A Qualitative Analysis of the Effects of COVID-19 on Home Visiting Service Provision.

Home visiting programs have been found to improve parenting practices and to reduce negative child outcomes. The 2019 coronavirus disease (COVID-19) resulted in an abrupt transition to telehealth services for many home visiting services. Limited research has examined the impacts of delivering home visiting services via telehealth, and the effects of this abrupt transition during COVID-19 is understudied as well. This study examined the impact of the abrupt transition to telehealth as a result of COVID-19 on home visiting service provision in one mid-sized midwestern community from the perspective of clients and providers. We conducted semi-structured interviews with both home visiting clients and providers (N = 26) in prevention-focused home visiting services. Although some benefits to telehealth were reported, providers discussed challenges with regard to engaging clients in services and difficulties in completing important home visiting tasks (i.e., assessment of child development, teaching parent-child interaction). Providers and clients also noted that they missed face-to-face interactions. Effective use of telehealth in home visiting requires provision of devices that allow for video-chatting as well as development of effective methods to engage in observation and teaching tasks.

"This has changed me to be a better mum": A qualitative study exploring how the Australian Nurse-Family Partnership Program contributes to the development of First Nations women's self-efficacy.

BACKGROUND: The Australian Nurse-Family Partnership Program is based on the Nurse-Family Partnership program from the United States, which was designed to support first-time mothers experiencing social and economic disadvantage from early in pregnancy until their child's second birthday. International trials have demonstrated this program measurably improves family environment, maternal competencies, and child development. The Australian program has been tailored for mothers having a First Nations baby. AIM: This study aimed to understand how the program impacts self-efficacy using a qualitative interpretive approach. METHODS: The study took place in two sites within one Aboriginal Community Controlled Health Service in Meanjin (Brisbane), Australia. Twenty-nine participants were interviewed: first-time mothers having a First Nations baby who had accessed the program (n = 26), their family members (n = 1), and First Nations Elders (n = 2). Interviews were conducted either face-to-face or by telephone, using a yarning tool and method, to explore women's experiences and perceptions. Yarns were analysed using reflexive thematic analysis. FINDINGS: Three main themes were generated: 1) sustaining connections and relationships; 2) developing self-belief and personal skills; and 3) achieving transformation and growth. We interpret that when the program facilitates the development of culturally safe relationships with staff and peers, it enables behaviour change, skill development, personal goal setting and achievement, leading to self-efficacy. DISCUSSION: Located within a community-controlled health service, the program can foster cultural connection, peer support and access to health and social services; all contributing to self-efficacy. CONCLUSION: We recommend the program indicators are strengthened to reflect these findings and enable monitoring and reporting of activities that facilitate self-efficacy, growth, and empowerment.

Changes in Comprehensive Health Literacy Among First-Time Parents Attending Extended Home Visiting in Swedish Multicultural Settings: A Case-Comparison Study.

INTRODUCTION: This study aimed to gain knowledge about the impact of an extended postnatal home visiting program on parents' comprehensive health literacy (CHL) in multicultural, socioeconomically disadvantaged Swedish settings. METHOD: This quasi-experimental study adopted a case-control sampling method recruiting first-time parents through two Child Health Care Centers in Stockholm. Participants were interviewed twice through structured questionnaires when their child was aged between less than two months (n = 193) and 15-18 months (n = 151) from October 2017 to August 2020. Analyses used linear regression models and nonparametric tests. RESULTS: A subgroup of parents that needed language interpreters demonstrated statistically significantly improved CHL from premeasures to postmeasures within the intervention group that received an extended home visiting intervention (F = 11.429; p <.001), and when compared with a corresponding subgroup that received merely the ordinary Swedish Child Health Care Centers program (F = 5.025; p = .027). DISCUSSION: Postnatal home visiting interventions may reduce inequity in CHL for parents living in multicultural, socioeconomically disadvantaged settings.

Clinician Racial Biases: Preliminary Investigation on Predictors of Poor Therapeutic Alliance and Retention in Home Visiting Intervention Program.

BACKGROUND: Home visiting programs are effective in improving maternal-child health, and higher therapeutic alliance is associated with improved program retention and outcomes. Black, single, low-income mothers have a higher risk for poorer health outcomes in pregnancy and postpartum and for early termination of therapeutic services. OBJECTIVE: To examine associations between clinician and client alliance and social, economic, and racial demographics. METHODS: Mothers (N = 71) who were pregnant or had an infant (age < 24 m) receiving Infant Mental Health (IMH) services through community health service agencies and their clinicians (N = 50) completed the Scale to Assess Therapeutic Relationships (clinicians: STAR-C, clients: STAR-P) at 3-, 6-, 9-, and 12 months, and provided demographic information. RESULTS: Survival analysis showed those with higher alliance ratings, both client and clinician ratings, at the 3-month time-point were more likely to remain in treatment longer (for clients est = -1.67, p = .0017; for clinician est = -.75, p = .031). Controlling for clinician experience and frequency of reflective supervision, Black clinicians had higher alliance ratings than white clinicians, (b = 3.1 (1.6), p = .049). Neither clinician-client racial match nor client marital status predicted alliance. Black clinicians' ratings of alliance did not vary by client race, but white clinicians reported weaker alliance with their Black, relative to white, clients (ß = .40, p = .045). CONCLUSIONS: Weaker alliance reported by white clinicians with Black clients, coupled with a lack of client-race related differences for Black clinicians, suggests white clinician racial bias may be important to consider in regards to program retention and health disparities.

"They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program.

BACKGROUND: Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS: We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS: Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS: Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up.

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

The role of maternal social networks on the outcomes of a home-based childhood obesity prevention pilot intervention.

BACKGROUND: Despite evidence that obesity and related behaviors are influenced by social networks and social systems, few childhood obesity initiatives have focused on social network factors as moderators of intervention outcomes, or targets for intervention strategies. OBJECTIVES: This pilot study examines associations between maternal social network characteristics hypothesized to influence health behaviors, and the target outcomes of a family-centered childhood obesity prevention initiative. The pilot intervention entailed the provision of healthy eating and activity components as part of an existing home visiting program (HVP) delivered to mothers and infants, to test the feasibility of this approach for improving mother diet, physical activity, and weight status; and infant diet and weight trajectory. METHODS: Mothers and their infants (N=50 dyads) receiving services from our HVP partner were recruited and randomized to receive the HVP core curriculum with or without a nutrition and physical activity enhancement module for six months. Assessments of mothers' social network characteristics, mother/infant food intake and mother physical activity, and mothers' postpartum weight retention and children's growth velocity were conducted at baseline and post-intervention. RESULTS: Several features of mothers' social networks, including the receipt of health-related social support, were significantly associated with the focal intervention outcomes (p < .05) at follow-up, controlling for study condition. CONCLUSIONS: Integrating childhood obesity prevention into HVPs appears promising. Future family-based interventions to prevent childhood obesity may be enhanced by including social network intervention strategies. For example, by addressing family network characteristics that impede healthy behavior change, or enhancing networks by fostering social support for healthy behavior and weight change.

Client experiences in a prenatal home visiting program: A prenatal care coordination program evaluation.

OBJECTIVE(S): Prenatal home visiting programs are a strategy to promote positive birth outcomes. Ongoing evaluations of these programs are important to promote fidelity and quality. The goal of this program evaluation was to gain clients' perspectives of their experiences in one Wisconsin Health Department's Prenatal Care Coordination program including: (a) why clients entered the program, (b) whether client expectations were met, and (c) how expectations impacted client retention. DESIGN: A Health Department in Wisconsin undertook a three-part program evaluation of their Prenatal Care Coordination program in 2014-2015. Highlighted here is the final phase of this evaluation. The evaluation was guided by the CDC's (1999) Framework for Program Evaluation in Public Health. SAMPLE: Clients meeting eligibility criteria were divided into representative clusters using k-means clustering model. Twenty semi-structured interviews with former clients of the Wisconsin Health Department's Prenatal Care Coordination program were conducted. RESULTS: Most clients had no expectations coming into the program and were satisfied with the services they received. Participants named the nurse-client relationship and support from this relationship as a key benefit of the program, while a secondary benefit was the information and resources received. The Health Department used these findings for program improvement and strategic planning.

Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability.

BACKGROUND: To improve prerequisites for better health development among children growing up in multicultural suburbs in Stockholm County, where poorer health is displayed in several aspects including child health, early support was initiated for first-time parents in one of the suburbs. An extended postnatal home visiting program during the child's first 15 months was offered to families with first-time mothers during 2013-2014 and consisted of six home visits by a child health care nurse and a parental advisor from social services. Almost all invited families (94%) participated in the program and the program evaluation. Fathers' participation in two or more home visits within the program was 53%. The aim of this study was to explore the experiences of fathers participating in the program, with respect to their role as a first-time parent from a resilience perspective. METHODS: In-depth interviews were conducted with nine fathers. Constructivist grounded theory (GT) was applied in the analysis. RESULTS: The fathers' experiences formed the core category of the study, 'striving for stability in living conditions', as well as three categories: 'everyday life conditions', 'adjustment to fatherhood in Sweden' and 'channels of support'. The fathers perceived that the home visiting program strengthened their parental confidence and increased their knowledge of societal services and local resources for their family. CONCLUSIONS: In terms of resilience, the extended postnatal home visiting program benefitted the interviewed migrant fathers on an individual level by meeting part of their need for support regarding knowledge and parental confidence; on a structural level the program helped fathers gain information about available societal services and resources in their local area. TRIAL REGISTRATION: The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI: https://doi.org/10.1186/ISRCTN11832097 ).

Reducing maltreatment recurrence through home visitation: A promising intervention for child welfare involved families.

Maltreatment of children is a key predictor of a range of problematic health and developmental outcomes. Not only are affected children at high risk for recurrence of maltreatment, but effective interventions with known long term impact are few and limited. While home visiting is one of the most tested secondary prevention models for improving parenting, its primary focus on young primiparous mothers underemphasizes one of the most important risk groups: child welfare involved multiparous mothers. This study's focus is a randomized controlled trial of Healthy Families New York that included a subgroup of mothers (n = 104) who had at least one substantiated child protective services (CPS) report before enrolling in the program. By the child's seventh birthday, mothers in the home visited group were as half as likely as mothers in the control group to be confirmed subjects for physical abuse or neglect (AOR = .46, p = .08). The number of substantiated reports for mothers in the control group was twice as high as for those in the home visited group (1.59 vs. 79 p = .02, ES = .44). Group differences were only observed after the child's third birthday, suggesting the possible effect of surveillance in early years. Post-hoc analyses indicate that home visited mothers had fewer subsequent births that may have contributed to less parenting stress and improved life course development for mothers. In light of our findings, we suggest considering and further testing home visiting programs as a tertiary prevention strategy for child welfare-involved mothers.

[Factors Influencing Theory of Mind Development in Preschoolers within the Context of Early Interventions]. / Einflussfaktoren auf die Theory of Mind-Entwicklung im Vorschulalter im Rahmen Früher Hilfen.

Factors Influencing Theory of Mind Development in Preschoolers within the Context of Early Interventions The Theory of Mind (ToM) competency is closely related to the child's cognitive, language, and socio-emotional development. In early interventions, skills and developmental processes associated with ToM development are often primary intervention targets, but empirical support for direct or indirect influences of early interventions on ToM development is missing so far. Within the home visiting program "Pro Kind" N = 755 families were accompanied by professionals from the last trimester of pregnancy until the child's second birthday. In the present follow-up study we investigated influences of treatment, pre- and postnatal family environment, parental competencies and child competencies on the ToM ability in a sample of n = 39 five-year-old children using Ctree analyses. Prenatal and current parental stress as well as an enriched family learning environment, and children's language competencies in interaction with temperament significantly predicted ToM competency. The treatment had no direct influence on ToM development. Thus, the results argue for the urgent need to address maternal stress regulation and mentalizing competencies in early interventions during pregnancy, as well as to focus on promoting positive stimulating learning environments and language development after the child's birth.

What's Happening During Home Visits? Exploring the Relationship of Home Visiting Content and Dosage to Parenting Outcomes.

Introduction Research has documented modest positive impacts of early childhood home visiting programs. However, understanding more about what home visitors do during visits and how much time they spend on specific topics may provide insight into the variability in effectiveness of services. Methods Outcome data were collected via parent survey at program enrollment and 12 months from 123 women in three MIECHV-funded home visiting models. Home visitors completed weekly home visit content and activity logs. Results Families received an average of 28 visits during the study (3.1 visits per month). Of ten content areas, the three most often discussed were early childhood development, physical care of children, and the parent-child-relationship. Multivariate regression models were used to explore the association of home visit dosage, home visit content and cumulative risk factors on parenting outcomes. Women whose visits were focused more on parenting topics reported lower parenting-related stress at follow-up compared to those whose visits had less parenting content. Additionally, higher-risk women who received greater numbers of home visits showed larger reductions in their attitudes about harsh punishment over time, compared to high-risk women with fewer home visits. Discussion Receiving home visits that emphasize parenting content may contribute to reduced parenting-related stress. For high-risk women in particular, receiving more visits overall may be important to achieving positive outcomes. Implications for practice include working to engage and retain high-risk families. Future home visiting research calls for improved methods for collecting data on content/activity during visits, the necessity for long-term follow-up, and testing for the effectiveness of varied and flexible visit schedules/content focus for women and families with trauma exposure.

Follow-up study regarding the medium-term effectiveness of the home-visiting program "Pro Kind" at age 7 years: study protocol for a randomized controlled trial.

BACKGROUND: Pro Kind is a German adaptation of the US Nurse Family Partnership program. It is an intervention based on home visits targeting first-time mothers from disadvantaged populations. Pro Kind was implemented as a randomized control trial from 2006 to 2012 with N = 755 first-time mothers (TG n = 394, CG n = 391). The 7-8-year follow-up aims to assess the mid-term effects of the program. METHODS/DESIGN: Mid-term outcomes are being assessed by trained assessors. In a multimethod approach telephone interviews, on-site interviews, observations and developmental tests will be held in order to assess children's and mothers' life satisfaction, mental health, cognitive and social development, parenting behavior, signs of child abuse or neglect as well as the family's socio-economic status. Furthermore, administrative data will be accessed to obtain information regarding the mother's usage of pediatric health care, welfare usage and employment history. DISCUSSION: Results regarding the mid-term effects of the intervention from the Pro Kind Follow-up will provide a scientific basis for future primary prevention programs as well as help stakeholders legitimizing early childhood investments. TRIAL REGISTRATION: German Clinical Trial Registration DRKS-ID, ID: DRKS00007554 . Registered on 11 June 2015, updated on 6 October 2017.

Addressing the needs of new mothers in a multi-cultural setting: an evaluation of home visiting support for new mothers - Mom to Mom (Negev).

This study evaluated the Mom to Mom (M2M) program operating in the Negev region of Israel, an area with a high proportion of immigrants. M2M helps women cope with the first year of parenting through home visits of volunteer mothers. Specific objectives were to evaluate (1) Participants' motivations for joining M2M; (2) Gains from participation; and (3) The effect of participation on post-partum depression (PPD). Three stages included (1) Analysis of demographics of all 440 mothers in M2M; (2) A telephone survey of 51 mothers to assess gains from participation; and (3) 137 mothers filled out the Edinburgh Post-Natal Depression Scale (EPDS) and were followed for one year. Most mothers in M2M were first time mothers, with a high rate of perinatal complications (54.4%) and positive EPDS scores (38.7%). Two major reasons for participation were being an immigrant and having low income. The greatest gains from home visits were increased self-confidence, improved parenting skills and communication with the partner. Seventy-nine percent of mothers with PPD symptoms were functioning at work and at home after a year from joining the program. Our findings suggest that M2M has the capacity to address challenges in the post-natal period among women from diverse cultures.

Postpartum Mental Health Promotion: Perspectives from Mothers and Home Visitors.

OBJECTIVE: The object of this study was to examine the implementation of the Towards Flourishing Mental Health Promotion Strategy, a demonstration project designed to promote the mental well-being of parents and their children that was added to an existing public health home visiting program. DESIGN AND SAMPLE: Structured interviews were conducted with program stakeholders including 13 women receiving home visiting services in the postpartum period and 6 home visitors. MEASURES: Thematic analysis of individual transcripts was conducted and results were compiled according to common themes. RESULTS: The results indicate that women and home visitors perceived the integration of a mental health promotion strategy into an existing public health program as feasible, acceptable and useful. The strategy provides a mechanism for women and home visitors to dialog about mental health and appears to have early positive impacts on the women. Factors that facilitated and impeded the successful implementation of the strategy are described. CONCLUSION: These results point to promising strategies to reach women early in the postpartum period to support their mental health. They also shed light on the barriers to supporting mental health, indicating the need to address stigma related to mental health and the social determinants of health.

O processo de desenvolvimento de um programa de visitação domiciliar para adolescentes gestantes e mães / The developing process of a program of home visitation for adolescent pregnant women and adolescent mothers

Este trabalho tem como objetivo relatar o processo de desenvolvimento de um programa de visita domiciliar para adolescentes gestantes e mães, implementado pelo Núcleo de Estudos da Violência da Universidade de São Paulo (NEV/USP). O local inusitado em que este programa tem origem um núcleo de pesquisas que tem como seu principal eixo de trabalho a relação entre democracia e direitos humanos, possibilitou que alguns conceitos, muitas vezes implícitos nas práticas de intervenção, fossem questionados e revistos a partir de questões relacionadas à cidadania, direitos e a democracia. Neste sentido, buscou-se, a partir de uma leitura de Michel Foucault sobre as práticas govenamentalizadas de poder, discutir questões que, tomadas como verdades, passam a acionar práticas prescritivas, normatizas e regularizadoras. Práticas que ativam e reativam relações de poder, muitas vezes de forma arbitrária e autoritária, principalmente quando tem alvo de suas intervenções o pobre e/ou a população empobrecida. Tendo como foco os saberes e, consequentemente, a produção discursiva que se forma em torno da adolescência e, posteriormente da gravidez na adolescência, buscou-se compreender em que contexto esta última se transforma não só em problema como também, a partir de sua associação com as idéias de risco e vulnerabilidade, passa a justificar práticas interventivas focadas, sobretudo, no indivíduo e/ou população. Por fim, busca-se descrever como estas questões conceituais foram constantemente tensionando os saberes e as práticas tanto da equipe envolvida na criação e implementação de um programa como também, posteriormente, das próprias participantes(AU)

The objective of this work is to report the process of development of a program of home visitation for adolescent pregnant women and adolescent mothers carried out by the Center for the Study of Violence of the University of São Paulo (NEV/USP). The unexpected institution where this program was born a research center that has as its main axe of work the relationship between democracy and human rights , made it possible that some of the concepts, frequently implicit on intervention practices, be questioned and revised from the point of view of matters of citizenship, rights and democracy. Departing from a reading of Michel Foucault about the governmentalized practices of power relations, this work sought to discuss matters that, taken as truths, trigger prescriptive, normative and regulating practices. Practices that activate and reactivate power relations, very often on arbitrary and authoritarian way, especially when the focuses of interventions are poor individuals or poor communities. Having as its focus the knowledge and, therefore, the discursive production that takes form surrounding adolescence and, latter, surrounding pregnancy during adolescence, the thesis sought to understand in which context this last one transforms itself into problems, as well as, from its associations with ideas of risk and vulnerability justifies interventions focused mainly on individuals and population.Lastly, it was sought to describe how these conceptual matters were constantly tensioning knowledge and practices not only among the professional team that developed and implemented the program but also, latter, by the participants themselves(AU)