Nurse Home Visitation Program Research Articles

Lessons Learned: Implementation of Pilot Universal Postpartum Nurse Home Visiting Program, Massachusetts 2013-2016.

Purpose Home visiting programs for new families in the United States have traditionally served high-risk families. In contrast, universal home visiting models serve all families regardless of income, age, risk or other criteria. They offer an entry point into a system of care for children and families, with the potential to improve population health. This paper describes lessons learned from the first threeyears of implementing a universal home visiting model. Description Welcome Family is a universal home visiting program in Massachusetts that offers a one-time visit by a nurse to new mothers up to eightweeks postpartum. The Massachusetts Department of Public Health (MDPH) is piloting Welcome Family in four communities with the goal of expanding statewide. Assessment Welcome Family served over 3000 families in its first threeyears. Program performance measures provided a framework to examine successes and challenges related to outreach and enrollment, program operations, and linkages with community resources. Early challenges included increasing referrals to a new program and limited capacity to serve all women giving birth. Local implementing agencies tested innovative strategies and MDPH made program modifications, such as developing quarterly data reports and establishing a learning collaborative, to address identified challenges. Conclusion MDPH is committed to the success of Welcome Family and uses continuous quality improvement to maximize the impact of the program on families and the system of care in Massachusetts. Lessons learned from the Massachusetts pilot can inform other states' efforts to enhance their early childhood systems of care through expanding universal home visiting.

A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective.

Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.

The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study.

We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

Improving children’s health and development in British Columbia through nurse home visiting: a randomized controlled trial protocol

BackgroundNurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States – improving children’s mental health and development and maternal wellbeing, and showing long-term cost-effectiveness. But it is not known whether the same benefits will be obtained in Canada, where public services differ. The British Columbia Healthy Connections Project therefore involves a randomized controlled trial evaluating Nurse-Family Partnership’s effectiveness compared with existing (usual) services in improving children’s mental health and early development and mother’s life circumstances. The trial’s main aims are to: reduce childhood injuries by age two years (primary outcome indicator); reduce prenatal nicotine and alcohol use; improve child cognitive and language development and behaviour at age two years; and reduce subsequent pregnancies by 24 months postpartum. Potential explanatory factors such as maternal mental health (including self-efficacy) are also being assessed, as is the program’s impact on exposure to intimate-partner violence. To inform future economic evaluation, data are also being collected on health and social service access and use.Methods/designEligible and consenting participants (N = 1040) are being recruited prior to 28 weeks gestation then individually randomized to receive existing services (comparison group) or Nurse-Family Partnership plus existing services (intervention group). Nurse-Family Partnership is being delivered following fidelity guidelines. Data are being collected during in person and telephone interviews at: baseline; 34–36 weeks gestation; and two, 10, 18 and 24 months postpartum. Additional data will be obtained via linkages from provincial datasets. Recruitment commenced in October 2013 and will continue for approximately three years.DiscussionThis trial will provide important information about the generalizability of Nurse-Family Partnership to the Canadian context. Findings will be published in peer-reviewed journals and shared with policymakers and practitioners through extensive public health collaborations already underway.Trial registrationRegistered July 18, 2013 with ClinicalTrials.gov Identifier: NCT01672060.

The effect of VoorZorg, the Dutch nurse-family partnership, on child maltreatment and development: a randomized controlled trial.

BackgroundChild maltreatment is a great public health concern that has long-term mental and physical health consequences and can result in death. We studied the effect of a nurse home visiting program on child maltreatment among young disadvantaged families in the Netherlands. This study is the first to investigate the effects of this program outside of the United States.MethodsWe conducted a single blind, parallel-group, randomized controlled trial that compared usual care with the nurse home visitation program, which began during pregnancy and continued until the children’s second birthdays, in 460 disadvantaged women who were pregnant for the first time and <26 years of age. The primary outcome was the existence of a report about the child from a child protecting services agency (CPS reports). Secondary outcome measures included home environment and child behavior.ResultsTwo hundred twenty-three participants were assigned to the control group, and 237 were assigned to the intervention group. Three years after birth, 19% of the children in the control group had a CPS report. The 11 percent of children in the intervention group with CPS files was significantly lower (relative risk 0.91, p-value 0.04). At 24 months, the intervention group scored significantly better on the IT-HOME. At 24 months after birth, the children in the intervention group exhibited a significant improvement in internalizing behavior (relative risk 0.56, p-value 0.04) but no evidence of a difference from the control group in externalizing behavior (relative risk 0.71, p-value 0.12).ConclusionThe number of CPS reports for the intervention group was significantly lower than that of the control group. Additionally, the long-term home environments were improved and internalizing behaviors of the children were lower in the intervention group.Trial RegistrationDutch Trial Register NTR854

Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses.

BackgroundThe Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. While the effectiveness of the NFP has been established in the United States, and is currently being evaluated in the Canadian public health care system, we have minimal understanding of how work of this nature impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels.MethodsThis two-phase study consisted of a qualitative secondary analysis of data from five focus groups conducted with PHNs (N = 6) who delivered the NFP intervention as part of a pilot study assessing feasibility and acceptability conducted in Hamilton, Ontario. The second phase, an interpretive description of individual interviews with the PHNs (N = 10) who have delivered the NFP in this context, further explored themes identified in the first phase. A practice, problem and needs analysis was conducted to describe and understand the phenomenon and promote sustainability of PHNs in this practice environment. Conventional content analysis was used to code and categorize data in the two datasets.ResultsThe nurse-client relationship, the core elements and structure of the NFP program and support of NFP colleagues were described as rewarding factors, while workload and workplace factors were identified as significant contributors to stress. PHNs described transforming their nursing practice through redefining success and shifting to a philosophy where the client is the expert of her own life. PHNs described the personal impact of worry about clients and doubt about their effectiveness in addressing client concerns. High levels of satisfaction were described in relation to the depth and intensity of relationships with clients and seeing them succeed over time.ConclusionsPHNs are impacted in multiple ways by their work with vulnerable, young mothers. The study findings have implications for identification of strategies to support PHNs in reducing staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improving program delivery.

Women's Reasons for Attrition from a Nurse Home Visiting Program

To describe mothers' reasons for leaving a home visiting program early. Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors. Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis. The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development.

Adaptation and implementation of the nurse-family partnership in Canada.

International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families. 108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24). Hamilton, Ontario.INTERVENTION AND DATA COLLECTION: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis. The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described. The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.

Adaptation and Implementation of the Nurse-Family Partnership in Canada

International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families.108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24).Hamilton, Ontario.INTERVENTION AND DATA COLLECTION: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis.The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described.The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.

Development of a nurse home visitation intervention for intimate partner violence.

BackgroundDespite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.MethodsFollowing a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.ResultsBased on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.ConclusionsNFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.

Maternal Jail Time, Conviction, and Arrest as Predictors of Children's 15-year Antisocial Outcomes in the Context of a Nurse Home Visiting Program

Data from the Nurse–Family Partnership intervention program were analyzed to compare the “selection” versus “unique” effects of maternal jail time on adolescent antisocial and health risk outcomes. Data from 320 women and their firstborn children were available from the prenatal, birth, and 15-year assessments. Consistent with a selection perspective, prenatal and demographic risks directly and indirectly related to many adolescent antisocial outcomes. Maternal conviction and arrest were also associated with adolescent contact with the criminal justice system and health risk behaviors. Maternal jail time predicted whether or not children had ever been stopped by police, sent to youth corrections, or run away from home. However, these associations were not significant after controlling for prenatal risk factors and maternal conviction and arrest. The results highlight the importance of maternal criminality and other risk factors in children's environments, including prenatal variables.

Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial

Child: Care, Health and DevelopmentVolume 37, Issue 5 p. 755-756 Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial Richard Reading, Richard ReadingSearch for more papers by this author Richard Reading, Richard ReadingSearch for more papers by this author First published: 04 August 2011 https://doi.org/10.1111/j.1365-2214.2011.01290_3.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume37, Issue5September 2011Pages 755-756 RelatedInformation

Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial

ObjectiveTo investigate the impact of a long-term nurse home visiting programme, embedded within a universal child health system, on the health, development and well-being of the child, mother and family.DesignRandomised...

Preventing mental disorders: the challenge ahead

Mental disorders, defined by alterations in thinking, mood, or behavior, are currently understood as the expression of deviant processes of brain development, precipitated by the conjoint effect of genetic predisposition, biological and environmental risks, which begin early in life and have last-longing effects [1, 2]. It is very likely that alterations in thinking, mood or behavior, as described by current diagnostic criteria, are late manifestations of deviant neurodevelopmental processes that are no longer sensible to remediation [3]. This would explain why available treatments for mental disorders are not curative. A good example of the persistence and severity of mental disorders and the limitations of currently available treatments is presented by Wachtel et al. in this issue [4]. To reduce the enormous burden caused by mental disorders, a logical strategy is to direct efforts to preventive measures, impeding deviations of neurodevelopmental processes or addressing them at early stages, when they are still sensible to modification [5, 6]. In fact, preventive interventions, such as hand washing and vaccines have played a crucial role in the history of medicine, and are clearly responsible for striking positive outcomes. However, prevention has not been a priority in the field of psychiatry until recently [6]. Nevertheless, a consistent body of evidence have accumulated over the past decades supporting the efficacy and effectiveness of preventive interventions that target a whole population (universal interventions) or individuals who are at risk of developing a disorder or who already present minimal symptoms (selective and indicated interventions, respectively) [6]. One example is a prenatal and early childhood nurse home visitation program for new mothers that reduced the incidence of antisocial behavior and use of substance in their offspring 15 years after the intervention [7]. Another example is the study by McArdle et al. in this issue [8] reporting the 2 and 3-year outcomes of a school-based intervention for children at risk or with behavioral or emotional difficulties in reducing general psychopathology. Children were identified by their teachers, and were subsequently randomized to either a drama group therapy or to a group of curriculum studies, which were delivered in weekly sessions over a school term. The investigators detected a decline in psychopathology as measured by teachers for the sample as a whole and low scores were maintained during time, with no effect reported by the subjects and their parents. The empirical evaluation of preventive measures faces several conceptual and methodological challenges. Universal strategies are expensive and it is not clear whether they are cost-effective as a group of interventions for preventing specific mental disorders. Selective and indicated interventions seem to be more cost-effective, but also offer challenges (for an excellent review on the subject, see [9]). One of the several challenges is to identify the deviant neurodevelopmental processes involved in the pathophysiology of the disorder, and have a specific intervention that addresses them. Besides that we need to reach at-risk children, who are not in the clinical settings, but at the community and schools. Teachers play a major role in this task, as the study by Lundervold et al. in this issue shows us [10]. Cognitive processing speed is an important aspect of intellectual ability, and seem to mediate the age-related G. V. Polanczyk (&) Department of Psychiatry, University of Sao Paulo Medical School, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Rua Dr Ovidio Pires de Campos 785, Sao Paulo, SP 05403-010, Brazil e-mail: gvp@usp.br

North Carolina Nurse-Family Partnership: Evidence-Based Nurse Home Visitation Program and Health Care Reform

North Carolina Nurse-Family Partnership: Evidence-Based Nurse Home Visitation Program and Health Care Reform

Systematic Review of Preventive Interventions for Children's Mental Health: What Would Work in Australian Contexts?

In childhood, mental health problems primarily consist of behaviour and emotional problems. These affect one in every seven children (i.e. 200 000 in Australia). Left untreated, up to 50% of preschool problems continue through the childhood years. Because of their high prevalence, population-based approaches will be needed to reduce their associated burden. The aim of the present study was therefore to identify evidence-based preventive interventions for behavioural and emotional problems of children aged 0-8 years. Randomized controlled trials of preventive interventions for behavioural and emotional problems were located by searching standard clinical databases and systematic reviews. The authors determined which programmes were effective and ineffective, dividing the effective programmes into those with high or low risk of trial bias. Among effective programmes, the most promising for delivery in Australian contexts were identified, selected for their strength of evidence, sample comparability to Australia's population, and programme compatibility with Australia's service system. Around 50 preventive interventions have been evaluated in randomized controlled trials. Most targeted children's behavioural problems, and a few targeted emotional problems. Three US programmes have the best balance of evidence: in infancy, the individual Nurse Home Visitation Programme; at preschool age, the individual Family Check Up; at school age, the Good Behaviour Game class programme. Three parenting programmes in England and Australia are also worthy of highlight: the Incredible Years group format, Triple P individual format, and Parent Education Programme group format. Effective preventive interventions exist primarily for behaviour and, to a lesser extent, emotional problems, and could be disseminated from research to mainstream in Australia, ensuring fidelity to original programmes. Future research should develop programmes targeting emotional problems, and replicate effective programmes for behaviour problems in quality population translation trials. Randomized trial methods in staged roll-outs can determine population cost-benefits for children's mental health without delaying dissemination.

The Influence of Collaboration on Program Outcomes

Though collaboration is often required in community initiatives, little evidence documents relationships between collaboration and program success. The authors contend that clarification of the construct collaboration is necessary for investigating its contribution to the success of community initiatives. After respecifying collaboration, they present a study of a multisite program that involved varying degrees of collaboration in the 16 communities adopting a nurse home visitation program. The authors employ hierarchical linear modeling (HLM) to test the predictive power of individual participant characteristics and examine the increased accuracy of predictions from a second level model of site qualities--specifically, features of the collaborative process associated with different sites. The first-level model predicted approximately 10% of the variance in attrition, or dropout, of program clients. The second-level model accounted for an additional 28% of the variance in attrition. A theory of commitment transfer is offered as a first explanation of this result.

PROTOCOL: Effectiveness of Early Family/Parent Training Programs in Preventing Antisocial Behavior &amp; Delinquency

PROTOCOL: Effectiveness of Early Family/Parent Training Programs in Preventing Antisocial Behavior &amp; Delinquency

Policy Implications of Present Knowledge on the Development and Prevention of Physical Aggression

Research indicates that children are born with aggressive tendencies which they learn to control through early socialization. A small group, however, shows high aggression levels early on which remain stable throughout their life. Physical aggression is an epiphenomenon in a wide variety of antisocial behaviour, which wrecks the life of the individual as well as having large and negative consequences on society. The premise of this article is that physical aggression can be successfully influenced, but that there is a small window of opportunity in which to do this. Five rules about interventions which are more likely to be successful are presented: 1) the need for adequate evaluation, 2) the increased benefits of early prevention rather than later intervention, 3) intervention in multiple domains of the child’s life, 4) the importance of paying attention to treatment fidelity and professional execution, and 5) The current lack of substantive guidelines for specific interventions types. Within this context we review seven types of interventions to prevent physical aggression including: (1) promotion of physical health of mother and child, (2) increase family income, (3) increase access to existing services, (4) home visiting, (5) childcare, (6) preschool programs and (7) improving parenting. We conclude that promoting the physical health of mother and child should be more actively pursued, though additional experimental evidence is needed to clarify the relationship between health and social behaviour. An increase in family income, however, was not found by itself to help prevent the occurrence of physical aggression. An increase in access to existing services does not seem to reduce physical aggression, possibly because of the variable quality of these services. There is strong evidence that nurse home visitation programs, like the Nurse-Family Partnership, as well as some of the more rigorous preschool programs like the High/Scope Perry Preschool program, can be effective in deterring a child’s trajectory into violence, though more research in both these areas is needed and this research should be done by those who are not connected to these programs or past evaluations. Finally, we find that improving parenting through programmes like the Parent-Child Interaction Therapy programme can reduce the likelihood of violent behaviour, though, again, more experimental evidence is necessary. Overall, we argue that more experimental studies are necessary to better guide policy.

Reducing the Impact of Uncontrollable Stressful Life Events Through a Program of Nurse Home Visitation for New Parents

The current study examined whether the Nurse Family Partnership (NFP), an intervention in which mothers received home visitation by registered nurses pre- and postnatally, reduced mothers' vulnerability to the effects of stressful life events several years after the program was completed. Data from a randomized trial of the NFP were examined for mothers (N = 324) who were generally low-income, young, and unmarried at the time of the birth of their first child. Structured interviews were done with mothers about 15 years after the program began. Results showed that experiencing uncontrollable stressful life events, such as the death of a loved one, led to fewer negative outcomes (fewer mental health problems, less binge drinking, and better parenting practices) among nurse-visited mothers than among mothers receiving no visitation. Furthermore, the program's effect on reducing vulnerability to the negative impact of life events was particularly evident among parents who were younger or had a lower sense of personal control at intake. These findings suggest that, in addition to preventing the occurrence of negative outcomes that were direct targets of the intervention, the NFP more generally enhanced mothers' ability to cope with future stressful life events.