Funded Projects

Enhancing Nurse Home Visiting to Address Vulnerabilities and Prevent Maltreatment

Grantee: Washington University
Principal Investigator: Melissa Jonson-Reid
Project Number: R62MC24947
Project Date: 9/1/2012

Age group(s)

• Prenatal
• Perinatal/Infancy (0-12 months)
• Toddlerhood (13-35 months)
• Women/Maternal

Abstract

Home visiting programs are in the forefront of evidence based practices designed to improve a broad range of child and family health outcomes (Brown & Sturgeon, 2004; Stagner & Lansing, 2009; Howard & Brooks-Gunn, 2009). Arguably one of the most costly, prevalent and serious threats to child well-being is abuse and neglect (Fang, Brown, Florence & Mercy, 2012). Unfortunately, our understanding of how to impact this outcome with nurse home visiting is limited. Few nurse home visiting (NHV) programs have been sufficiently studied and only the Nurse Family Partnership was reviewed as evidenced based in the recent systematic review sponsored by the US Department of Health and Human Services (Paulsell, Avellar, Sama Martin, & Del Grosso, 2011). This program, however, focuses only on first time mothers, must begin during the prenatal period, and has not had a substantial impact on child maltreatment during early childhood (Paulsell, et al., 2010). This model may both miss a substantial proportion of vulnerable families and by itself is not sufficient to prevent maltreatment. While other NHV models exist, they lack the empirical evidence to suggest these models as alternatives. Further, we have insufficient knowledge to guide practice with populations that may face additional barriers to benefitting from home visitation such as depressed and anxious mothers and families in rural areas. This proposal contains three major components poised to help address these gaps in our knowledge building on significant foundational studies and a close collaborative relationship with a large established, but understudied nurse home visiting program - Nurses For Newborns (NFN). NFN serves both rural and urban areas, targets very high risk families, enrolls in pre and postnatal periods up to 18 months, and both first-time parents and families with multiple children. This study follows feasibility work to conduct a randomized effectiveness trial of an evidence-based intervention (Problem Solving Therapy, PST) to address maternal depression and stress (risk factors for maltreatment). But because PST does not specifically target parenting, a second phase includes a randomized pilot of engaging mothers completing PST into a group format evidence-based parenting program (Incredible Years, IY) offered by a trained team collaborating on this project. This tests the theory that one reason for the disappointing impact of NHV on maltreatment may be the lack of intentional focus on maternal risks like depression and stress and the lack of focus on building parenting competence outside the domain of infant health. Finally, because of the unique use of laptops by NFN to record all visit information in the home and case notes, we are able to examine practice in the rural areas to assess feasibility of expanding the use of PST should the trial indicate advantageous results. A long collaborative history between the research team members with synergistic interests laid the foundation for this work along with a strong field-research partnership with NFN. As the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) enables states to expand programs like nurse home visiting, it is imperative that we understand more about promising models. It is also critical that we further develop knowledge about how to prevent the significant public health problem of child abuse and neglect. This project will specifically inform efforts to enhance nurse home visiting to be effective in the prevention of maltreatment and understanding of service delivery processes in rural areas that may pose specific challenges to such enhancements. Dissemination will include reports and web-based information for the practice community as well as peer reviewed journals and academic conferences.