Nurse home visitation with vulnerable families in rural areas: A qualitative case file review.

OBJECTIVE: Nurse home visiting may address challenges and resource disparities that threaten maternal and infant well-being in rural areas, but little is known about United States' program implementation. This qualitative study explored how family and community characteristics affected rural nurse home visiting. SAMPLE: The sample for content analysis included families beginning services in 2010-2011 living in the rural counties with the highest caseloads (433 families). DESIGN: Electronic nurse home visiting case files from three rural counties were analyzed using a content analysis approach. The partner agency provided input on key constructs of interest but independent coding was also done to capture additional themes. Quantitative county level data and comments from member checking informed interpretation. Member checking included individual nurses serving the selected counties (n = 3) and input from an agency level supervisory meeting for validation. RESULTS: Concerns of families served (e.g., mental health) may not be unique to rural areas, but challenges to accessing resources and constellation of needs were. Nurses adapted engagement and service strategies to meet these needs. CONCLUSION: Agencies serving rural areas should allocate resources and adapt training to support nurses based on unique community profiles. More research on rural nurse home visiting practice and outcomes is needed.

Impact of Pathways Triple P on Pediatric Health-Related Quality of Life in Maltreated Children.

OBJECTIVE: Child maltreatment is an adverse childhood experience associated with reductions in child well-being. This study examines whether an evidence-based parenting intervention delivered to families served by the child welfare system (CWS) affects pediatric health-related quality of life (HRQoL). METHOD: This study is a randomized controlled trial of Pathways Triple P (PTP) delivered to families with open child welfare cases for child physical abuse or neglect (N = 119). Children were 5 to 11 years old and remained in the home after the investigation. The primary outcome measure for this study was the Pediatric Quality of Life Inventory (PedsQL) 4.0, which measures HRQoL across 4 subdomains: physical functioning, emotional functioning, social functioning, and school functioning. Child- and parent-reported PedsQL 4.0 was assessed at baseline and post-test after the 14-week intervention. RESULTS: Controlling for other factors, children in families randomly assigned to the PTP condition had a significant improvement in overall HRQoL after the intervention compared with families receiving usual services (ßchild-report = 6.08, SE = 2.77, p = 0.03; ßparent-report = 3.83, SE = 1.88, p = 0.04). Subdomain effect sizes differed when considering children's self-report or parents' proxy report. Children's self-report yielded the largest improvement in emotional functioning, whereas social functioning had the largest gain based on parents' proxy report. CONCLUSION: The PTP parenting intervention was associated with higher pediatric HRQoL as reported by both the child and parent. This intervention holds promise to improve child well-being when implemented in the CWS.

A Randomized Trial of Home Visitation for CPS-Involved Families: The Moderating Impact of Maternal Depression and CPS History.

Home visitation (HV) interventions may hold promise to improve parenting and prevent child maltreatment recidivism in families reported to child protective services (CPS) with young children, but this has rarely been studied. Findings are presented from an 18-month randomized controlled trial in which intact families ( N = 122) with at least one CPS report were provided with a facilitated connection to a paraprofessional evidence-based HV program or usual care services from child protection. Results are reported for changes in maternal stress, depression, and social support outcomes and repeat reports to CPS. No significant changes were found in maternal outcomes by group. Among nondepressed mothers or families without multiple CPS reports prior to study enrollment, HV was associated with a significantly lower likelihood of CPS report recidivism. These results indicate potential for HV to prevent maltreatment recidivism but suggest that higher intensity intervention is warranted for mothers exhibiting significant depressive symptoms or families with extensive CPS histories.

Enhancing Social Support Postincarceration: Results From a Pilot Randomized Controlled Trial.

OBJECTIVE: Over 50% of released prisoners are reincarcerated within 3 years. Social support from loved ones postincarceration significantly reduces the likelihood of reincarceration. Increasingly, intervention developers aim to implement interventions that will enhance the stability of support available. This study responds to gaps in knowledge. METHOD: The current efficacy study reports findings from a randomized controlled trial (n = 57) of a social support intervention. A priori power analysis indicated moderate effect sizes could be detected. Participants were men, average age was 25 years, and over 90% were African American. Preliminary effects on social support, cognitions, substance use, and rearrest were assessed. Recruitment and consent occurred in prison; the intervention and 4 follow-ups occurred postrelease. RESULTS: Findings converge with research indicating declines in social support (b = -.70, p < .05) and perceived quality of support (b = .05, p < .01) over time. Age showed inverse relationships with support (b = -1.77, p < .05). There were no statistically significant group effects for social support, cognitions, substance use (with the exception of marijuana), or recidivism. Clinical implications are discussed. CONCLUSION: This study advances research on intervention dosage, potency, and measurement considerations.