Enhancing Nurse Home Visiting to Address Vulnerabilities and Prevent Maltreatment
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. While many home visiting models name child maltreatment prevention as a goal, success in this area has been mixed (Reynolds, Mathieson, & Topitzes, 2009; Le Croy & Whitaker, 2005; Duggan, et al., 2000). Even the Nurse Family Partnership model has been found not to have an impact on child maltreatment reports prior to age five (Zielinski, Eckenrode & Olds, 2009). This innovative field-university partnership will address important gaps in knowledge by conducting a study of an enhanced program to prevent maltreatment building on a well-established, large nurse home visiting program (Nurses for Newborns; NFN).
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. Finally, while the trial and pilot are conducted in a metropolitan region, the feasibility of expanding this effort into rural areas served by NFN will also be explored. This project tests the theory that one reason for the disappointing impact of nurse home visitation on maltreatment in prior research 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.
Melissa Jonson-Reid, PhD
John Constantino, MD
Eric Speigel, MD
Patricia Kohl, PhD
Health Resources and Services Administration
Nurses for Newborns
September 2012 – September 2015