) had higher rates of health … Address correspondence to David Olds, PhD, Prevention Research Center for Family and Child Health, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, 13121 E 17th Ave, Room 5317, Aurora, CO 80045. E-mail: david.olds{at}cuanschutz.edu

Changing Systems That Influence Birth Outcomes in Marginalized Zip Codes.

* Abbreviations: ECEP — : early childhood education provider FIMR-CAT — : Fetal and Infant Mortality Review Community Action Team GMCHL — : grassroots maternal and child health leader HP — : Healthy People IMR — : infant mortality rate MCH — : maternal and child health SDOH — : social determinants of health SSWG — : Safe Sleep Work Group Indiana’s government is prioritizing the reduction of the state’s persistently high infant mortality levels. Despite improvements in overall state and Black infant mortality rates, high rates persist within Indianapolis zip codes, characterized by multigenerational poverty and underrepresented minorities (Table 1). These rates occur in the presence of high-quality health care and home-visiting programs working to address the leading causes of infant death (birth defects, preterm birth and low birth weight, maternal pregnancy complications, and sudden unexpected infant death).1 Numerous studies, however, link infant mortality to underlying root causes associated with the social determinants of health (SDOH).2–4 Addressing the SDOH requires sustainable improvements in social systems that influence women’s health and birth outcomes. Our work complements the work of health care by building the capacity of individuals and organizations within targeted zip codes to remove social inequities that impact birth outcomes. View this table: TABLE 1 Indiana Urban Zip Codes With Persistently High Infant Mortality Rates, 2014–2018 Our work with families motivated and informed our approach. First, many families have experienced infant mortality across multiple generations. Second, even with public communication campaigns focused on prenatal care, safe sleep practice, and women’s health, many residents are unaware of the leading and root causes of poor birth outcomes. Third, residents are not aware of the linkages between social demographics and poor birth outcomes. Fourth, neighborhood networks within communities are often insular; likewise, policy-making networks are insular. There is a need to merge community and policy networks to facilitate dialogue and share realities and solution strategies. Finally, … Address correspondence to Nancy L. Swigonski, MD, MPH, MBA, FAAP, Department of Pediatrics, School of Medicine, Indiana University, 410 W 10th St, Suite 2000, Indianapolis, IN 46202. E-mail: nswigons{at}iu.edu

Child Development and Early Interaction: PERL Research Protocol, a Preventive Home Visiting Program, Randomized Controlled Trial in France.

Background: Early childhood is a key period for reducing the social inequalities that affect health. Some parenting support and home visitation programs have proven to be effective in assisting parents during this period. France's Protection Maternelle et Infantile (maternal and child welfare) services (PMIs) are at the heart of this primary prevention and may adapt their intervention to improve parenting support. In this manuscript, we describe the protocol of the PERL study, an intervention based on a home visiting program.Method and design: The PERL study is a single-center, randomized, controlled interventional trial. The aim was to assess the impact of a preventive home visiting program on the development of young children and parent-baby interaction. Visits were made by PMI nurses to 64 randomly recruited families from the general population. All families who had a baby born after 37 weeks of pregnancy between September 2018 and December 2019, and who resided in the trial area were eligible. Participants were randomly allocated to the intervention group or the control group. The PMI nurses made 12 home visits in the first year, 6 in the second year, and 4 in the third and fourth years of the child's life. Primary and secondary outcomes were measured when the child was 4 and 24 months old. These measurements recorded (i) the child's developmental milestones, in particular, language and socio emotional skills, (ii) early interaction, maternal sensitivity, and attachment patterns, (iii) maternal psychopathology including depression.Discussion: This study aims to assess the impact of home visits, made by specifically-trained and supervised nurses, on the child's development and parent-child interactions. Such interventions are complementary to other preventive programs addressing the impact of social inequalities on perinatal health. Placing nurses' professional skills at the center of this project may prove an effective and cost-saving intervention compared to existing programs. The study proposes a prevention model that is in keeping with the principle of reducing social inequalities in health by providing support from the earliest age through public service.Clinical Trial Registration: The clinical trial number is NCT03506971, registered on April 24, 2018.

Key lessons from a mixed-method evaluation of a postnatal home visit programme in the humanitarian setting of Gaza

Background: The World Health Organization recommends postnatal home visits to improve maternal and newborn health. Evidence of postnatal home visit effectiveness in humanitarian settings is limited. Aims: To evaluate postnatal home visits implemented in the constrained humanitarian context of Gaza. Methods: Qualitative data were obtained through key informant interviews, in-depth interviews and/or focus group discussions with women targeted by the programme, nontargeted women, husbands, and home visitors. These data were complemented by a secondary analysis of quantitative data from existing household surveys and project monitoring data. Qualitative data were analysed using thematic analysis, and quantitative data were analysed to describe trends over time. Results: Women in the programme demonstrated improved breastfeeding practices and increased uptake of breastfeeding, and behavioural changes reduced harmful traditional norms and practices. The programme increased mutual understanding and respect between health providers and women, allowed for a more personalized approach and increased self-esteem among the women. To improve postnatal care throughout the population, interventions should focus not only on home visits but also address immediate postnatal care in maternity, postnatal follow-up in clinics, and improvements in the coordination and communication between the different levels of care. Conclusion: Implementation of postnatal home visits in a constrained humanitarian context such as Gaza is feasible and positively contributes to breastfeeding and newborn care practices, as well as to improved interactions between health providers and their clients. Positive effects could be leveraged if postnatal care were strengthened throughout the continuum of care.

Development of an Asthma Home-Visit Training Program for Community Health Workers and Their Supervisors in Washington State.

The community health worker (CHW) asthma home-visiting model developed by Public Health-Seattle & King County (PHSKC) is an evidence-based approach proven to improve health outcomes and quality of life. In addition, it has been shown to be an effective and culturally appropriate approach to helping people with asthma understand the environmental and behavioral causes of uncontrolled asthma, while acquiring the skills they need to control their asthma. This paper describes the development and implementation of training curricula for CHWs and supervisors in the asthma home visiting program. To facilitate dissemination, this program took advantage of the current healthcare landscape in Washington State resulting from Centers for Medicare & Medicaid Services (CMS) approval of the 1115 Medicaid Waiver project. Key aspects of the training program development included: (1) Engagement: forming a Community Advisory Board with multiple stakeholders to help prioritize training content; (2) Curriculum Development: building the training on evidence-based home-visit protocols previously developed at PHSKC; (3) Implementation of the training program; (4) Evaluation of the training; and (5) Adaptation of the training based on lessons learned. We describe key factors in the training program's improvement including the use of a community-based participatory approach to engage stakeholders at multiple phases of the project and ensure regional adaption; combining in-person and online modules for delivery; and holding learning collaboratives for post-training and technical support. We also outline our training program evaluation plan and the planned evaluation of the home visit program which the trainees will deliver, both of which follow the RE-AIM framework. However, because the COVID-19 pandemic has curtailed training activities and prohibited the trainees from implementation of these CHW home visit practices, our evaluation is currently incomplete. Therefore, this case study provides insight into the adaptation of the training program, but not the delivery of the home visit program, the outcomes of which remain to be seen.

Recognition and Practice of Home-Management of Malaria among Mothers of Under-Five Children in Obafemi Owode Community, Abeokuta, Ogun State

The study investigates the factors influencing the recognition and practice of Home-management of malaria among mothers of under-five children in Obafemi Owode Community, Abeokuta, Ogun State. The study employed a descriptive cross-sectional design. The study employed a multi-staged sampling technique to select 299 nursing mothers of under-five children at the primary health care centre of Obafemi Owode Community. The main instrument for the study was a questionnaire. The selected socio-demographic variables were analyzed using the descriptive analysis while the hypotheses were tested using Pearson Product Moment Correlation and linear regression analysis. The result indicated that 38.5% of the nursing mothers had a high level of knowledge of home-based management of malaria. 55.9% of the respondents had an average attitude towards home-based management of Malaria. 46.8% had a good level of practice of home-based management of malaria. There was a significant relationship between the demographic factors of nursing mothers and knowledge of home-based management of malaria among nursing mothers of Obafemi Owode Community, Abeokuta, Ogun State (p< .05). However, the age of mother is not significantly associated with knowledge of home-based management (p> 0.05). The calculated R Squared and p-value for demographic variables on practice of home-management of malaria among nursing mothers is: 0.788 which signifies 78.8% contribution to practice of home-management among nursing mothers. Hence, all demographic characteristics of nursing mothers are significant predictors of practice of home-based management of Malaria among Nursing mothers of Obafemi Owode Community, Abeokuta, Ogun State. The study recommended that Primary Health centres should put in place mechanisms for example incorporating components of home visit in the performance appraisal of community Health Officers to ensure the recommended number of visits are adhered to. Also, caregivers’ seemingly inability to correctly dissociate between the two essentials of knowledge related to malaria can be addressed by Community Health Officers through the home visit programme.

A Qualitative Study of Mothers' Perspectives on Enrolling and Engaging in an Evidence-Based Nurse Home Visiting Program.

Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based nurse home visitation program shown in randomized trials to improve maternal and child health and life course outcomes for first-time parents experiencing economic adversity, particularly for mothers with limited psychological resources. The purpose of this study was to understand enrollment and engagement experiences of mothers with previous live births referred to NFP in a formative study of the program for this population, but did not enroll or dropped out before program graduation. We used a grounded theory approach and purposively selected three NFP sites with variation in enrollment rates. We conducted telephone interviews with 23 mothers who were either referred to NFP and declined enrollment or former clients who dropped out before graduation. All interviews were conducted in English, recorded, transcribed, and validated. We developed an iterative codebook with multiple coders to analyze our data in NVivo11 and wrote thematic memos to synthesize data across study sites. Mothers described experiencing overlapping risk factors including physical and behavioral health conditions, child welfare involvement, and housing insecurity. Mothers from all sites discussed how they were referred to the NFP program, their experience of the enrollment process, reasons for enrolling or not enrolling, and reasons for dropping out after initial enrollment. Key themes that influenced mothers' decision-making were: perceptions of program value, not needing the program, their living situation or being too busy as a deterrence, and past experiences including a distrust of health care. Reasons for attrition were related to no longer needing the service, being assigned a new nurse, being too tired postpartum, and moving out of the service area. One way to support home visiting nurses in family enrollment and engagement is to build their professional capacity to implement trauma-informed strategies given mothers' life experiences.

Evaluations on the Family Home Visit Programme of 3<sup>rd</sup> Grade Students’ in Ankara University School of Medicine

Evaluations on the Family Home Visit Programme of 3<sup>rd</sup> Grade Students’ in Ankara University School of Medicine

Faculty Service-Learning Students as Home-Visitors: Outcomes of a Lifestyle Modification Program for Vulnerable Families With Residents in Rural Indonesian Communities.

Background: Risks attributed to chronic diseases, cancer, musculoskeletal discomfort, and infectious diseases among Indonesians were found to be associated with lifestyle behaviors, particularly in rural areas. The aim of this study was to examine the outcomes of a home-visiting lifestyle modification program on improving health risk behaviors among Indonesians living in rural areas.Methods: A total of 160 Indonesians living in rural hamlets in the Yogyakarta Region of Indonesia participated in the program in the period of June 21 to July 21, 2019. In the pre-intervention home interview, learning needs of diet, exercise, hand hygiene, and substance use were identified by using structured assessment tools. In the next home visit, the visitors provided health education and facilitated lifestyle planning based on the related affective and cognitive domains of learning. Subsequent follow-up interviews were conducted 3 weeks after intervention.Results: The results showed that the self-reported intake of vegetables, fruits, meat and salt, cooking with less oil, hand hygiene before eating, number of cigarettes smoked, and symptoms of muscle stiffness significantly improved after the intervention. The lifestyle modification program consisted of the affective and cognitive domains of learning, and could lead to the target behavioral changes in self-reported and observable measures over 1 month.Conclusions: The findings contributed to the framework of community-based health education for health risk reduction and behavioral modification in developing rural communities where health care resources were limited. Further studies with control groups and vigorous objective measures were recommended to elucidate its long-term impacts. The factors leading to its sustainability concerning collaborative care partnerships between community residents and faculty resources are worthy of continued exploration.

Training Treatment Skill of Children Abuse Victims for College Students

Child abuse is a serious phenomenon that needs treatment to recover the victims. The present article aims at describing a training of giving treatments to recover children as victims from abuse and violence to show the students’ (participants) knowledge and service before they do internship program at an orphanage. The subject of research is 7th semester students of guidance and counseling program at Universitas Slamet Riyadi, Indonesia. The result of the research are the improvements of the college students’ knowledge and service in giving treatment for child abuse victims; they are familiar with six forms of treatment to recover the victims that consist of Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT), Parent Training and Multi-systemic Therapy, Project Support (Children’s Protective Services), Web-based parenting skills, Home Visiting Program, and School Based Mental Health Intervention for Children. The conclusion of the article is treatments in the form of collaboration between parents (caregivers), schools, and children (as victims) to recover child abuse and violence through a variety of phases to realize the purposes and children abuse as victims need appropriate treatment based on the condition of them and such six treatments as a choice and solution to recover the victims.

Siblings Are Also at Risk for Abuse.

Approximately 9 of every 1000 children in the United States are identified as victims of maltreatment, including neglect, physical abuse, emotional abuse, or sexual abuse.1 However, many cases of maltreatment are not identified,2 which has severe consequences for affected children.3 Although it is important to evaluate any child at risk for abuse, identifying risk can be challenging. In this issue of Pediatrics, Kisely et al4 evaluated whether siblings of children with suspected abuse are themselves at increased risk. These researchers followed a large cohort of sibling pairs in Australia. They found a 60-fold increase in abuse reports for siblings of children who had themselves been reported as abused previously. The risk was even greater when the mother was <20 years of age. The type of abuse (eg, physical, sexual, neglect) was often concordant between sibling pairs.Sibling risk has previously been studied but not on the scale of this new publication. Lindberg et al5 collected data from almost 3000 children who were evaluated for physical abuse. Contacts, including siblings or others in the same environment (including day care) of physically abused children were at significantly increased risk for injury.5 This risk was even higher among twins.Armed with the knowledge of the increased risk to siblings, medical providers and child welfare professionals should advocate for evaluations of these children at high risk. In cases of physical abuse, the evaluation by Lindberg et al5 included head imaging for contacts aged <6 months or those with mental status changes, skeletal surveys for contacts aged <2 years, and physical examinations for all contacts aged <5 years. This evaluation by Lindberg’s team parallels the recommended evaluation for any child when there is concern for physical abuse, although it may be reasonable to perform head imaging on any infant at high risk for abuse, such as siblings.6,7 To conduct a thorough examination, providers should familiarize themselves with injuries that are most specific for abuse, such as facial bruises and frenular injuries.8Siblings of sexual abuse victims should also be evaluated. Although the American Academy of Pediatrics policy statement on sexual abuse does not mention siblings or contacts, the National Children’s Alliance (the accrediting body for children’s advocacy centers) recognizes that siblings and other household contacts of abuse victims are themselves at risk.9,10 Evaluations for possible sexual abuse typically involve a forensic interview (if a child is developmentally capable) and a sexual abuse evaluation performed by a provider with training in pediatric sexual abuse examinations.9,10 Children’s advocacy centers are present throughout the country to assist in these evaluations of both suspected sexual abuse victims and their siblings.10The finding that children are at increased risk for maltreatment if they live with a young mother can help inform prevention efforts. For example, some home visitation programs, such as Nurse-Family Partnership, which works with first-time mothers in poverty, can help target the risks seen with young mothers, including lack of support and lack of education, and may have some benefit to prevent physical abuse.11As pediatricians, we are advocates for children, so our evaluation for suspected child abuse or neglect should include asking about the presence of siblings or other children in that environment. Subsequently, we should follow-up to ensure that any siblings are appropriately evaluated for abuse themselves.

Efficacy of home visits by public health providers for high-risk pregnant women in Egypt

Background: Home visits programs aim to improve care management for high-risk pregnant women. Birth outcomes, such as preterm birth, low birth weight (LBW), and small for gestational age (SGA), are crucial indicators of child development and health. The present study evaluates the efficacy of home visits by public health providers for high-risk pregnant women in Egypt to prevent adverse pregnancy outcome.Methods: This is a cohort study using administrative data collected in obstetrics department, Faculty of Medicine, Beni-Suef University. All women with high risk pregnancy were followed by home visits by public health providers.Results: Birth outcomes were documented and evaluated. Women from the home-visit group had a heavier birth weight 2752.85±286.571, longer gestational age 38.36±1.257, less LBW infants 52 (18.6%), less preterm birth 22 (7.9%), and less SGA infants 27 (9.6%) compared to participants who did not receive the home-visit program.Conclusions: Our findings suggest that home visits by public health nurses for high-risk pregnant women in Egypt might be effective in preventing preterm birth, but not SGA. This study adds to the evidence of the effectiveness of population-based home-visit programs as a public healthcare measure.