Home Visiting: Best Practices Resource Guide

December 2002

Table of Contents

  1. Introduction
  2. Section I: Home Visiting Articles
  3. Section II: Home Visiting Special Publications
  4. Section III: Home Visiting Videos, Curricula & Websites
  5. How to Obtain Materials

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Introduction - December 2002

The Home Visiting Best Practices Resource Guide for the Family Home Visiting Program is divided into three sections. The first section (Home Visiting: Articles) consists of 43 key peer-reviewed articles from 1986 - 2002, which are numbered and abstracted for your convenience. These articles address a range of home visiting related topics, including research outcomes, theories, and practice models. We suggest that you review the abstracts, and if interested, obtain those articles that pertain to your program’s goal(s), objectives, and methods. The three digit numbers that precede each article are used to reference “Suggested Articles to Read” in the Family Home Visiting Statewide Evaluation Plan.

The second section (Home Visiting: Special Publications) is a compilation of special publications, some of which can be accessed via the Internet or can be ordered directly from the publisher. Information is also available on Dr. David Olds’ Nurse-Family Partnership approach to home visiting (www.nccfc.org/nurseFamilyPartnership.cfm).

The third section of this Resource Guide (Home Visiting: Videos, Curricula & Websites) lists several videos, curricula and websites that link to home visiting programs and other resources.

To obtain a copy of any of the resources listed in this document, see How to Obtain Materials.

Section I
Home Visiting: Articles - December 2002

001. Inj Prev 1997 Mar;3(1):14 6
Evaluation of a community based childhood injury prevention program.
Bablouzian L, Freedman ES, Wolski KE, Fried LE

OBJECTIVES: This pilot study evaluates the effectiveness of a community based childhood injury prevention program on the reduction of home hazards. METHODS: High risk pregnant women, who were enrolled in a home visiting program that augments existing health and human services, received initial home safety assessments. Clients received education about injury prevention practices, in addition to receiving selected home safety supplies. Fourteen questions from the initial assessment tool were repeated upon discharge from the program. Matched analyses were conducted to evaluate differences from initial assessment to discharge. RESULTS: A significantly larger proportion of homes were assessed as safe at discharge, compared with the initial assessment, for the following hazards: children riding unbuckled in all auto travel, Massachusetts Poison Center sticker on the telephone, outlet plugs in all unused electrical outlets, safety latches on cabinets and drawers, and syrup of ipecac in the home. CONCLUSIONS: A community based childhood injury prevention program providing education and safety supplies to clients significantly reduced four home hazards for which safety supplies were provided. Education and promotion of the proper use of child restraint systems in automobiles significantly reduced a fifth hazard, children riding unbuckled in auto travel. This program appears to reduce the prevalence of home hazards and, therefore, to increase home safety.

002: Home Health Nurse 1998 May; 16(5): 294-303; quiz 304
Postpartum home visits: extending the continuum of care from hospital to home.
Bennett RL, Tandy LJ

Crucial maternal, newborn, and family healthcare needs arise during the early postpartum period providing the opportunity for home care nurses to extend the continuum of care from hospital to home. This study identifies common early postpartum problems discovered on home health visits and describes the related interventions of home health nurses. Correlational analysis revealed that young mothers, first time mothers, breastfeeding mothers, and single mothers are priority candidates for follow up home care.

003: Pediatrics 2001 May;107(5):107
Home and videotape intervention delays early complementary feeding among adolescent mothers.
Black MM, Siegel EH, Abel Y, Bentley ME

OBJECTIVE: This investigation evaluated the efficacy of an intervention to delay the early introduction of complementary feeding among first-time, black, adolescent mothers living in multigenerational households. The intervention focused on reducing the cultural barriers to the acceptance of the recommendations of the American Academy of Pediatrics, WIC, and World Health Organization on complementary feeding by highlighting three topics: 1) recognition of infants’ cues; 2) non-food strategies for managing infant behavior; and 3) mother-grandmother negotiation strategies. The intervention was delivered through a mentorship model in which a videotape made by an advisory group of black adolescent mothers was incorporated into a home-visiting program and evaluated through a randomized, controlled trial. METHODS: One hundred eighty-one first-time, low-income, black mothers <18 years old, living in multigenerational households were recruited from 3 urban hospitals. Infants were born at term, with birth weight appropriate for gestational age and no congenital problems. Shortly after delivery, mothers and grandmothers completed a baseline assessment and mothers were randomized into an intervention or control group. Intervention group mothers received home visitation every other week for 1 year. At 3 months, a subset of 121 adolescent mothers reported on their infant’s intake through a food frequency questionnaire. Mothers who fed their infant only breast milk, formula, or water were classified as optimal feeders. Mothers who provided complementary foods other than breast milk, formula or water were classified as less optimal feeders. RESULTS: Sixty-one percent of the infants received complementary foods before 3 months old. Multivariate hierarchical logistic regression was used to evaluate the determinants of being in the optimal versus less optimal feeders group. After controlling for infant age and family income, mothers of infants in the optimal feeders group were more likely to report accurate messages from WIC regarding the timing of complementary food and nearly 4 times more likely to be in the intervention group. The most common complementary food was cereal mixed with formula in the bottle. CONCLUSIONS: The success of this relatively brief intervention demonstrates the importance of using ecological theory and ethnographic research to design interventions that enable participants to alter their behavior in the face of contradictory cultural norms. The intervention focused on interpreting infants’ cues, nonfood methods of managing infant behavior, and mother-grandmother negotiations. It was delivered through methods that were familiar and acceptable to adolescent mothers—a mentorship model incorporating home visits and videotape. The skill-oriented aspects of the intervention delivered in a culturally sensitive context may have enabled the young mothers to follow the guidelines that they received from WIC and from their pediatricians. Strategies, such as those used in this intervention, may be effective in promoting other caregiving recommendations, thereby enabling providers to meet the increasing demands from parents for advice regarding children’s early growth and development.

004: Image: Journal of Nursing Scholarship 1999;31(1):27-32
Questioning the quality of maternal caregiving during home visiting.
Byrd ME

PURPOSE: To formulate theory that will provide a meaningful framework for practice and for studies examining the efficacy of maternal-child home visits. DESIGN: Field research, over a period of 8 months, 1995-1996, conducted with one nurse employed by a visiting nurse association in rural New England. A total of 53 home visits were observed; documents and records were reviewed. METHODS: Data collection, field note recording, and analysis were simultaneous. Informal interviewing and observation of the key nurse participant throughout the day focused on her intentions, actions, and meanings as she anticipated, enacted, or reflected on her visits. Client-nurse interaction and client characteristics were described and interpreted. Analysis focused on the nurse’s home visits and the consequences of these visits. FINDINGS: The nurse conducted a specific type of home visit, identified as “child-focused,” in three patterns: single, short-, and long-term. The short-term pattern, labeled “Questioning the quality of maternal caregiving,” is described in this article. The nurse minimally questioned and then confirmed the quality of maternal caregiving during some visits, while she seriously questioned and then continuously doubted the quality of caregiving in others. The categories of potential consequences of these visits were maternal, child, interactive, and environmental. CONCLUSIONS: Future research should address the most effective processes for working with families when nurses doubt the quality of maternal caregiving. Field research was helpful in developing a beginning typology of maternal-child home visits, in understanding practice, and as a basis for further research examining the efficacy of maternal-child home visits.

005: Child Abuse & Neglect 2001;25:1269-89
Family preservation and family support programs: child maltreatment outcomes across client risk levels and program types.
Chaffin M, Bonner BL, Hill RF

OBJECTIVES: This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66. METHOD: A total of 1601 clients (primarily low-income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home-based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined. RESULTS: A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents. CONCLUSIONS: The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored.

006: Can J Public Health 1996; 87(3):193-8.
A systematic overview of the effectiveness of home visiting as a delivery strategy for public health nursing interventions.
Ciliska D, Hayward S, Thomas H, Mitchell A, Dobins M, Underwood J, Rafael A, Martin E

The purpose of this systematic overview was to assess the evidence for the effectiveness of public health nursing interventions when carried out by the strategy of home visiting. A search of published and unpublished literature resulted in retrieval of 108 articles; 77 articles were judged to be relevant. Validity criteria included method of allocation to the study groups, level of agreement to participate in the study, control for confounders, method of data collection (pretesting of data collection tools, blinding of data collectors to group allocation of study participants), quantitative measure of effect and percentage of participants available at follow-up. Using these criteria, 9 articles were judged to be strong, 5 moderate and 63 weak. There were no reported negative effects of home visiting in the 9 strong articles. Positive outcomes included improvement in children’s mental development, mental health and physical growth; reduction in mother’s anxiety, depression, and tobacco use; improvement in maternal employment, nutrition and other health habits; government cost saving; and reduced level of care required for the elderly.

007: Infant Mental Health Journal 1998;19(2):111-23.
Parent education home visitation program: adolescent and non-adolescent mother comparison after six months intervention.
Culp AM, Passmark L

Adolescent and nonadolescent mothers were visited weekly by trained and supervised child development paraprofessionals. The mothers were taught parenting skills, child development, and were linked to community services. Repeated measures multivariate analysis of variance (MANOVA) was used to determine group by time effects. After 6 months of intervention, the mothers significantly improved their knowledge of (1) infant development; (2) empathic responsiveness; and (3) child and parent roles in the family. In addition, the safety of their homes improved significantly and their involvement with agencies in the community increased significantly. The adolescent mothers scored significantly lower than the nonadolescent mothers at baseline on only two measures: knowledge of infant development and understanding of child and parent roles; however, after 6 months of intervention, their scores were not significantly different from the nonadolescent mothers. The model described in this paper seems to help adolescent and nonadolescent mothers even when the adolescent mothers begin the program with less information on child development and parenting than that of nonadolescent mothers.

008: Pediatrics 2000 Jan;105(1 Pt 3):250 9
Hawaii's healthy start program of home visiting for at risk families: evaluation of family identification, family engagement, and service delivery.
Duggan A, Windham A, McFarlane E, Fuddy L, Rohde C, Buchbinder S, Sia C

OBJECTIVE. To describe family identification, family engagement, and service delivery in a statewide home visiting program for at risk families of newborns. SETTING. Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at risk families of newborns via population based screening and assessment, and 2) paraprofessional home visiting to improve family functioning, promote child health and development, and prevent child maltreatment. DESIGN. Cross sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. SUBJECTS. Cross sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at risk families in the intervention group of a randomized trial of the HSP (n = 373). MEASURES. Process: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. RESULTS. Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have >/=12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but >/=80% of those active at 1 year, received core home visiting services. Performance varied by program site. CONCLUSIONS. It is challenging to engage and retain at risk families in home visiting. Service monitoring must be an integral part of operations.

009: Development and Psychopathology 2001;13:873-90
Child maltreatment and the early onset of problem behaviors: can a program of nurse home visitation break the link?
Eckenrode J, Zielinski D, Smith E, Marcynyszyn LA, Henderson CR Jr., Kitzman H, Cole R, Powers J, Olds DL

This study investigated the relationship between child maltreatment and the early onset of problem behaviors in the Elmira Nurse Home Visitation Program. Participants were predominantly low-income and unmarried mothers and their first-born children who were randomized either to receive over 2 years of home-visitation services by nurses or to be placed in a comparison group. Data were drawn from a follow-up study that took place when the children were 15 years of age. Results demonstrated that, in the comparison group, child maltreatment was associated with significant increases in the number of early onset problem behaviors reported by the youth. For the youth in the nurse-visited group there was no relationship between maltreatment and early onset problem behaviors. We suggest that this finding was due to the effects of the intervention in reducing the number as well as the developmental timing of the maltreatment incidents. Results suggest that prenatal and infancy home visiting by nurses can moderate the risk of child maltreatment as a predictor of conduct problems and antisocial behavior among children and youth born into at-risk families.

010: Public Health Nursing 1999;16(3):182-9
The adolescent parenting program: improving outcomes through mentorship.
Flynn L

The purpose of this study was to analyze the efficacy of a program designed to improve infant outcomes through the enhancement of health practices and parenting skills in a sample of 137 low-income, pregnant and parenting adolescents who reside in an urban area and who screened positive for risk of child maltreatment. Based on theories of mentorship and social support, the program provided intensive home visitation by nursing paraprofessionals, indigenous to the community, for the 2 year study period. Program outcomes were compared to local and national data. Findings revealed only 4.6% of program infants were low-birthweight compared to local and national percentages of 13.5% and 9.42%. The mean length of gestation was 39.27 weeks (SD=1.55). The incidence of infant morality was zero, comparing favorably with national data as well as the local infant mortality rate (almost twice the state average). There were only four cases of child neglect, representing only 2.91% of the sample. This finding also compares favorably with national data.

011: J Community Health Nurs 1999;16(1):17 28
Postpartum home visits: infant outcomes.
Frank Hanssen MA, Hanson KS, Anderson MA

Early postpartum discharge of mothers and infants has increased as health care providers and payers attempt to control health care cost. Questions regarding patient safety have been raised. Literature supports the safety of early discharge when providers adhere to strict discharge guidelines and when clients comply with home follow up. Previous studies calculated hospital readmission rates, but few examined other outcomes or characteristics. The purposes of this descriptive study were to examine outcome data for infant participants in a postpartum home visit program and to explore factors that may influence hospital readmissions for infants. Using an audit tool with established reliability and validity, a convenience sample of 199 infant medical records was reviewed for demographic information, characteristics, and outcomes. The hospital readmission rate for all infants within 3 weeks of discharge was comparable to other studies; however, the rate for only early discharge infants was higher than the rate reported in other studies. The study of postdelivery outcomes for infants provides additional insight into the issue of early discharge and may reflect the significance of postpartum follow up care and education.

012: Child Abuse & Neglect 2000;24(11):1399-1429
Home visiting intervention for vulnerable families with newborns: follow-up results of a randomized controlled trial.
Fraser JA, Armstrong KL, Morris JP, Dadds MR

OBJECTIVE: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child’s environment that predict poor adjustment to the parenting role. METHOD: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. RESULTS: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any
predictive value to demographic characteristics, which secondary prevention efforts typically target. CONCLUSIONS: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, the study not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.

013: ANS Adv Nurs Sci 1995 Dec;18(2):57 66
Implementing the COACH relationship model: health promotion for mothers and children.
Hanks C, Kitzman H, Milligan R

Program designers and nurses developed and implemented the COACH Relationship Model to help low income mothers change health related behaviors as part of a clinical trial conducted from 1990 to 1994 of the impact of nurse home visitation. By first orienting the program nurses to the theoretical underpinnings (caring, ecological, role supplementation, and self efficacy theories) and then involving them in developing program materials to translate the theoretical and philosophical concepts into nursing interventions, the essential features of the relationship model were retained through the implementation process.

014: J Pediatr 1989 Dec;115(6):927 31
Family support and parenting education in the home: an effective extension of clinic based preventive health care services for poor children.
Hardy JB, Streett R

A study was designed to assess the effect and cost of providing parenting and child care education in the home to inner city mothers of poor infants receiving comprehensive health care in a large federal Children and Youth Program. Randomly selected, healthy neonates weighing more than 2000 g and born to black women aged 18 years and older (n = 131) and to comparable control subjects (n = 132) were followed for a mean of 23.4 and 22.9 months, respectively. A community woman, with educational, social service, and medical backup support from the Children and Youth Program, made home visits 7 to 10 days after the birth and between regularly scheduled well child care visits. Improved compliance with well child care, fewer illness visits, and sharp reductions in hospitalization and in neglect or abuse were found in the visited group compared with the control group, and substantial cost was averted. Prerequisite and concomitant to focusing the mother's attention on the infant was the resolution of the numerous crises and survival problems experienced by these poor women. Only then was parenting education accepted by the mother.

015: Prof Care Mother Child 1998;8(6):161 3
Reducing child accidents: lessons from down under.
Haycock Stuart E

Home visits by public health nurses with knowledge of accident prevention strategies can reduce hazards to children. Several areas in Australia are developing "safe communities" in response to a WHO project. In several towns the public health nurse delivers age related safety information to families during routine contacts. Health visitor education in the UK is failing to respond to the challenge of reducing the main cause of death in children aged 1 4 years because it is not giving practitioners adequate preparation for accident prevention work.

016: Journal of Community Psychology 1997;25(1):77-93.
Paraprofessional home visitation: Conceptual and pragmatic considerations.
Hiatt SW, Sampson D, Baird D

The adaptation for paraprofessional visitors of a home visitation model originally developed for nurses is described. There are several hypothesized benefits of using paraprofessional home visitors, including power as role models and increased empathy with clients. Challenges inherent in employing paraprofessionals include limited formal education and resulting lack of credibility among professional care providers, difficulties in acculturation to the workplace, and learning how to effectively focus their commitment to and identification with the community. These challenges result in the need for unique training and sensitive and consistent supervision. Implementation data from the randomized trial of home visitation in Denver indicate that paraprofessional visitors conducted the program according to the prescribed visitation schedule and covered the material appropriately. Differences that emerged between nurse and paraprofessional visitors regarding content covered are discussed and suggestions are made for future programmatic considerations.

017: Environ Health Perspect 1998 Feb;106(2):79 83
Effect of interventions on children's blood lead levels.
Hilts SR, Bock SE, Oke TL, Yates CL, Copes RA

Trail, Canada, has been the site of an active lead/zinc smelter for nearly a century. Since 1991, the Trail Community Lead Task Force has carried out blood lead screening, case management, education programs targeted at early childhood groups and the general community, community dust abatement, exposure pathways studies, and remedial trials. From 1989 through 1996, average blood lead levels of children tested for the first time declined at an average rate of 0.6 microg/dl/year, while blood lead levels in Canadian children not living near point sources appeared to be leveling off following the phase out of leaded gasoline. Since there was no concurrent improvement in local environmental conditions during this time, it is possible that the continuing decline in Trail blood lead levels has been at least partly due to community wide intervention programs. One year follow up of children whose families received in home educational visits, as well as assistance with home based dust control measures, found that these specific interventions produced average blood lead changes of +0.5 4.0 microg/dl, with statistically significant declines in 3 years out of 5. Education and dust control, particularly actions targeted toward higher risk children, appear to have served as effective and appropriate interim remedial measures while major source control measures have been implemented at the smelter site.

018: Australian and New Zealand Journal of Family Therapy 1999;20(1):41-5.
Home visiting family therapy for children at risk.
Huston C, Armstrong K

Home visiting has a long history in the areas of health and welfare (Baldock, 1990: 121). Early intervention through home visiting programs has been found effective in preventing abuse and neglect in many countries including the USA (Olds, 1992), Ireland (Johnson, 1993), and Europe (Cox, 1993). The success of these programs lay in their effectiveness in reducing social isolation, improving parenting skills and enhancing self-esteem. This paper reports on the role of family therapy in home-based early intervention for families with newborns. The project has shown that a home-based multidisciplinary approach to vulnerable families’ needs is both acceptable and effective.

019: Public Health Nursing 2002;19(1):3-10
Dropping out of maternal and child home visits.
Josten LE, Savik K, Anderson MR, Benedetto LL, Chabot CR, Gifford MJ, McEiver J, Schorn MA, Frederickson B

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurse, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.

020: Journal of Nursing Scholarship 2000;32(4):369-76
Effects of home visits to vulnerable young families.
Kearney MH, York R, Deatrick JA

PURPOSE: This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim. DESIGN: The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity. METHODS: Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described. FINDINGS: Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported. CONCLUSIONS: Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.

021: Arch Dis Child 2000 Jun;82(6):443 51
Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.
Kendrick D, Elkan R, Hewitt M, Dewey M, Blair M, Robinson J, Williams D, Brummell K

AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

022: Pediatrics 2001 Aug;108(2):382-8
The effectiveness of a home visit to prevent childhood injury.
King W.J, Klassen TP, LeBlanc J, Bernard-Bonnin AC, Robitaille Y, Pham B, Coyle D, Tenenbein M, Pless IB

OBJECTIVE: To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. This randomized controlled trial examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention. SETTING: A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers. PARTICIPANTS: Children <8 years old, initially enrolled in an injury case-control study, were eligible to participate. INTERVENTION: Subsequent to a home inspection conducted to determine baseline hazard rates for both single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures. MAIN RESULTS: The median age was 2 years, with males comprising~60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (OR) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented. CONCLUSIONS: An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.

023: JAMA 2000 Apr 19;283(15):1983 9
Enduring effects of nurse home visitation on maternal life course: a 3 year follow-up of a randomized trial.
Kitzman H, Olds DL, Sidora K, Henderson CR Jr, Hanks C, Cole R, Luckey DW, Bondy J, Cole K, Glazner J

CONTEXT: A home visitation program using nurses to improve maternal and child outcomes had favorable results in a randomized trial with a primarily white, semirural population. Many of the short term findings have been replicated with urban blacks, but whether the program will continue to demonstrate effectiveness after its conclusion is uncertain. OBJECTIVE: To determine the effectiveness of a prenatal and infancy home visitation program on the maternal life course of women in an urban environment 3 years after the program ended. DESIGN AND SETTING: Three year follow up of a randomized controlled trial of women seen consecutively between June 1990 and August 1991 at an obstetrical clinic in Memphis, Tenn, who were enrolled in a visitation program for years after the birth of their first child. PARTICIPANTS: A cohort of 743 women who were primarily black, were pregnant for less than 29 weeks, had no previous live births, and had at least 2 sociodemographic risk factors (unmarried, <12 years of education, or unemployed). INTERVENTION: An average of 7 (range, 0 18) home visits during pregnancy and 26 (range, 0 71) from birth to the child's second birthday. MAIN OUTCOME MEASURES: Rate of subsequent pregnancy, mean interval between first and second birth, and mean number of months of welfare use. RESULTS: Compared with the control group, women who received home visits by nurses had fewer subsequent pregnancies (1.15 vs 1.34; P=.03), fewer closely spaced subsequent pregnancies (0.22 vs 0.32; P=.03), longer intervals between the birth of the first and second child (30.25 vs 26.60 months; P=.004), and fewer months of using Aid to Families with Dependent Children (32.55 vs 36.19; P=.01) and food stamps (41.57 vs 45.04; P=.005). Compared with the effect of the program while the program was in operation, the effect after it ended was essentially equal for Aid to Families with Dependent Children, greater for food stamps, greater for rates of closely spaced subsequent pregnancies, and smaller for rates of subsequent pregnancy overall. CONCLUSIONS: We found enduring effects of a home visitation program on the lives of black women living in an urban setting. While these results were smaller in magnitude than those achieved in a previous trial with white women living in a semirural setting, the direction of the effects was consistent across the 2 studies.

024: J Obstet Gynecol Neonatal Nurs 1999 Jan Feb;28(1):51 9
An early intervention program for adolescent mothers: a nursing demonstration project.
Koniak Griffin D, Mathenge C, Anderson NL, Verzemnieks I

OBJECTIVE: To improve health outcomes in a vulnerable population of adolescent mothers and their infants. DESIGN: Effects of an intensive early intervention program (EIP) are compared with those of traditional public health nursing (TPHN) care. SETTING: A large California county with urban and rural communities, an ethnically diverse population, and a high teen birth rate. PARTICIPANTS: One hundred twenty one young mothers and their children from impoverished and predominantly minority backgrounds. INTERVENTIONS: During pregnancy and through 1 year postpartum, participants (n=63) in the EIP were provided with 4 prenatal classes and approximately 17 home visits by specially trained public health nurses. Interventions addressed health issues, sexuality and family planning, life skills, the maternal role, and social support systems. Participants in TPHN (n=58) received three home visits (for intake, prenatal care, and postpartum/well baby care information). MAIN OUTCOME MEASURES: Antepartum, intrapartum, and newborn medical records; maternal responses to written questionnaires; and nurse interviews. RESULTS: Early program outcomes indicate reduced premature birth rates for both groups compared with national data on adolescent mothers, and fewer days of infant hospitalization during the first 6 weeks postpartum for the EIP participants. CONCLUSION: Public health nurse care (both traditional and intensive) significantly improved perinatal outcomes; the intensive intervention significantly reduced the number of infant hospitalization days.

025: Pediatrics 2000 May;105(5):1058 65
A randomized comparison of home and clinic follow up visits after early
postpartum hospital discharge.
Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM

BACKGROUND: Recently enacted federal legislation mandates insurance coverage of at least 48 hours of postpartum hospitalization, but most mothers and newborns in the United States will continue to go home before the third postpartum day. National guidelines recommend a follow up visit on the third or fourth postpartum day, but scant evidence exists about whether home or clinic visits are more effective. METHODS: We enrolled 1163 medically and socially low risk mother newborn pairs with uncomplicated delivery and randomly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day. In contrast with the 20 minute pediatric clinic visits, the home visits were longer (median: 70 minutes), included preventive counseling about the home environment, and included a physical examination of the mother. Clinical utilization and costs were studied using computerized databases. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks' postpartum. RESULTS: Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group, no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum, maternal or newborn urgent clinic visits within 10 days postpartum, or breastfeeding discontinuation of maternal depressive symptoms at the 2 week interview. The same was true for a combined clinical outcome measure indicating whether a mother newborn pair had any of the above outcomes. In contrast, higher proportions of mothers in the home visit group rated as excellent or very good the preventive advice delivered (80% vs 44%), the provider's skills and abilities (87% vs 63%), the newborn's posthospital care (87% vs 59%), and their own posthospital care (75% vs 47%). On average, a home visit cost $255 and a pediatric clinic visit cost $120. CONCLUSIONS: For low risk mothers and newborns in this integrated health maintenance organization, home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly, but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction. This study had limited power to identify group differences in rehospitalization, and may not be generalizable to higher risk populations without comparable access to integrated hospital and outpatient care.

026: MCN Am J Matern Child Nurs 1998 Nov-Dec; 23(6):322-8
Care paths. A new approach to high risk maternal-child home visitation.
Lowry LM, Hays BJ, Lopez P, Hernandez G

Care paths for the maternal and infant populations are used to define immediate and long term outcomes related to care received in the home. This article describes a care path developed by public health nurses for intervention with an at risk maternal child population in a city/county health department. A public health nursing care management model provided the framework for developing this care path to foster cost effective use of limited resources. It is crucial that public health nurses articulate clearly the services provided in the home both for those who may seek service and for policy makers who determine funding structure. The project demonstrated that care paths for home visitation involving high risk prenatal clients are useful tools that streamline documentation, foster consistency and continuity of care, facilitate quality improvement efforts, and provide outcome data.

027: Children and Youth Services Review 1996;18(3):243-59.
Outcomes of a home visitation trial for pregnant and postpartum women at risk for child placement.
Marcenko MO, Spence M, Samost L

This study is a randomized clinical trial designed to test the psychosocial efficacy of a pre- and postpartum home visitation model for women at risk for out of home placement of their newborns. An experimental and control group were randomly assigned out of 225 pregnant women with high-risk pregnancies for psychosocial reasons. After an average of 16 months of exposure to the intervention, women in the experimental group reported significantly greater access to services and there was a trend for the experimental group to show a decrease in psychological distress. At 10 months, there was a trend for experimental group women to experience an increase in social support, but this was not sustained at 16 months. Although the difference was not statistically significant, a higher percentage of women in the experimental group had children in out-of-home living arrangements. There was also a trend among those with children in placement, for children of experimental group women to be placed in extended family care rather than foster care more frequently than controls. The implications of the findings for interventions with at-risk families are discussed.

028: Child Welfare League of America 2000 Nov/Dec;LXXIX:711-28
Linking child maltreatment retrospectively to birth and home visit records: an initial examination.
Murphy DA, Braner M

This study tested the feasibility of linking administrative datasets for evaluation of home visiting as a strategy to reduce the incidence of child abuse and neglect. It also examined associations between maternal and child attributes coded in the birth record, and subsequent child maltreatment. The results show that home visiting efforts in Vermont were, in general, targeted to the populations most at-risk for child maltreatment. Mother’s educational attainment, in particular, was identified as a potent correlate of child maltreatment, a finding with implications for high school drop-out prevention and recovery efforts.

029: Public Health Nursing 2000 Jul/Aug;17(4):280-91
Social support and psychological functioning among high-risk mothers: the impact of the baby love maternal outreach program.
Navaie-Waliser M, Marin SL, Tessaro I, Campbell MK, Cross AW

This study compared two groups of high-risk Medicaid-eligible mothers, 221 who participated in a maternal home visitation program and 198 who did not, to determine whether program participation was associated with improvements in the mothers’ psychological functioning 1 year after delivery, and whether these improvements were associated with the type and intensity of support provided by home visitors. The results suggest that, compared to nonparticipants, participants provided with more intensive home visitor support had significantly higher self-esteem (p=0.039) and were less depressed (p=0.015). Participants with less intensive home visitor support, however, did not differ significantly from nonparticipants in their self-esteem or depression levels. No significant differences were observed in the perceived stress levels of participants as compared with nonparticipants, regardless of the intensity of home visitor support. Mothers who had support from the baby’s father, however, had significantly lower perceived stress levels than mothers with no support from the baby’s father (p=0.046). Moreover, the type of support provided by home visitors (emotional, instrumental, informational) did not appear to be related to the mothers’ psychological functioning. This study suggests that the intensity of support is an important component of maternal home visitation programs that aim to improve women’s psychological functioning.

030: Journal of Community Psychology 1997;25(1):47-57.
Application of solution-focused interventions to nurse home visitation for pregnant women and parents of young children.
O’Brien RA, Nacca RP

This article describes the recent evolution of a component of the theoretical foundations of a program of prenatal and early childhood home visitation tested in three randomized trials during the past two decades, first in Elmira, New York, then in Memphis, Tennessee, and most recently in Denver, Colorado. We discuss the use of a solution-focused approach by the nurse home visitors in further operationalizing that component of the program model which promotes client self-efficacy. We delineate the advantages of the solution-focused approach over a problem-solving approach in dealing with family concerns as well as the promotion of positive health behaviors. Basic assumptions of the solution-focused approach, techniques to facilitate solution-focused interactions, and illustrative applications of solution-focused interactions with pregnant women and parents of young children are presented.

031: Am J Dis Child 1992 Jun;146(6):704 8
Home visitation for pregnant women and parents of young children.
Olds D

Many of the most pervasive, intractable, and costly problems faced by high risk women and young children in our society today are a consequence of adverse maternal health related behaviors (such as cigarette smoking, drinking, and drug use during pregnancy), dysfunctional infant care giving, and stressful environmental conditions that interfere with individual and family functioning. These problems include low birth weight, child abuse and neglect, childhood injuries, unintended and closely spaced pregnancy, and reduced economic self sufficiency on the part of parents. Evidence is accumulating that these problems can be reduced with comprehensive programs of prenatal and infancy home visitation by nurses. While we are witnessing a renaissance of interest in home visitation as a means of addressing these problems, the recommendations of various health and human service advisory groups about the structure of proposed home visitation initiatives are uncoordinated and frequently inconsistent with the empirical evidence. Home visitation is a promising strategy, but only when the program meets certain standards. The more successful programs contain the following: (1) a focus on families at greater need for the service, (2) the use of nurses who begin during pregnancy and follow the family at least through the second year of the child's life, (3) the promotion of positive health related behaviors and qualities of infant care giving, and (4) provisions to reduce family stress by improving the social and physical environments in which families live.

032: Journal of Community Psychology 1998;26(1):5-21.
The promise of home visitation: results of two randomized trials.
Olds D, Henderson C, Kitzman H, Eckenrode J, Cole R, Tatum R

Two randomized trials of prenatal and infancy home visitation conducted in semirural and urban areas are described and their results are presented. The strudies provide consistent findings that nurse home visitors can improve women’s health related behaviors, qualities of infant caregiving, and can help women improve their own life-course development (reflected in behaviors such as rates of subsequent pregnancies and births, and receipt of welfare). The effects of the program on reducing the rates of dysfunctional care (reflected in rates of child maltreatment and health care encounters for injuries) were concentrated in women with few psychological resources.

033: Curr Probl Pediatr 2000 April;30(4):105-48
Update on home visiting for pregnant women and parents of young children.
Olds D, Hill P, Robinson J, Song N, Little C

This article reviews the evidence from scientifically controlled studies regarding the extent to which [home visiting] programs have been successful in meeting their goals and examine variations in design that may contribute to a program’s effectiveness. This is an updated analysis of scientifically controlled studies of home visiting published since a comprehensive review of this topic was reported by Olds and Kitzman in 1993. The six programs reviewed in this article are: 1) The Nurse Home Visitor Program; 2) Hawaii Healthy Start Program; 3) Healthy Families America; 4) Comprehensive Child Development Program; 5) Parents as Teachers; and 6) Home Instruction Program for Preschool youngsters.

034: Pediatrics 1990 Jul;86(1):108 16
Can home visitation improve the health of women and children at environmental risk?
Olds D, Kitzman H

We reviewed randomized trials of prenatal and infancy home visitation programs for socially disadvantaged women and children. Some home visitation programs were effective in improving women's health related behaviors during pregnancy, the birth weight and length of gestation of babies born to smokers and young adolescents, parents' interaction with their children, and children's developmental status; reducing the incidence of child abuse and neglect, childhood behavioral problems, emergency department visits and hospitalizations for injury, and unintended subsequent pregnancies; and increasing mothers' participation in the work force. The more effective programs employed nurses who began visiting during pregnancy, who visited frequently and long enough to establish a therapeutic alliance with families, and who addressed the systems of behavioral and psychosocial factors that influence maternal and child outcomes. They also targeted families at greater risk for health problems by virtue of the parents' poverty and lack of personal and social resources.

035: Journal of Community Psychology 1997;25(1):9-25.
Theoretical foundations of a program of home visitation for pregnant women and parents of young children.
Olds D, Kitzman H, Cole R, Robinson J

This article reviews the theoretical foundations of a program of prenatal and early childhood home visitation that has been tested and refined over the past two decades while it was examined in a series of three randomized trials. It describes the role that theories of self-efficacy, human attachment and human ecology have played in shaping the content and clinical methods of the program. The program was designed to improve: (1) the outcomes of pregnancy; (2) qualities of parental caregiving (and associated child health and developmental outcomes); and (3) maternal life-course development (helping women return to school, find work, and plan future pregnancies).

036: J Health Soc Policy 1999;11(1):53 64
Community postpartum care needs assessment and systems development for low income families.
Pistella CY, Synkewecz CA

Decreased lengths of stay for U.S. childbirth hospitalization, infant morbidities, repeat adolescent pregnancies, and high no show rates for postpartum visits among disadvantaged populations suggest barriers to continuity of maternity care. Findings of a survey of maternity health professionals (N = 78) providing postpartum case management with an urban Healthy Start project indicated less tracking and follow up for postpartum care as compared to prenatal care as well as maternal postpartum health education, social support, and environmental needs. Recommendations included: (a) earlier timing of postpartum visit, (b) community care sites and home visiting, (c) coordinated postpartum maternal and infant care, and (d) increased postpartum psychosocial and environmental services.

037: J Community Health 1992 Aug;17(4):221 9
Effects of a home visiting program on prenatal care and birthweight: a case comparison study.
Poland ML, Giblin PT, Waller JB Jr, Hankin J

Recent reports have stressed the importance of social support services to the health and well being of pregnant women and their newborns. The impact of paraprofessional support services on the amount of prenatal care received and birthweight was studied in a sample of 111 low income women. Paraprofessionals were women who had been on public assistance and successfully attained health and human services for themselves and their infants. They were similar to the patients they served in educational background and ethnicity. A six week training program prepared them to counsel and assist pregnant women with health and social services, housing, food, transportation and other basic necessities. Women attending a publically funded prenatal clinic were randomly assigned to a paraprofessional. A comparison group matched for ethnicity, parity and trimester entering prenatal care was also selected. Women followed by a paraprofessional had significantly more prenatal appointments (8.0 vs 6.5 visits) and infants with average higher birthweight (3125 grams) over the matched comparison group (3273 grams). While intensity of contact with a paraprofessional contributed significantly to the amount of prenatal care received by patients of paraprofessionals, the mechanism for improvement in birthweight is unknown.

038: Pediatrics 1989 Jul;84(1):157 64
Home visiting of varying frequency and child development.
Powell C, Grantham McGregor S

Two studies were made of home visiting and psychosocial stimulation with deprived urban children in Jamaica. The aim was to determine the relative effectiveness of different frequencies of visiting on the children's developmental levels and the feasibility of integrating the model into government primary health care services. Health paraprofessionals supervised by a nurse from a local health center conducted the intervention. In the first study, 152 children aged 6 to 30 months were assigned to groups visited biweekly, monthly, or not at all by area of residence. The biweekly group showed small but significant increases in scores on the Griffiths Mental Development Scales (developmental quotient) and performance subscale compared with the monthly and control groups, whereas no benefit was shown in the Griffiths scores of the monthly group. In the second study, 58 children aged 16 to 30 months from the same neighborhoods were randomly assigned to weekly visited and control groups. The group visited weekly showed marked improvements in the performance and hearing and speech subscales as well as the developmental quotient scores. The results indicate that as the frequency of visiting increases from none through monthly and biweekly to weekly, the benefits increase as well.

039: Public Health Nurs 1998 Feb;15(1):44 9
Home visitors' beliefs and practices regarding childhood injury prevention.
Pratt LK, Runyan CW, Cohen LR, Margolis PA

Injuries are the leading cause of death for children under age 19. Prevention efforts focus on eliminating hazards or changing individuals' behavior. Few interventions address psychosocial factors that contribute to injuries. Home visiting programs target families' functioning and help parents overcome barriers that inhibit their readiness and ability to address injury prevention. This study, a telephone interview with 87 public health nurses and social workers, assessed home visitors' preparedness to address childhood injury prevention, their practices and factors influencing their ability to undertake injury prevention activities. Results showed that 41% of home visitors talked to parents about injury prevention during visits. To identify hazards, most visitors (81%) assessed the home environment as they did other things; 51% never used a home safety checklist. Most home visitors discussed hot water temperature (82%), smoke detectors (76%), and firearms (50%). To respond to hazards, most relied on verbal education. Other priorities and time constraints were major barriers to injury prevention activities. Home visitors' beliefs in the importance of injury prevention and willingness to implement strategies suggest that home visiting can be an effective delivery strategy for injury prevention. It is important to consider how to include, in a systematic manner, injury prevention in home visitor training.

040: Arch Dis Child 1999 Jan;80:500 6
A randomized controlled trial of specialist health visitor intervention for failure to thrive.
Raynor P, Rudolf MC, Cooper K, Marchant P, Cottrell D

AIMS: To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. METHODS: Children referred for failure to thrive were randomized to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioral scales. RESULTS: Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children <12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. CONCLUSIONS: The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed.

041: Public Health Nurs 1999 Dec;16(6):390 6
Public health nursing in children's protective services.
Smart JD

This article describes the development and integration of a Los Angeles County, Department of Health Services, Public Health Nursing (PHN) program within the local Children's Protective Services (CPS) agency to assist the Children's Social Workers (CSWs) with their legally mandated health case management services. It summarizes the unique health needs of children who enter protective services, and explains why CPS agencies often overwhelmed by an increasing number of cases and diminishing resources, have had difficulty providing necessary health care monitoring and oversight. Program evaluation data detailing PHN services during the first 2 years of program implementation gives valuable insight into their evolving role function within this new practice arena. Issues regarding the integration of disciplines, and the contribution of the PHNs to the CPS agency are discussed.

042: Future Child 1999 Spring Summer;9(1):134 51
Using home visits for multiple purposes: the Comprehensive Child Development Program.
St Pierre RG, Layzer JI

The Comprehensive Child Development Program (CCDP) was a two generation program that employed case management and home visiting to assure low income children and their parents of a range of educational, health, and social services. Designed to meet the complex needs of disadvantaged families, CCDP was predicted by its planners to generate positive short and long term effects across a variety of child and parent well being indicators. This article describes the CCDP program and reviews the results of the program evaluation. The evaluation of 21 project sites and 4,410 families followed for five years found no statistically significant impact of CCDP on program families when they were compared with control families in any of the assessed domains: early childhood education, child and family health, parenting education, family economic self sufficiency, or maternal life course. The authors conclude that the results of this evaluation do not support home visiting as an effective means of social service delivery and parenting education for low income families.

043: Child Abuse Negl 1994 Mar;18(3):271 83
Survey of home visiting programs for abused and neglected children and their families.
Wasik BH, Roberts RN

This study reports on home visitation programs that provide services for abused and neglected children and their families. Data were collected as part of a national survey of home visiting programs. Of the 1,904 programs participating in the survey, 224 had as their primary focus services for children who were abused or neglected. For this group, data are presented on program characteristics, characteristics of home visits, credentials of home visitors, and program documentation procedures. The survey data showed that over 70% of the 224 programs identified social service as their organization affiliation which, in contrast to other providers, offered a broad range of services for the abused or neglected children and their families. The most frequently identified purpose for providing services was the social and emotional development of the child. Parenting skills and parent coping were considered the most important services. Stress management as considered more important by respondents of programs for maltreating families than by those providing services to nonmaltreating families. Approximately half the respondents reported that they required a bachelor's or master's degree for employment. Results are discussed in relation to research and practice implications.

Section II
Home Visiting: Special Publications - December 2002

Cohen, M. (1999). Tapping TANF: When and how welfare funds can support reproductive health or teen parent initiatives. [http://www.nwafdev.org/Papers/TapTANF.htm]

Home Visiting. (1993). The Future of Children, 3 (3). Winter, 1993. [http://www.futureofchildren.org/]

Home Visiting: Recent program evaluations. (1999). The Future of Children, 9 (1). Spring/Summer, 1999. [http://www.futureofchildren.org/]

Nurse-Family Partnership (Dr. David Olds’ Research Model). (2002). [www.nccfc.org/nurseFamilyPartnership.cfm]

The Nurse-Family Partnership represents a highly refined approach to the long-established service strategy of home visiting. It has been tested, refined, and found to be consistently effective in a series of scientifically-controlled studies over a 20-year period by Dr. David Olds and his colleagues. For more information contact: Matt Buhr-Vogl, MPH, Site Development Specialist. National Center for Children, Families and Communities, 1825 Marion Street, Denver, CO 80218. (303) 864-5839. Email: Buhr-Vogl.Matthew@tchden.org

Olds, D., Hill, P., & Rumsey, E. (1998). Prenatal and early childood nurse home visitation. U.S. Department of Justice Programs. Office of Juvenile Justice Home Visiting. (1993). Office of Juvenile Justice and Delinquency Prevention.

This article describes David Olds’ home visiting model/program. The article outlines the model’s components, and also addresses the program’s impact on reducing anti-social behaviors. Cost savings is also discussed. To obtain a copy of this article, please contact: Juvenile Justice Clearinghouse, Publication Reprint/Feedback, P.O. Box 6000, Rockville, MD 20849-6000, 800-638-8736. Fax 301-519-5212. E-mail: askncjrs@ncjrs.org.

Research Subcommittee Data and Research Committee Health Care Coalition on Violence. (1998). Review of the research on home visiting: A strategy for preventing child maltreatment. Health Care Coalition on Violence.

This publication reviews articles on home visiting. To obtain a copy of this review, please contact: Health Care Coalition on Violence, 2829 Verndale Avenue, Anoka, MN 55303, 612-576-1825, fax 612-427-7841.

Section III
Home Visiting: Videos, Curricula & Websites -December 2002

(Videos and Curricula can be obtained on loan from the Minnesota Department of Health library 612-676-5274; library@health.state.mn.us)

“Baby To Be: The video guide to pregnancy.” 2002. Poly Health Media. (1 hour)
“Baby Talk: The video guide for new parents.” 2002. Poly Health Media. (1 hour)

Each video presents real women who share information and offer emotional support for behavioral change in pregnancy and parenting. Information is presented with warmth and humor, using multi-cultural role models.

“Depression Across the Life Span: A Focus on Women.” April 25, 2000. (2 hours)

A video and outline of a satellite presentation by the Illinois Department of Health--Women’s Health Series, with an excellent section for home visitors on the implications of antepartum and postpartum depression.

“Home Visiting Forum”. Local Public Health Association (LPHA). Snelling Office Park, St. Paul, Minnesota. June 15, 2000. (2 hours, 2 videos)

This video provides an overview of the TANF-PHN Home Visiting Program as presented at the LPHA meeting. In addition, Dr. LaVohn Josten from the University of Minnesota School of Nursing discusses research that demonstrates best practices in home visiting, and a panel of local county public health agencies (Kandiyohi, Dakota, Cass, and Olmsted counties) present information on their current home visiting programs.

“Make Parenting A Pleasure: A group-based positive parenting curriculum for parents of children 0-8.” 2000. Birth To Three, Inc.

A comprehensive parenting education curriculum. Parents learn the importance of taking care of themselves so they can better care for their children, and learn practical stress management and communication skills; gain greater understanding of their children;
learn effective parenting skills and positive approaches to discipline; and build a support network.

“Opening Doors Video.” 2002.

This video is a documentary program which takes its viewers into the lives of the Public Health Nurse. The viewer travels with the Public Health Nurse throughout Washington State into communities that are common to all America. From inner city Seattle to the rural community of San Juan Island, issues such as addiction support, teen pregnancy
counseling and limited access to health care and social services are documented.

“Psychological Disorders in Reproductive Age Women.” December 11, 2002. (2 hours)

A satellite conference produced by Video Communications, Alabama Department of Public Health.

“The Home Visiting Video Library: Reality Based Training For Home Visitors.” 2002. (11 videos, Trainer’s Manual, and Discussion Guides)

This Video Library presents 10 videos of very different home visits. Each begins with the visitor describing the client, their history, and the goals for the day’s visit. Afterwards the visitor comments on how they felt the visit went. An 11th video contains short clips that target specific topics for discussion. The Trainer’s Manual suggests ways
in which trainers can adapt the videos to their own training needs and explains a variety of ways in which they may be used.


Administration for Children and Families.

Child Trends, Inc.

Department of Human Services (Minnesota).

Maternal and Child Health Bureau.

National Center for Children, Families and Communities.

National Clearinghouse on Child Abuse and Neglect.

Prevent Child Abuse America.

The Future of Children.

The Rand Corporation.

How to Obtain Materials

To obtain a copy of any of the resources listed in this document, contact your local library or the Minnesota Department of Health (MDH) library at (651) 201-5090 or library@health.state.mn.us. Some special publications can be downloaded from the given website or ordered directly from the publisher. The videos are available on loan from the MDH library.

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