Maternal involvement in a nurse home visiting programme to prevent child maltreatment

Publication Date20 June 2016
AuthorTara Flemington,Jennifer Anne Fraser
SubjectHealth & social care,Vulnerable groups,Children's services
Maternal involvement in a nurse
home visiting programme to prevent
child maltreatment
Tara Flemington and Jennifer Anne Fraser
Tara Flemington is a RN/PhD
Student and Jennifer Anne
Fraser is an Associate
Professor, both at the Sydney
Nursing School, The University
of Sydney, Sydney, Australia.
Purpose Nurse homevisiting programmesdesigned to reducethe likelihood of childmaltreatment infamilies
at risk have been widely implemented in Australia and overseas. The purpose of this paper is to examine the
intensityand durationof maternal involvement ina nurse home visitingprogramme to preventchild maltreatment.
Design/methodology/approach A retrospective, longitudinal design was employed. The clinical records
of 40 mothers who had received nurse home visits following the birth of a new baby for at least six months,
and had provided consent for their details to be accessed for research purposes, were selected for analysis.
The influence of antenatal characteristics and well-being on maternal involvement in a nurse home visiting
programme was examined using reliability of change indices.
Findings Mothers with impairedfamily functioning reportingthey experienced violence at home were more
likely toleave the programme early andreceived fewer than the prescribednumber of home visits comparedto
mothers whohad been enroled into the programme forother complex psychosocial needs.At the same time,
mothersenroled on the basis of impairedpsychological functioningand who did notreport violence in the home
remained, and receivedmore than the prescribed number of homevisits over the course of their involvement.
Originality/value Results showed that domestic violence increased the risk of poor engagement with a
targeted nurse home visiting programme. At the same time, home visitors responded to complex individual
and family needs by increasing the number of home visits accordingly. This theoretically based pilot research
has helped to disentangle antecedents of maternal involvement and the subsequent impact on programme
outcomes. Further investigation using a larger study sample is needed.
Keywords Retention,Neglect, Child maltreatment, Engagement, Community nursing,Child health nursing,
Health visiting, Homevisiting, Child abuse
Paper type Research paper
Targeted nurse home visiting programmes for the prevention and early intervention of child
maltreatment are generally acknowledged to be effective in promoting healthy adjustment to
the parenting role and family functioning in the first years of a childs life. The size of their
effect varies according to the programme, the population being visited and the outcomes
being measured.
In the USA, the Nurse-Family Partnership has had a positive impact on improving child safety and
reducing child maltreatment, especially amongst mothers with the least social and psychological
resources (Olds et al., 1999). Comparable interventions in New Zealand (Early Start) and the USA
(Child FIRST and Early Head Start) have reported similarly encouraging results of reduced
parental aggression, less child protection involvement and fewer reports of physical punishment
of children (Fergusson et al., 2013; Lowell et al., 2011; Roggman and Cook, 2010).
Received 4 February 2015
Revised 15 July 2015
7 December 2015
Accepted 7 December 2015
VOL. 11 NO. 2 2016, pp. 124-140, © Emerald Group Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-02-2015-0003
Nurse-led home visiting also has the potential to increase positive parenting behaviours, reduce
parental stress and link families at risk of maltreatment to appropriate community resources. The
Family Care targeted nurse home visiting programme was tested in Queensland, Australia in
2000 and shown to be effective in reducing parental stress and improving adjustment to the
parenting role in the immediate postpartum period (Fraser et al., 2000). It was implemented
widely in Australian states as an early child protection programme. A trial augmentation of this
programme, Family Care +Parents Under Pressure Babies, showed significant promise in its
potential to reduce the risk of postnatal depression during pregnancy and in the early postnatal
period. Furthermore, women in the augmented group experienced more contact with community
health-related services in the postnatal period in comparison to the standard Family Care group
(Kowalenko, 2007). Universal nurse home visiting in the Durham Connects programme resulted
in a higher quality home environment, more positive parenting behaviours and families accessing
more community resources (Dodge et al., 2013). Despite the promise shown by nurse-led
programmes, a variety of home visiting interventions are led by social workers, occupational
therapists, psychologists and lay people.
Home visiting programmes differ greatly in terms of their goals (prevention of child maltreatment,
improvement of maternal health, promotion of infant health outcomes), delivery (nurses,
paraprofessionals, lay people, number of visits, duration of intervention) and effectiveness. To
ensure relevancy, the following literature will, where possible, focus on home visiting programmes
that are nurse led, aim to prevent child maltreatment and commence in the antenatal period or at
birth. While there are a plethora of measures used in quantifying maternal involvement in home
visiting programmes, in this paper duration of maternal involvement refers to the period of time the
mother is enroled, while intensity of maternal involvement is the number of home visits received.
Family involvement in home visiting programmes
Data concerning maternal involvement in the Australian Nurse-Family Partnership (ANFP) is
available via the National Annual Data Report (Australian Nurse-Family Partnership Program,
2015). Evaluation of the initial implementation of this programme across three sites (Cairns, Alice
Springs and Auckland, New Zealand) indicates that the ANFP experiences similar levels of
participant attrition and low dosage of home visits as many other home visiting interventions.
For example, of the 699 clients accepted to the programme since June 2014, 410 of these were
inactive at time of reporting (Australian Nurse-Family Partnership Program, 2015). This reported
attrition clearly exceeds the international Nurse-Family Partnership goal of 40 per cent or less by
the childs second birthday. Of the clients who left the programme early, 31 per cent left during
the pregnancy phase, 52 per cent left during the infancy phase and 17 per cent left during the
toddlerhood phase. Furthermore, at 19 per cent, the quantity of maternal of involvement (number
of visits received) is also considerably less than the Nurse-Family Partnership goal of 80 per cent.
This has considerable implications for the effectiveness of the programme given the relationship
between quantity of maternal involvement in home visiting and client outcomes (Goyal et al.,
2013). Further analysis is necessary to determine risk factors for client attrition and decreased
intensity of maternal involvement in this programme.
Families at greatest demographic risk for child maltreatment have been more likely to schedule a
home visit in targeted programmes such as the nurse-led Durham Connects intervention in the
USA (Alonso-Marsden et al., 2013), as well as nurse home visits in Queensland, Australia
(Brodribb and Miller, 2014; Fraser et al., 2000). At the same time, these families are less likely than
their lower risk counterparts to complete the scheduled visits. Community characteristics,
maternal factors and visitor profiles have been found to influence this. For example, maternal illicit
drug use (Damashek et al., 2011), increased maternal isolation and high levels of
community violence (McGuigan et al., 2003) have been associated with decreased rates of
programme completion.
In the SafeCare+home visiting programme psychological aggression but not physical violence in
the home predicted programme completion (Damashek et al., 2011). The intervention included
bachelor level, specially trained home visitors, and families with children aged five years and
under. The paraprofessional-led Healthy Start Programme found that fathers who were violent
VOL. 11 NO. 2 2016

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