Home Visits Research Articles

A Comprehensive, Home-Based, Fall Prevention Initiative: Preliminary Data From the Raise'Age Program.

Although falls among older adults pose substantial health risks and are often preventable, many fallers do not seek medical care. The Raise'Age program addresses this challenge by offering proactive fall prevention for older adults who require "lift assistance" but are not taken to hospital. The program includes (i) screening by emergency medical services (EMSs), (ii) referrals for a comprehensive geriatric assessment, (iii) in-home evaluations by a mobile geriatric team (MGT), and (iv) referrals to primary care physicians (PCPs). Here, we outline the program's design, development, and implementation. The program's activity in 2023 was assessed with regard to the number of EMS fall reports, the reports' completeness, the program's eligibility, and acceptance by physicians and patients, in-home assessments, adherence to geriatric follow-up programs, and coordination delays. In 2023, the Raise'Age program received 959 reports, accounting for 48% of lift assistances by paramedics. Of these, 37% of the reports were reviewed for eligibility. Reports were often archived due to irrelevance, a recent hospital stay, or difficulty contacting PCPs. Among eligible reports, 77% were approved for in-home evaluations, and the remainder were referred to a geriatrician or scheduled for hospital admission. The median processing time was 26 days. Of 228 patients eligible for home visits, 150 accepted the intervention. Visit acceptance rates were higher when a PCP endorsed the program. Follow-up was provided to 36% of the patients- primarily via teleconsultation. Finally, 15.6% of the patients for whom a lift assistance report was sent to the MGT completed the Raise'Age program. The Raise'Age program demonstrates that EMS screening and collaboration with MGTs are feasible, although some patients may decline the services offered. Continuous evaluations and interventions by MGTs and referrals to community-based medical and social services effectively address the needs of older adults.

A Situational Analysis and an Untapped Opportunity for Tackling Challenges Associated with Coverage of Tuberculosis Preventive Treatment: A Multi-Centric Study in India.

To assesses the coverage, adherence, reasons for non-initiation and non-completion of tuberculosis preventive treatment (TPT) among household child contacts (HHCC) of pulmonary tuberculosis (TB). This cross-sectional study was conducted across eight sites in India. Estimated sample size was 200 per site. Information was collected through record review and house-to-house visits of HHCCs of notified pulmonary TB cases during January to March 2022. Coverage and adherence was assessed by proportion of eligible HHCC initiated and completed TPT, respectively. Of 2554 HHCCs eligible for TPT, initiation and completion rate was 34% and 22%, respectively. Across the sites the median time to conduct home visit was 14 d (IQR 9, 22) and TPT initiation was 7 d (IQR 1, 21). Reasons for the non-initiation were no information provided by paramedical workers (82%), information provided by paramedical workers but TPT was not given (19%), parents felt it's not important (9%), and fear of side-effects (3%). Reasons for non-completion were: TPT received for less than six months (from healthcare providers) (54%), advised for the lesser duration TPT by the doctors (4%), parents felt completion was not important (32%), parents' fear of side-effects or myth (5%), and HHCC complained of side-effect (0.7%). Inadequate emphasis on home visits leads to TPT initiation in only one-third and completion in less than one-fourth of eligible HHCCs. This poor coverage was primarily due to the health system related issues. Rarely reported TPT side-effects highlighted its safety.

The cost-efficiency of vitamin A supplementation services in Kenya: An assessment of a Malezi Bora event in Kenya.

Vitamin A supplementation (VAS) remains a cornerstone of global child survival programs. As available funding declines, countries are seeking alternative delivery platforms. We examine a VAS-deworming delivery event in 2019 in Kenya, called Malezi Bora (MB), that employed four delivery platforms: health clinics, Early Childhood Development centers, community distribution points, and home visits. VAS coverage data were collected via household surveys in four subcounties, three of which received financial and technical assistance, and one of which received technical assistance only. Data on costs were collected using structured and semi-structured questionnaires. Only one subcounty achieved the targeted VAS coverage rate (80%) across most age subgroups; the subcounty not receiving financial assistance covered just 37% of children 6-59 months of age. Two other funded subcounties had higher coverage rates but failed to achieve 80% coverage for any age subgroup. Most children in the funded subcounties received VAS in their homes. Most children in the unfunded subcounty received VAS at a health facility. Being aware of MB was the most important factor associated with receiving VAS. Cost per child reached, including opportunity costs, varied across subcounties from $1.81 to $11.13 USD. Salaries were the main cost drivers.

The Pittsburgh Study: A Tiered Model To Support Parents During Early Childhood

ObjectiveTo test the feasibility of implementing The Pittsburgh Study’s (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children. Study designTPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1,040 children 4-years-old and under. Participants were assigned to one of four tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group. ResultsAbout 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary versus targeted/universal groups (81.4% vs. 72.8%), and tertiary versus universal and targeted/universal groups (83% vs. 74.1% and 72.8%, respectively; p < .001). ConclusionOur high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.

Caseworker Visitation After Reunification and Children's Reentry Into Foster Care: A Survival Analysis.

To prevent children from reentering the welfare system, it is crucial to understand the role of caseworker visits after reunification on reentry and identify the factors related to reentry. Utilizing the administrative data of one Mid-Atlantic state, children who reunified with their families between July 2016 and June 2020 were selected as the study sample (N = 3,510). Reentry rates were higher for children who did not have caseworker visits after reunification than for those who did. The survival analysis revealed that male children, living in metropolitan areas, having a prior history of removal, having a behavioral issue, and court-ordered return increased the risk of reentry, while Black children, older children, having a last placement as trial home visit, and caseworker visits after reunification decreased the risk of reentry. The study suggests formally outlining policies for post-reunification caseworker visits and increasing collaboration between the child welfare system and court system.

Effect of motivational interviewing to promote advance care planning among palliative care patients in ambulatory care setting: a randomized controlled trial

BackgroundMany patients have mixed feelings about end-of-life care, even when facing life-limiting conditions. Motivational interviewing might be useful for supporting patients in evoking reasons for advance care planning. This study aimed to examine the effects of an advance care planning program adopting motivational interviewing among palliative care patients.MethodsA two-arm parallel randomized controlled trial was conducted between January 2018 and December 2019 in the palliative care clinics of two hospitals. Adult patients who were newly referred to palliative care services, with a score of 60 or higher in the Palliative Performance Scale and mentally competent, were eligible for the study. While all participants received palliative care as usual care, those in the intervention group also received the advance care planning program through three home visits. The primary outcome was the readiness to discuss and document end-of-life care decisions, and the secondary outcomes included decisional conflict, perceived stress, and quality of life.ResultsA total of 204 participants (mean [SD] age, 74.9 [10.8]; 64.7% male; 80.4% cancer) were recruited. Generalized estimating equation analyses showed a significant improvement in readiness for advance care planning behaviors in the intervention group compared with the control group at 3 months post-allocation (group-by-time interaction, appointing proxy: β = 0.80; 95% CI, 0.25–1.35; p = .005; discussing with family: β = 0.76; 95% CI, 0.22–1.31; p = .006; discussing with medical doctors: β = 0.86; 95% CI, 0.30–1.42; p = .003; documenting: β = 0.89; 95% CI, 0.36–1.41; p < .001). The proportions of signing advance directives and placing a do-not-attempt cardiopulmonary resuscitation order were significantly higher in the intervention group, with a relative risk of 3.43 (95% CI, 1.55–7.60) and 1.16 (95% CI, 1.04–1.28), respectively. The intervention group reported greater improvements in social support and value of life than the control group immediately after the intervention. Significant improvements in decisional conflicts and perceived stress were noted in both groups.ConclusionsMotivational interviewing was effective in supporting patients to resolve ambivalence regarding end-of-life care, thereby increasing their readiness for discussing and documenting their care choices.Trial registrationClinicalTrials.gov Identifier: NCT04162912 (Registered on 14/11//2019).

Prevalence of undernutrition and associated factors among adolescent pregnant women in Dolo-Ado town, Somali region, Ethiopia.

Maternal malnutrition, particularly among adolescent pregnant women, is a significant public health issue globally, with far-reaching consequences for both maternal and fetal health. It increases the risk of complications such as stillbirth, low birth weight,preterm birth, uterine bleeding, and other pregnancy-related issues. This study aimed to assess the prevalence of undernutrition and associated factors among adolescent pregnant women (aged < 20years) in the Dolo-Ado town, Somali region, Ethiopia. A cross-sectional study was conducted from January 1-30, 2022, involving 380 pregnant adolescents randomly selected from the Dolo-Ado town. A structured, pretested questionnaire was used to gather data on socio-demographics, maternal nutrition, and obstetric characteristics. Nutritional status was assessed using mid-upper arm circumference (MUAC), with undernutrition defined as MUAC ≤ 22cm. Data were collected via home visits, and the accuracy of anthropometric measurements was standardized through training and pretesting. Descriptive statistics were used for data description, and binary logistic regression was performed to explore the associations between independent and dependent variables. A total of 380 pregnant adolescents participated, achieving a 100% response rate. The mean age of the participants was 17.7 (± 0.78) years. Approximately 32.1% of the participants experienced food insecurity, and only 3% met the minimum dietary diversity score. The prevalence of undernutrition was 21% (79/380), as indicated by a MUAC of < 22cm. The high prevalence of undernutrition among pregnant adolescent women in Dolo-Ado poses a significant public health concern. Key factors associated with undernutrition include maternal education [AOR] of 3.9; 95% Confidence Interval [CI]: 1.9-8.0), rural residence (AOR of 12; 95% CI: 3.5-42.9), low family income (AOR of 2.6; 95% CI: 1.2-5.4), food insecurity (AOR of 6.2; 95% CI: 2.8-13.9), iron-folic acid supplementation (AOR of 3.6; 95% CI: 1.7-7.5), and low dietary diversity intake (AOR of 13.1; 95% CI: 2.2-77.3). Therefore, targeted efforts to address family income, household food insecurity, dietary diversity, and access to iron-folic acid supplementation should be prioritized by both government and non-governmental organizations for pregnant adolescents.

A community-based father education intervention on breastfeeding practice in Ethiopia: a quasi-experimental study.

Breastfeeding is the cornerstone of a newborn's nutrition, containing crucial nutritional components. While a substantial body of research focuses on mothers, there is limited understanding regarding effective strategies to engage fathers in promoting breastfeeding practices. Therefore, this quasi-experimental study investigated a community-based intervention to improve breastfeeding exclusivity and initiation rates by targeting fathers in breastfeeding education. This research was conducted in Dessie City in the Amhara region of Northeast Ethiopia from 5th October 2020 to 30th August 2021. Fathers and their wives were assigned individually to the intervention and control groups. Baseline data were gathered from selected Kebeles (Kebele: the lowest administrative level in Ethiopia) to identify couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education services at health facilities or home visits during antenatal, delivery, and postpartum periods. Trained midwives participated in giving breastfeeding education. In the control arm, they received routine counseling activities. Factors associated with early initiation and exclusive breastfeeding were analyzed using multivariable analysis among the two groups. The intervention involved 327 participants, 155 in the intervention arm and 172 in the control group. The multivariable analysis indicated that the community-based father health education intervention significantly influenced the early initiation of breastfeeding. Mothers in the intervention group were found to be nearly five times more likely to initiate breastfeeding within the first hour of their infants' lives (AOR: 4.85, 95% CI: 1.36-17.32). A significant positive impact was also found for exclusive breastfeeding (EBF) of infants at the 1st, 4th, and 6th months (AOR: 3.95, 95% CI: 1.09-14.27), (AOR: 5.47, 95%CI: 2.18-13.70), and (AOR: 1.70, 95% CI: 1.02-2.85) respectively. This study confirmed the positive effects of a community-based father education intervention on the rates of exclusive breastfeeding during the first, fourth, and sixth months, as well as the early initiation of breastfeeding. The government and healthcare workers should implement policies supporting father-inclusive breastfeeding initiatives such as creating awareness and the critical role fathers' play.

Characteristics and outcomes associated with fidelity in the Family-Nurse Partnership in England: a data linkage cohort study

ObjectivesTo determine (1) which maternal and area characteristics are associated with reaching fidelity targets (the expected number of visits mothers should receive at each stage of the programme) in the...

Home visiting for postpartum depression.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits of home visiting models for postpartum depression amongst mothers of young children, where either the mothers or the children are enrolled in early childhood home visiting programs or interventions. To identify core components essential for a home visiting program to effectively address postpartum depression in mothers of young children. The hypothesized core components of such a program include the priority level given to PPD intervention, the type of home visitors, the intensity of the program, the percentage of BIPOC participants, and the service recipients' baseline level of and risk for depression.

Medically Tailored Grocery Deliveries to Improve Food Security and Hypertension in Underserved Groups: A Student-Run Pilot Randomized Controlled Trial

Background/Objectives: Randomized controlled trials (RCTs) are needed to evaluate the impact of food is medicine (FIM) programs, such as medically tailored groceries (MTGs) to treat hypertension among diverse populations. Partnerships between academic centers’ student-run organizations (SROs) and community-based organizations (CBOs) offer critical safety nets for historically underserved groups, positioning these organizations to effectively undertake FIM programs among populations disproportionately affected by hypertension. We conducted an unblinded pilot RCT whose objectives were to assess the feasibility and acceptability of an SRO-coordinated, CBO-partnered MTGs intervention targeting blood pressure (BP) and food insecurity (FI) in underserved groups. Methods: Adult Black/African American and Hispanic/Latinx patients in Durham, North Carolina, where essential hypertension and FI were randomized (parallel arm, computerized 1:1 ratio) to 12 weeks of home-delivered, hypertension-focused MTGs plus in-person nutrition education sessions with compensation (intervention) versus data collection sessions with compensation (control). We offered transportation, childcare, and home visits to facilitate session attendance. The primary outcomes were the eligibility, enrollment, and retention rates (feasibility), and the survey feedback from the participants and CBO partners (acceptability). The secondary outcomes included the changes in the mean BP and median FI score with associated 95% confidence intervals. Results: Medical record screening identified 1577 eligible participants. Of the 94 reached to confirm eligibility, 77 met the enrollment criteria, and 50 were randomized (82% post-screen eligibility, 65% enrollment). A conventional content analysis of 15 participant surveys and CBO partner feedback affirmed the acceptability, noting intervention components that enhanced the retention (e.g., home delivery, transportation support, home visits). Pre–post analyses of secondary outcomes for 13/25 intervention and 15/25 control participants completing ≥2 sessions ≥2 months apart were performed. The intervention was associated with an average change in systolic BP of −14.2 mmHg (−27.5, −4.5) versus −3.5 mmHg (−11.7, 5.9) in the control group. The FI scores improved by −2 (−2.2, −0.5) in the intervention group and −1 (−1.3, −0.2) in the control group. No adverse events were reported. Conclusions: SRO-CBO partnerships could be feasible and acceptable avenues for conducting FIM trials among underserved populations. This multi-component FIM approach enhanced the study equity by addressing the participants’ disease-related social needs and warrants expansion into a powered RCT.

Transformative learning in community healthcare practicums: Impact on nursing students’ professional development

This study explores the transformative learning experiences of nursing students during community health practicums, focusing on how these experiences shape their understanding and professional development in healthcare settings. Grounded in Mezirow’s transformative learning framework, this qualitative study employs Interpretative Phenomenological Analysis (IPA) to examine participants’ lived experiences, particularly their emotional and ethical challenges in real-world healthcare environments. Eighteen final-year nursing students, selected for their involvement in community health practicums, participated in semi-structured interviews. The participants, aged 19–21 years (with an average age of 20.68 years), comprised predominantly female students (88.88%). These students were chosen based on their exposure to complex healthcare challenges within the community healthcare context. The study identified four key themes. The first theme, Emotional Dilemmas Requiring Empathy and Professionalism, explores how students faced emotionally intense situations and developed essential emotional regulation skills. This theme highlights their ability to balance empathy with professionalism and navigate family disagreements in care decisions. The second theme, Ethical Dilemmas in Patient Care, addresses the ethical challenges students encountered, including decisions related to patients with limited recovery potential and respecting patients’ autonomy when they declined treatment. Through these experiences, students refined their ethical reasoning and decision-making capabilities. The third theme, Navigating Roles and Responsibilities within Community Healthcare Teams, examines how students clarified their roles within multidisciplinary teams, improving their communication and collaboration skills. This theme emphasizes the growth in confidence and adaptability as students engaged in team-based care. The fourth theme, Resource Allocation Ethics in Community Healthcare, discusses the challenges posed by resource limitations. Students developed critical thinking and adaptability as they navigated ethical dilemmas related to resource constraints, particularly in home visits and access to care. Through these experiences, students critically reassessed their beliefs, refined their ethical decision-making, and developed emotional intelligence and problem-solving strategies. Reflective practices, including journaling, played a key role in bridging theoretical knowledge with experiential insights, further enhancing adaptability and relational understanding. The findings underscore the significance of integrating transformative learning principles into nursing education. Structured experiential and reflective practices foster critical thinking, emotional regulation, and interprofessional collaboration, thereby preparing nursing students to address the challenges of contemporary healthcare with professionalism and ethical integrity.

Factors associated with assertiveness among Japanese community pharmacists: a cross-sectional study

BackgroundCommunity pharmacists play a crucial role in promoting medication safety within the community healthcare team. Effective communication by community pharmacists with other health professionals is essential to facilitate the sharing of patient healthcare information. In the context of information sharing between physicians and community pharmacists, assertive self-expression (defined as ‘a style of openly expressing one's needs and feelings while respecting others’) is beneficial. The aim of this study is to identify factors associated with assertive self-expression among community pharmacists.MethodsA cross-sectional study was conducted by surveying 3,446 Japanese community pharmacists working at pharmacies across 10 prefectures. Participants were invited to complete a survey form by email and assessed for assertive self-expression using the Interprofessional Assertiveness Scale. Characteristics of participants and pharmacies were compared using univariate analysis. A generalized linear model was used to explore the factors associated with assertive self-expression.ResultsA total of 961 responses by community pharmacists were included in the analysis. Univariate analysis identified significant differences in assertive self-expression scores based on age, employment status, education, years of working experience as a pharmacist, pharmacist home visit service, and participation in joint regional workshops or conferences. After adjustment, participation in joint regional workshops or conferences was significantly associated with assertive self-expression (odds ratio, 1.037; 95% confidence interval, 1.005–1.070; p = 0.023).ConclusionsThis study showed that assertive self-expression among community pharmacists was associated with participation in joint regional workshops and conferences. Further research is needed to examine whether enhancing assertive self-expression facilitates pharmacists' interprofessional communication skills and improves medication safety.

Stakeholder Perceptions of Digital Nutrition Education Modules on Infant Feeding in Home Visiting Programs.

Evaluate the usability and acceptability of a digital infant feeding module for use in a home visiting program. Home visitors (n = 11) and mothers (n = 10) completed a qualitative interview while viewing a digital nutrition education module on infant feeding. Quantitative data were collected using the mHealth App Usability Questionnaire. Qualitative data were analyzed using inductive thematic analysis. Most participants (90%) reported that they would very likely use the module as part of home visits. mHealth App Usability Questionnaire subscale scores supported usability on a scale of 0-7 with ease of use (6.9 ± 0.40), interface and satisfaction (6.9 ± 0.30), and usefulness (6.8 ± 0.50). Barriers to usability included technology access and phone compatibility. The digital infant feeding module was deemed usable and acceptable by home visiting stakeholders. Future research is needed to determine the impact of brief digital educational modules on parental feeding behaviors and child health outcomes.

Social Networks, Health Support, and Dietary Intake in Mothers Receiving Home Visiting Services.

Home visiting programs (HVPs) provide services to pregnant individuals and parents of young children to improve families' health and well-being. However, little is known about these families' social contexts. This study explores the social networks and dietary intake of mothers enrolled in a HVP, focusing on health support and health undermining. Cross-sectional data from 76 mothers enrolled in a HVP in Los Angeles County were collected by interview, using validated measures. Almost all mothers (95.7%) had one or more health supporters, while 55.1% had one or more health underminers. Some key findings related to health support were that mothers with higher income had more health supporters in their network (b = 1.36, p = 0.03), and network members were more likely to be health supporters if they were a romantic partner (OR = 3.41, p < 0.001), a resource-based connection (OR = 3.46, p < 0.01), or if they lived in the same neighborhood as the mother (OR = 1.68, p < 0.05). Further, having a health supporter who lived in the same neighborhood was associated with consuming more (1 + daily servings) vegetables (OR = 3.0, p < 0.05) and no sugar-sweetened beverages (OR = 0.29, p < 0.05). There were fewer findings related to health undermining: network members more likely to be underminers were romantic partners (OR = 8.93, p < .0001), and those perceived as having overweight or obesity (OR = 3.98, p < 0.001), but health undermining did not predict dietary intake. Overall, a broad set of network features were linked with health support, and given that some types of support were linked with better diet, network-based diet interventions leveraging health support may be effective in this priority population.

Smartphone Applications-Based Intervention to Reduce Body Mass Index and Improve Health-Related Behavior Among Children with Overweight/Obesity: A Pilot Clinical Trial.

To assess changes in body mass index (BMI), diet and physical activity (PA) of 8-15-y-old children with overweight/ obesity, following a smartphone applications-based intervention; and to understand facilitators and barriers for BMI reduction. Children were enrolled through online sessions on childhood obesity for students, parents and teachers at five private schools in Delhi, and requesting parents who perceived their children as having obesity to contact the study team. Eligibility was confirmed through home visit by a technician. Questionnaires regarding diet, PA, attitude and practices were filled by participants and parents, followed by online intervention of three-month duration (weekly counselling; yoga classes 3 d/wk, sharing of resources on healthy eating, and goal setting), and repeat anthropometry by home visit. Twenty-six children (16 boys) aged 11.6 ± 2.3 y were enrolled. Mean BMI (kg/m2) decreased from 25.4 ± 4.3 to 24.6 ± 4.1, p < 0.001. Any reduction in BMI was seen in 19 (73.1%) children, and reduction > 1kg/m2 in 11 (42.3%), mediated by increase in the duration of PA and improvement in eating habits. The most cited barriers by parents were unhealthy eating when there were guests (by 69.2%); and problems with compliance due to conflicts between parent and child (by 38.5%). Smartphone applications-based online intervention was effective in improving diet and physical activity, and reducing BMI in children with overweight/ obesity.

Feasibility and Acceptability of the Mazi Umntanakho Digital Tool in South African Settings: A Qualitative Evaluation

ABSTRACTTo address the need for interventions targeting social emotional development and mental health of young children in South Africa, the Mazi Umntanakho (‘know your child’) digital tool was co‐designed, and piloted with caregivers and 3–5‐year‐old children involved in home visiting programmes promoting early childhood development. The aim of this study was to qualitatively evaluate the feasibility and acceptability of this tool in four urban and four rural low‐income communities, from the perspective of home visitors and caregivers. Focus groups were conducted with home visitors (n = 117) and caregivers (n = 72). Issues relating to the feasibility of implementing the tool included timing of using the tool, technical and social implementation challenges, WhatsApp as the preferred platform, and participants' recommendations for future implementation. Overall, the tool was acceptable for home visitors and caregivers and was perceived to have a positive impact on children's development, and the relationship between caregivers and children.

SAÚDE MENTAL NA MEDICINA DE FAMÍLIA: RELATO DE CASO EM CONTEXTO FAMILIAR

Depression is a serious mental health issue in Brazil, with high prevalence among women and individuals with chronic diseases, and is recognized as the leading cause of global disability. Objective: This study aimed to investigate the influence of the doctor-patient relationship in the Family Health Strategy (FHS) on the diagnosis and treatment of depression in a rural community. It is justified by the relevance of mental health in the context of primary care, where the FHS plays a strategic role. Method: The methodology involved a qualitative case study, analyzing the care of a 40-year-old patient provided by an FHS team in Monteiro-PB. Data were collected through home visits and interviews with the patient and her family, focusing on the interaction between the health team, the patient, and the community. The theoretical framework was based on primary care models and social determinants of health. Results: The results highlight that continuous follow-up, a humanized approach, and the strengthening of the family support network were crucial factors for the improvement of the patient’s clinical condition, with a reduction in depressive symptoms and suicidal thoughts. Conclusion: It is concluded that the FHS, by integrating decentralized and humanized actions, can have a positive impact on mental health in rural areas, reinforcing the need for public policies that expand coverage and enhance primary care services.

Early parent-child interaction and home environments of children exposed prenatally to opioids: A comparison of biological mothers and out-of-home caregivers.

Children born to mothers with opioid use disorder (OUD) are at increased risk of maltreatment and out-of-home care (OOHC) placement. This study examines the parent-child interaction quality and home environments of 92 New Zealand children with prenatal opioid exposure (OE) and 106 non-opioid-exposed (NE) children. Experiences for those in maternal care versus OOHC were of particular interest. Biological mothers completed a lifestyle interview during late pregnancy/at birth. At 18 months, parent-child interaction observations, maternal/primary caregiver interviews, and the Home Observation for Measurement of the Environment were completed during a home visit. At age 4.5, children underwent developmental assessment. By 18 months, 20% of OE children were in OOHC. Mothers with OUD who were younger, less cooperative, and had increased polysubstance use during pregnancy were more likely to have lost custody of their child. OE children in their mother's care experienced less positive parenting and lower-quality home environments than NE children. OE children in OOHC had similarly resourced environments to NE children, yet experienced lower levels of parental warmth and responsiveness. Early parenting predicted child cognition, language, and behavior 3 years later, underscoring the critical importance of supporting the parenting and psychosocial needs of OE children's parents/caregivers to improve long-term outcomes.

Drug-Dependent Mother’s Needs in Childcare: An Integrative Literature Review

Objectives: Substance abuse is becoming a particularly alarming issue among women and has been a concerning surge in societies. Childcare is a principal part of pediatric preventive healthcare. A robust body of research has linked maternal substance use with less optimal motherhood and childcare. Given the challenges of parenting for mothers with substance use, as well as the existence of a gap in the literature regarding substance use mothers’ needs in childcare, this integrative literature review was performed. This review aimed to explore the parenting needs of drug-dependent women to optimize the long-term health and development of their children. Methods: Electronic searching of Medline, PubMed, Scopus, Cochrane, Embase, Web of Science, SID, and Google Scholar was performed up to October 2024. Inclusion criteria consist of both English and Persian-published studies assessing childcare challenges and needs in drug-abused women. In the long run, 464 studies met the inclusion criteria. The quality of 20 final reports was evaluated by two researchers who extracted data based on the Whittemore and Knafl recommendations. Results: The childcare needs of these mothers were classified into two main categories: Health care &amp; clinical services (primary health care, perinatal health care, home visits, reproductive health care, breastfeeding counseling, exclusive breastfeeding training, family-planning, self-care education, health education, mental health screening, and counseling, educated health providers, healthcare accessibility) and human &amp; social services (parenting skills education, informative interventions, family counseling, psychological counseling, financial support, instrumental support, spiritual support, emotional support, risk behaviors control, social skills education, empower women, create peer communities, support networks, insurance plans). Conclusions: The childcare needs of these mothers were classified into two main categories: health care &amp; clinical services and human &amp; social services. The findings of this research indicate that childcare for mothers affected by opioid use disorder necessitates a multi-disciplinary approach to identify, develop, and address their needs.