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Adynski H, Propper C, Beeber L, Gilmore JH, Zou B, Santos HP. The role of emotional regulation on early child school adjustment outcomes. Arch Psychiatr Nurs 2024; 51:201-211. [PMID: 39034079 DOI: 10.1016/j.apnu.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/09/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
Emotional regulation involves managing attention, affect, and behavior, and is essential for long-term health and well-being, including positive school adjustment. The purpose of this secondary data analysis from the Durham Child Health and Development Study was to explore how parent and teacher reported emotional regulation behaviors related to school adjustment outcomes (social skills, academic performance, and academic achievement) during early childhood. Parent and teacher reports on emotional regulation behaviors showed mixed concordance, however they correlated with critical aspects of school adjustment. Clinical and practical implications are discussed, including the role of psychiatric nurses in promoting positive emotional regulation and school adjustment outcomes across settings.
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Affiliation(s)
- Harry Adynski
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, CA, United States.
| | - Cathi Propper
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Baiming Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, United States
| | - Hudson P Santos
- The University of Miami School of Nursing and Health Studies, FL, United States
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2
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Mitani H, Kondo N, Amemiya A, Tabuchi T. Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan. BMJ Open 2024; 14:e082134. [PMID: 38925696 PMCID: PMC11202639 DOI: 10.1136/bmjopen-2023-082134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses. DESIGN Cross-sectional survey. SETTING Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022. PARTICIPANTS This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years). PRIMARY AND SECONDARY OUTCOME MEASURES The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models. RESULTS CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%). CONCLUSION CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended.
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Affiliation(s)
- Haruyo Mitani
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Airi Amemiya
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Division of Epidemiology, School of Public Health, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
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Alvarez D, Adynski H, Harris R, Zou B, Taylor JY, Santos HP. Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes. J Am Psychiatr Nurses Assoc 2024:10783903241243092. [PMID: 38600825 DOI: 10.1177/10783903241243092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes. AIMS The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects. METHODS The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms. RESULTS Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms. CONCLUSIONS These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.
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Affiliation(s)
- Dallis Alvarez
- Dallis Alvarez, BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Harry Adynski
- Harry Adynski, PhD, RN, PMH-BC, University of California San Francisco, San Francisco, CA, USA
| | - Rebeca Harris
- Rebeca Harris BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Baiming Zou
- Baiming Zou, PhD, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacquelyn Y Taylor
- Jacquelyn Y. Taylor, PhD, RN, FAHA, FAAN, Columbia University, New York, NY, USA
| | - Hudson P Santos
- Hudson P. Santos Jr, PhD, RN, FAAN, University of Miami, Coral Gables, FL, USA
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Trillingsgaard T, Fentz HN, Simonsen M. Does group-based parent support during the transition to parenthood affect child socio-emotional problems and health care utilization? A randomized controlled trial. Soc Sci Med 2024; 347:116741. [PMID: 38520827 DOI: 10.1016/j.socscimed.2024.116741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/26/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
As government-funded universal programs for new parents continue to expand, it is critical to investigate their short- and longer-term effects. The level of knowledge, especially on the effect of group-based interventions, is sparse. This study is the second report from a large trial of a widely implemented universal group-based parenting program in Denmark and includes outcomes on child socio-emotional problems and use of health services. A sample of 1701 unborn children from families representative within the area, were randomized to intervention or care as usual beginning November 2014. From these families, 1268 mothers and 999 partners (mean age 29.4 and 31.19, respectively; 6% migration background) filled in the Ages and Stages Questionnaire. Intention-to-treat-analyses showed fewer socio-emotional problems in the intervention group (between-group difference - 2.34, 95% CI [0.40, 4.30], d = - 0.13) as reported by mothers, but not partners, when children were 10 months old. This finding was transitory (no longer significant at 19 months). No effects were found on health care utilization. The previous report from this trial showed no effects on measures of parenting. In total, these findings serve the purpose of adjusting future expectations to the size and type of effect to be gained from a universal parent program in a resourceful setting. We conclude that even if the Family Startup Program (DK: Familieiværksætterne) 2 was liked, well implemented, and well attended by the parents, the positive effect on children's socio-emotional problems, was too modest to be the argument that can carry the weight of policy going forward. PUBLIC SIGNIFICANCE STATEMENT: This study examined the effects of the Family Startup Program (DK: Familieiværksætterne), a universal, group-based program to support parents during the transition to parenthood. Results showed a modest transitory preventive effect on children's socio-emotional problems and no effects on health care utilization. These findings adjust down previous expectations to the size and type of effects to be gained from universal group-based parent support in a well-resourced setting.
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Affiliation(s)
- Tea Trillingsgaard
- Department of Psychology and Behavioral Sciences, Bartholins Allé 11, Aarhus BSS, Aarhus University, DK-8000, Aarhus C, Denmark; TrygFonden's Centre for Child Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark.
| | - Hanne Nørr Fentz
- Department of Psychology and Behavioral Sciences, Bartholins Allé 11, Aarhus BSS, Aarhus University, DK-8000, Aarhus C, Denmark; TrygFonden's Centre for Child Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark
| | - Marianne Simonsen
- Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark; TrygFonden's Centre for Child Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Fuglesangs Allé 4, DK-8210, Aarhus V, Denmark
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Schepan ML, Jungmann T, Kliem S, Siegert C, Sandner M, Brand T. What contributes to the long-term implementation of an evidence-based early childhood intervention: a qualitative study from Germany. FRONTIERS IN HEALTH SERVICES 2024; 3:1159976. [PMID: 38313330 PMCID: PMC10834770 DOI: 10.3389/frhs.2023.1159976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024]
Abstract
Background Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Methods Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. Results A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. Conclusions We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.
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Affiliation(s)
- Marie Lisanne Schepan
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Department of Public Health, University of Bremen, Bremen, Germany
| | - Tanja Jungmann
- Department of Special Needs Education and Rehabilitation, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Sören Kliem
- Department of Social Work, Ernst-Abbe-Hochschule Jena, University of Applied Sciences, Jena, Germany
| | - Carolin Siegert
- Department of Social Work, Ernst-Abbe-Hochschule Jena, University of Applied Sciences, Jena, Germany
| | - Malte Sandner
- Department of Business Administration, Nuremberg Institute of Technology, Nuremberg, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
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Kanda K, Blythe S, Grace R, Elcombe E, Rodgers K, Kemp L. 'Everything's adaptable': A qualitative study of how nurses make decisions in sustained home-visiting care with mothers and children experiencing adversity. J Adv Nurs 2023; 79:4568-4579. [PMID: 37314007 DOI: 10.1111/jan.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
AIMS To explore nurse decision-making processes in the delivery of sustained home-visiting care for mothers of young children who are experiencing adversity. DESIGN Qualitative descriptive research design using focus group interviews. METHODS Thirty-two home-visiting nurses participated in four focus group interviews exploring their decision-making in the care they provide to families. The data were analysed using a reflexive thematic analysis approach. RESULTS Four steps of a recurring stepwise decision-making process were identified: (1) information gathering; (2) exploring; (3) implementing; (4) checking. The facilitators and barriers to effective decision-making processes were also identified and included elements relating to good relationship skills, a good attitude, high quality training and mentoring and resources. CONCLUSION The findings indicate that a recurring stepwise process of decision-making requires both analytical and intuitive approaches. The intuition required by home-visiting nurses is to sense unvoiced client needs and identify the right time and way to intervene. The nurses were engaged in adapting the care in response to the client's unique needs while ensuring the fidelity of the programme scope and standards. We recommend creating an enabling working environment with cross-disciplinary team members and having well-developed structures, particularly the feedback systems such as clinical supervision and case reviews. Enhanced skills to establish trusting relationships with clients can help home-visiting nurses make effective decisions with mothers and families, particularly in the face of significant risk. IMPACT This study explored nurse decision-making processes in the context of sustained home-visiting care, which has been largely unexplored in the research literature. Understanding the effective decision-making processes, particularly when nurses customize or individualize the care in response to the client's unique needs, assists with the development of strategies for precision home-visiting care. The identification of facilitators and barriers informs approaches designed to support nurses in effective decision-making.
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Affiliation(s)
- Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Rebekah Grace
- Transforming early Education and Child Health, Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Kim Rodgers
- Acting Nurse Manager, Child and Family Health Nursing, Primary and Community Health, South Western Sydney Local Health District, NSW Health, Liverpool, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Price A, Bryson H, Mensah FK, Kenny B, Wang X, Orsini F, Gold L, Kemp L, Bruce T, Dakin P, Noble K, Makama M, Goldfeld S. Embedding nurse home visiting in universal healthcare: 6-year follow-up of a randomised trial. Arch Dis Child 2023; 108:824-832. [PMID: 37399321 DOI: 10.1136/archdischild-2023-325662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Nurse home visiting (NHV) is designed to redress child and maternal health inequities. Of the previous trials to investigate NHV benefits beyond preschool, none were designed for populations with universal healthcare. To address this evidence gap, we investigated whether the Australian 'right@home' NHV programme improved child and maternal outcomes when children turned 6 and started school. METHODS A screening survey identified pregnant women experiencing adversity from antenatal clinics across two states (Victoria, Tasmania). 722 were randomised: 363 to the right@home programme (25 visits promoting parenting and home learning environment) and 359 to usual care. Child measures at 6 years (first school year): Strengths and Difficulties Questionnaire (SDQ), Social Skills Improvement System (SSIS), Childhood Executive Functioning Inventory (CHEXI) (maternal/teacher-reported); general health and paediatric quality of life (maternal-reported) and reading/school adaptation items (teacher-reported). Maternal measures: Personal Well-being Index (PWI), Depression Anxiety Stress Scales, warm/hostile parenting, Child-Parent Relationship Scale (CPRS), emotional abuse and health/efficacy items. Following best-practice methods for managing missing data, outcomes were compared between groups (intention-to-treat) using regression models adjusted for stratification factors, baseline variables and clustering (nurse/site level). RESULTS Mothers reported on 338 (47%) children, and teachers on 327 (45%). Patterns of group differences favoured the programme arm, with small benefits (effect sizes ranging 0.15-0.26) evident for SDQ, SSIS, CHEXI, PWI, warm parenting and CPRS. CONCLUSIONS Four years after completing the right@home programme, benefits were evident across home and school contexts. Embedding NHV in universal healthcare systems from pregnancy can offer long-term benefits for families experiencing adversity. TRIAL REGISTRATION NUMBER ISRCTN89962120.
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Affiliation(s)
- Anna Price
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
| | - Hannah Bryson
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Fiona K Mensah
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
| | - Bridget Kenny
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Xiaofang Wang
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, Vic, Australia
| | - Lynn Kemp
- Ingham Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Tracey Bruce
- Ingham Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Penny Dakin
- Policy & Projects, Australian Research Alliance for Children and Youth, Canberra, Australian Capital Territory, Australia
| | - Kristy Noble
- Policy & Projects, Australian Research Alliance for Children and Youth, Canberra, Australian Capital Territory, Australia
| | - Maureen Makama
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, Vic, Australia
- Population Health, Murdoch Children's Research Institute, Parkville, Vic, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia
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Adynski H, Propper C, Beeber L, Gilmore JH, Zou B, Santos HP. The role of social adversity on emotional dysregulation during infancy and early childhood. J Pediatr Nurs 2023; 72:26-35. [PMID: 37037102 PMCID: PMC10560316 DOI: 10.1016/j.pedn.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood. DESIGN & METHODS A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis. RESULTS Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability. CONCLUSION & PRACTICAL IMPLICATIONS Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention.
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Affiliation(s)
- Harry Adynski
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States.
| | - Cathi Propper
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Baiming Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, United States
| | - Hudson P Santos
- The University of Miami School of Nursing and Health Studies, Florida, United States
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Brown SM, McConnell L, Zelaya A, Doran M, Swarr V. Tailored Nurse Support Program Promoting Positive Parenting and Family Preservation. Nurs Res 2023; 72:E164-E171. [PMID: 37104683 PMCID: PMC10415074 DOI: 10.1097/nnr.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Public health nurse home visiting is a promising approach for addressing the complex needs of families at risk of child maltreatment. The Colorado Nurse Support Program advances service provision by using evidence-based practices to provide tailored assessment and intervention to low-income, primiparous, and multiparous families with children under 18 years of age identified as high risk by county human service systems. OBJECTIVES This study aimed to test the effects of the Nurse Support Program on child protective services case characteristics between Nurse Support Program families and a demographically comparable reference group of families and evaluate changes in parenting outcomes from pre- to postprogram involvement for Nurse Support Program families. METHODS We used a matched comparison group quasi-experimental design in which families in the Nurse Support Program ( n = 48) were compared to families ( n = 150) who were identified using administrative data from Colorado's Comprehensive Child Welfare Information System. Outcomes were child protective case characteristics (child protection referrals, open assessments, founded assessments, open cases, and children's placement in out-of-home care) and parenting outcomes. RESULTS Nurse Support Program families were less likely to have a child protection case opened or have their child placed in out-of-home care. There were no significant between-group differences in child protection referrals, open assessments, or founded assessments. Families in the Nurse Support Program showed improvements in parenting outcomes over time. DISCUSSION Findings suggest that the Nurse Support Program is a successful public health nurse home-visiting approach to promote positive parenting and family preservation among families with complex needs. Implementing tailored public health nurse home-visiting programs, such as the Nurse Support Program, should continue to be evaluated and supported to mitigate the public health risk of child maltreatment.
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Affiliation(s)
| | | | | | - Mary Doran
- Tri-County Health Department, Westminster, CO
| | - Vicki Swarr
- Tri-County Health Department, Westminster, CO
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Bonakdar Tehrani M, Baird K, Trajkovski S, Kemp L. Having to manage: culturally and linguistically diverse mothers' lived experiences with sustained nurse home visiting programs. BMC Health Serv Res 2023; 23:354. [PMID: 37041620 PMCID: PMC10091528 DOI: 10.1186/s12913-023-09315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/21/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Culturally and linguistically diverse (CALD) mothers with young children with limited English proficiency (LEP) encounter multiple barriers in accessing and engaging with primary healthcare services. The aim of this study was to explore the lived experiences and perceptions of CALD mothers with LEP in receiving child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs. METHODS Fourteen mothers were interviewed from two large Local Health Districts in Sydney. All interviews were audio-recorded for transcription purposes. Interpretative Phenomenology Analysis (IPA) was used for analysis and the socioecological approach was applied to interpret the data. RESULTS CALD mothers with LEP experienced both challenges and facilitators in their access and engagement with CFHN services and SNHV programs that were identified in four themes: managing culture; managing the service system; managing the relationship; and strengths and weaknesses of CFHN services. CONCLUSION The integration of strategies such as building trusting relationships, using female professional interpreters and better understanding of CALD mothers' cultural practices may address CALD mothers' needs and facilitate communication. Design and development of model of support involving CALD mothers with LEP in ways that voice their ideas could meet their needs and contribute to better engagement of this vulnerable population with CFHN services and SNHV programs.
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Affiliation(s)
- Mehrnoush Bonakdar Tehrani
- Translational Research and Social Innovation (TReSI), Ingham Institute for Applied Medical Research, Level 3, 1 Campbell Street, Liverpool, NSW, 2170, Australia.
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
| | - Kelly Baird
- Translational Research and Social Innovation (TReSI), Ingham Institute for Applied Medical Research, Level 3, 1 Campbell Street, Liverpool, NSW, 2170, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Suza Trajkovski
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Lynn Kemp
- Translational Research and Social Innovation (TReSI), Ingham Institute for Applied Medical Research, Level 3, 1 Campbell Street, Liverpool, NSW, 2170, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Nurse home visiting to improve child and maternal outcomes: 5-year follow-up of an Australian randomised controlled trial. PLoS One 2022; 17:e0277773. [PMID: 36441705 PMCID: PMC9704648 DOI: 10.1371/journal.pone.0277773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Nurse home visiting (NHV) is widely implemented to address inequities in child and maternal health. However, few studies have examined longer-term effectiveness or delivery within universal healthcare systems. We evaluated the benefits of an Australian NHV program ("right@home") in promoting children's language and learning, general and mental health, maternal mental health and wellbeing, parenting and family relationships, at child ages 4 and 5 years. SETTING AND PARTICIPANTS Randomised controlled trial of NHV delivered via universal, child and family health services (the comparator). Pregnant women experiencing adversity (≥2 of 10 risk factors) were recruited from 10 antenatal clinics across 2 states (Victoria, Tasmania) in Australia. INTERVENTION Mothers in the intervention arm were offered 25 nurse home visits (mean 23·2 home visits [SD 7·4, range 1-43] received) of 60-90 minutes, commencing antenatally and continuing until children's second birthdays. PRIMARY AND SECONDARY OUTCOMES MEASURED At 4 and 5 years, outcomes were assessed via parent interview and direct assessment of children's language and learning (receptive and expressive language, phonological awareness, attention, and executive function). Outcomes were compared between intervention and usual care arms (intention to treat) using adjusted regression with robust estimation to account for nurse/site. Missing data were addressed using multiple imputation and inverse probability weighting. RESULTS Of 722 women enrolled in the trial, 225 of 363 (62%) intervention and 201 of 359 (56%) usual care women provided data at 5 years. Estimated group differences showed an overall pattern favouring the intervention. Statistical evidence of benefits was found across child and maternal mental health and wellbeing, parenting and family relationships with effect sizes ranging 0·01-0·27. CONCLUSION An Australian NHV program promoted longer-term family functioning and wellbeing for women experiencing adversity. NHV can offer an important component of a proportionate universal system that delivers support and intervention relative to need. TRIAL REGISTRATION 2013-2016, registration ISRCTN89962120.
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Kanda K, Blythe S, Grace R, Elcombe E, Kemp L. Does customised care improve satisfaction and positively enable parents in sustained home visiting for mothers and children experiencing adversity? BMC Health Serv Res 2022; 22:1361. [DOI: 10.1186/s12913-022-08759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
The Maternal Early Childhood Sustained Home-visiting program (MECSH) is a structured nurse-delivered program designed to address health inequities experienced by families experiencing significant adversity. There is strong evidence for the effectiveness of this program, but limited research exploring the practice and process elements that are core to positive parent outcomes. This study aimed to examine the relationship between customised care related to the mother’s risk factors and parent satisfaction and enablement in the delivery of a MECSH-based program.
Methods
A cross-sectional study design was used. Program delivery data collected as part of a large randomised controlled trial of a MECSH-based sustained nurse home visiting program in Australia (right@home) were analysed. This study used the data collected from the intervention arm in the trial (n = 352 women). Parent satisfaction was measured at child age 24 months using the modified short-form Patient Satisfaction Questionnaire. Parent enablement was measured at child age 24 months by a modified Parent Enablement Index. Customised care was defined as appropriate provision of care content in response to four maternal risks: smoking, mental health, domestic violence and alcohol and drugs. Logistic analysis was performed to assess the impact of customised care on parent satisfaction and enablement while adjusting for covariates such as sociodemographic factors. A significance level of 95% was applied for analysis.
Results
Our results indicated high levels of satisfaction with the care provided and positive enablement. There were several sociodemographic factors associated with satisfaction and enablement, such as language spoken at home and employment experience. The mothers who received customised care in response to mental health risk and domestic violence had significantly greater satisfaction with the care provided and experienced an increase in enablement compared to those who did not receive such care.
Conclusion
This study contributes to the existing body of empirical research that examines the relationship between care processes and client outcomes in the delivery of home visiting services. It is essential for the sustained nurse home visiting service model to be flexible enough to cater for variations according to family circumstances and needs while maintaining a core of evidence-based practice.
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Mersky JP, Choi C, Lee CP. Quasinatural Experiment of Postnatal Home Visiting: An Independent Impact Study of Family Connects. Am J Prev Med 2022; 63:783-789. [PMID: 35786357 DOI: 10.1016/j.amepre.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Family Connects (FC) is a postnatal nurse home visiting program that has scale-up potential because it is brief, inexpensive, and universal. Three investigations have linked Family Connects to improved maternal and family outcomes, but no independent impact studies have been conducted to date. METHODS This study investigates a FC program in Racine County, WI that was implemented by a multimunicipal health department in partnership with a local hospital. The sampling frame included all women who gave birth at the hospital from July 1, 2018 to August 31, 2019 (N=1,511). A quasinatural experiment resulted from systematically restricting FC recruitment to weekdays. All eligible women whose birth records and addresses were obtained from a vital records office were mailed a 6-month postpartum survey. Data collected from 489 respondents (32.4%) were analyzed in February 2022 to estimate the impact of FC on maternal health, infant health and development, and parenting behavior outcomes under intent-to-treat and per protocol assumptions. RESULTS No significant differences were observed between study groups at baseline. Despite evidence that the FC program in Racine met many model standards for implementation fidelity, null effects were observed at 6 months after delivery for most outcomes. Results suggested that parents from eligible households reported more frequent infant emergency medical episodes than parents who were not offered the program. CONCLUSIONS This study found few significant effects associated with FC participation. Further investigation is needed to identify the populations with and conditions under which the program produces its intended effects.
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Affiliation(s)
- Joshua P Mersky
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
| | - Changyong Choi
- Department of Social Welfare, Gachon University, Seongnam, South Korea
| | - ChienTi Plummer Lee
- Institute for Child and Family Well-being, Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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Harwood J, Fernández L, Vallejo V, Day C. Baby and us: Community-based, Feasibility Trial of a Psychosocial Intervention for New Parents and their Infants. JOURNAL OF PREVENTION 2022; 43:589-604. [PMID: 35902491 PMCID: PMC9482590 DOI: 10.1007/s10935-022-00685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
Infancy is a critical period during which major developmental transformations occur. Early parenting is one of the strongest influences on infants’ immediate and longer-term outcomes. The transition to parenting can be demanding and stressful for mothers and fathers. This paper reports results from a feasibility study of the Empowering Parents Empowering Communities Baby and Us programme, an 8-week, universal, peer-led parenting programme for new parents living in socially disadvantaged communities. This study is a quasi-experimental, one arm, no control group study, assessing the feasibility and acceptability of Baby and Us. Programme participants (n = 158) completed standardised self-report measures of parent goal attainment, self-efficacy, knowledge about parenting, mental wellbeing, parental confidence, and programme acceptability. We found that recruiting parents from disadvantaged backgrounds was feasible (96% of programmes recruited sufficient parents to proceed, mean = 6.6 parents per programme); parent goals closely matched the aims of the programme; programme completion was high (74%), and self-report measurement completion rates were in line with other large scale community delivered parenting programmes; parents rated the programme as highly satisfactory; and they reported significant improvements in their mental wellbeing, confidence, parenting skills, self-efficacy, and goal attainment. These results provide important data to conduct a full-scale trial of Baby and Us.
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Barboza M, Marttila A, Burström B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health 2022; 22:1091. [PMID: 35650586 PMCID: PMC9158140 DOI: 10.1186/s12889-022-13492-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood. METHODS Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme. RESULTS The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme. CONCLUSIONS The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities. TRIAL REGISTRATION The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).
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Affiliation(s)
- Madelene Barboza
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 80176, Gävle, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Region Stockholm, Centre for Epidemiology and Community Medicine, Box 45436, 104 31, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
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Fortuna LR, Tobón AL, Anglero YL, Postlethwaite A, Porche MV, Rothe EM. Focusing on Racial, Historical and Intergenerational Trauma, and Resilience: A Paradigm to Better Serving Children and Families. Child Adolesc Psychiatr Clin N Am 2022; 31:237-250. [PMID: 35361362 DOI: 10.1016/j.chc.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research across populations demonstrates that intergenerational trauma can have lasting biological, psychological, and social consequences and affects groups of individuals in different ways. An appreciation of intergenerational trauma as experienced in diverse populations is important not only for understanding vulnerabilities and risk but also for cultivating opportunities for posttraumatic growth and healing. Understanding the contexts of trauma for children and families and the unveiling of structural inequities, both past and present, offers the opportunity to address these in using clinical and systems of care approaches in the public health spheres.
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Affiliation(s)
- Lisa R Fortuna
- University of California San Francisco, Zuckerberg San Francisco General Hospital, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue 7M8, San Francisco, CA 94110, USA.
| | - Amalia Londoño Tobón
- National Institutes of Health, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Yohanis Leonor Anglero
- Boston Children's Hospital, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | | | - Michelle V Porche
- University of California San Francisco, Zuckerberg San Francisco General Hospital, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue 7M8, San Francisco, CA 94110, USA
| | - Eugenio M Rothe
- Herbert Wertheim College of Medicine Florida International University, FIU Health Miami, 11200 Southwest 8th Street, Miami, FL 33199, USA
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Adams C, Hooker L, Taft A. A systematic review and qualitative meta-synthesis of the roles of home-visiting nurses working with women experiencing family violence. J Adv Nurs 2022; 79:1189-1210. [PMID: 35285982 DOI: 10.1111/jan.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
AIMS To systematically review and synthesize qualitative research exploring home-visiting nurses' roles and identify the challenges for nurses working with women experiencing family violence. DESIGN We undertook a thematic synthesis of qualitative studies, focusing on the family violence work of nurse home visitors. DATA SOURCES A systematic search of four scientific databases (ProQuest Central, CINAHL, MEDLINE, EMBASE) was undertaken in August 2021. Grey literature was searched, including government and non-government research documents, theses, clinical guidelines, policy documents and practice frameworks. REVIEW METHODS Inclusion criteria included research from high-income countries, peer-reviewed qualitative studies in English published from 1985 to 2021, and included research on home-visiting nurse family violence practice. The first author conducted the data search and the initial screening. The first and second authors independently reviewed the full text of 115 papers, identifying 26 for inclusion in the thematic synthesis (Figure 1-PRISMA flowchart). RESULTS The thematic synthesis identified two themes: (1) relationship building-with the client, with services and with colleagues/self; and (2) family violence practice-ask/screen, validate/name, assess risk/safety plan and safeguard children. CONCLUSION The thematic synthesis confirmed the multiple roles fulfilled by home-visiting nurses and enabled insight into the challenges they face as they undertake complex and demanding work. The roles of the home-visiting nurse have evolved, with the initial focus on safeguarding children leading to broader family violence nursing practice roles, including the identification of family violence and safety planning discussions with women. IMPACT Our meta-synthesis has confirmed the high-level communication and rapport-building skills required by nurses undertaking complex and conflicting roles. Nurses need support and supervision to undertake emotionally demanding work. Integrated health systems, clinical practice guidelines and tools, and training programmes need to encompass the breadth and complexity of the roles of these specialist practitioners.
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Affiliation(s)
- Catina Adams
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.,Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Kanda K, Blythe S, Grace R, Kemp L. Parent satisfaction with sustained home visiting care for mothers and children: an integrative review. BMC Health Serv Res 2022; 22:295. [PMID: 35241062 PMCID: PMC8895511 DOI: 10.1186/s12913-022-07666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To synthesise and analyse the existing literature regarding parent satisfaction with sustained home visiting care for mothers and children. BACKGROUND Sustained home visiting is a service delivery mechanism of both prevention and intervention, in which people receive structured support services within their home environment over an extended period of months or years. For the purposes of this paper, sustained home visiting refers to in-home nursing support to address health inequities for mothers and young children. Sustained home visiting programs have been found to support improved health, wellbeing, and developmental outcomes for children and families. However, there is limited knowledge with regards to the level of parent satisfaction with care provided at home, and the factors and elements of care parents perceive to be critical to their satisfaction. It is important for healthcare practitioners to understand what practices and process parents consider to be a priority in securing their ongoing engagement. DESIGN Integrative review. DATA SOURCES PubMed/Medline, CINAHL, Embase, and PsycINFO. METHODS A multi-step approach was used to search and retrieve peer-reviewed studies from the databases. Study selection, data extraction, data synthesis and critical appraisal were undertaken by two independent researchers. RESULTS A total of 13 studies met the inclusion criteria, including nine quantitative and four qualitative studies. The review found that parents provided with home visiting interventions had higher levels of satisfaction with care than those who received routine or facility-based care. Service dose was a factor associated with parent satisfaction, however, the direction of impact on parent satisfaction was mixed. Other elements of care parents perceived as important to service satisfaction included the nurse-client relationship, being treated with respect, empowerment, and emotional support. CONCLUSION While it is critically important that home visiting practitioners provide evidence-based care and interventions, it is equally important that services are delivered in the context of positive and empowering relationships. Further research is recommended to understand the care process and mechanisms that enhance parent satisfaction and positive experiences, providing optimal quality of care.
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Affiliation(s)
- Kie Kanda
- School of Nursing and Midwifery, Translational Research and Social Innovation Group, Western Sydney University, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia.
| | - Stacy Blythe
- School of Nursing and Midwifery, Translational Research and Social Innovation Group, Western Sydney University, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Rebekah Grace
- Transforming Early Education and Child Health, Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Translational Research and Social Innovation Group, Western Sydney University, Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
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Adams C, Hooker L, Taft A. The characteristics of Australian Maternal and Child Health home visiting nurses undertaking family violence work: An interpretive description study. J Adv Nurs 2022; 79:1314-1328. [PMID: 35084788 DOI: 10.1111/jan.15160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
AIMS To explore the family violence practice of home visiting nurses and identify the personal and professional characteristics of nurses undertaking family violence work. DESIGN A qualitative research design using interpretive description. METHODS The family violence nursing practice and characteristics of home visiting nurses in Victoria, Australia, were explored by analysing semi-structured interviews (n = 37) conducted over 4 months in 2019-2020. Twenty-five nurses and 12 nurse managers worked in urban, regional city and rural/remote settings. The data were analysed using reflexive thematic analysis. RESULTS We categorized the characteristics of home visiting nurses into two broad themes with sub-themes: 'Things you can learn'; and 'You just bring yourself'. CONCLUSION By researching the characteristics of home visiting nurses undertaking family violence work, this study has identified the personal characteristics managers should consider when recruiting nurses to this specialist role. Identifying the personal and professional skills required will improve nurses' working experience by reducing the risk of a potential skill/role mismatch. These insights may enhance the effectiveness of home visiting nurses so that the Enhanced Maternal and Child Health program contributes effectively to the support of women experiencing family violence. IMPACT Interviewing home visiting nurses and their managers has enabled a clearer insight into this specialist practitioner's previously unexplored work. Identifying the nurses' personal, professional, and clinical characteristics should inform the development of position roles and identify nurses who are best suited for this role. This knowledge will ensure that the Maternal and Child Health program effectively supports women experiencing family violence.
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Affiliation(s)
- Catina Adams
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Kanda K, Blythe S, Grace R, Elcombe E, Kemp L. Variations in sustained home visiting care for mothers and children experiencing adversity. Public Health Nurs 2021; 39:71-81. [PMID: 34862813 PMCID: PMC9299687 DOI: 10.1111/phn.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
Objective This study aimed to examine the variations in care received by mothers and families within a sustained home visiting program. We sought to identify the extent to which there were variations in home visiting care in response to the program schedule and families’ risk factors. Design and sample Data collected within the right@home program, a randomized controlled trial (RCT) for a sustained nurse home visiting intervention in Australia, were analyzed. A total of 352 women comprised the intervention arm of the trial. Measurements Visit content in the home visiting program, sociodemographic data, and families’ risk factors were used for analysis. Results Our results confirmed that the majority of women received scheduled content on time or within an acceptable timeframe, except for the sleeping program. Women with identified risks were significantly more likely to receive content related to those risks than women without those risks (smoking: Odds Ratio [OR] = 15.39 [95%CI 3.7–64.7], mental health: OR = 15.04 [1.8–124.0], domestic violence: OR = 4.07 [2.0–8.3], and drugs and alcohol: OR = 1.81 [1.1–3.0]). Conclusions The right@home program had high compliance with the scheduled content. Capacity development in responding to mothers with the risk of domestic violence and drugs and alcohol is recommended. Further research is required to explore the relationship between variations in care and critical outcomes.
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Affiliation(s)
- Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Rebekah Grace
- Transforming early Education and Child Health, Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Translational Research and Social Innovation group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Giallo R, Rominov H, Fisher C, Jones A, Evans K, O'Brien J, Fogarty A. A mixed-methods feasibility study of the Home Parenting Education and Support Program for families at risk of child maltreatment and recurrence in Australia. CHILD ABUSE & NEGLECT 2021; 122:105356. [PMID: 34634523 DOI: 10.1016/j.chiabu.2021.105356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Efforts to prevent child maltreatment and its recurrence in infancy and early childhood are critical to disrupting pathways to poor physical and mental health and interpersonal relationships across the life course. The Home Parenting Education and Support (HoPES) program is an intensive 8-week home-visiting intervention for families of infants and young children (0-4 years) receiving child protection services or welfare services. OBJECTIVE The aims of this feasibility study were to: (a) explore parents' and clinicians' perceptions of the outcomes related to participation in HoPES, and (b) obtain preliminary data about potential intervention outcomes related to parent-child interactions, parent mental health, and parenting self-efficacy. PARTICIPANTS AND SETTING HoPES was delivered to 30 families by a child and family health service. Seven mothers and eight HoPES clinicians also participated in qualitative interviews. METHODS A mixed-methods evaluation was conducted incorporating qualitative interviews and self-report pre-post intervention data was conducted. RESULTS Interviews with mothers identified perceived benefits for parent mental health and wellbeing, parenting, and relationships with children. This was further supported by clinician interviews and by the analysis of pre-post assessment data which revealed moderate to large decreases in maternal stress (d = 0.35) and increases in parental self-efficacy (0.76). CONCLUSIONS The findings of this study have important implications for further development of HoPES, and the design of a rigorous evaluation in next stage of evaluation research.
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Affiliation(s)
- Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; School of Psychology and Public Health, La Trobe University, Bundoora, Australia.
| | - Holly Rominov
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
| | | | - Andi Jones
- Tweddle Child and Family Health Service, Footscray, Australia
| | - Kirsty Evans
- Tweddle Child and Family Health Service, Footscray, Australia
| | - Jacquie O'Brien
- Tweddle Child and Family Health Service, Footscray, Australia
| | - Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia
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Mothers' Experiences with Child Protection Services: Using Qualitative Feminist Poststructuralism. NURSING REPORTS 2021; 11:913-928. [PMID: 34968278 PMCID: PMC8715453 DOI: 10.3390/nursrep11040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The postpartum period is often portrayed as a blissful, calm and loving time when mothers, partners and family members bond with their newborn babies. However, this time may be experienced quite differently when mothers are monitored by Child Protection Services. Having a baby under these circumstances can be very difficult and traumatizing. While all new parents require support and information to help them through the transition to parenthood and address physical and psycho-social changes, mothers who are involved with Child Protection Services require more specialized support as they encounter higher incidences of postpartum stressors and higher rates of poverty, mental illness and substance abuse. The impact of support for mothers involved with Child Protection Services is not well-understood from the perspective of mothers. AIM The aim of the study was to understand how new mothers in Nova Scotia prioritized their postpartum needs and where they went to obtain information and support. METHODS Feminist poststructuralism was the methodology used to understand how the experiences of five mothers who accessed a family resource center and had been involved with Child Protection Services in Nova Scotia Canada had been personally, socially and institutionally constructed. RESULTS Themes include: (1) We are Mothers, (2) Being Red Flagged, (3) Lack of Trust, (4) Us Against Them and (5) Searching for Supportive Relationships. CONCLUSION Personal stories from all participants demonstrated how they experienced stigma and stereotypes from healthcare workers and were often not recognized as mothers. They also struggled to find information, supports and services to help them keep or regain their babies.
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Bonakdar Tehrani M, Kemp L, Baird K. Sustained nurse home-visiting with culturally and linguistically diverse families: Australian nurses' perspectives. Public Health Nurs 2021; 39:40-47. [PMID: 34687070 DOI: 10.1111/phn.12996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Australia, sustained nurse home-visiting (SNHV) programs are designed and implemented to promote positive outcomes for mothers with young children experiencing complex life challenges. Despite the crucial role of trained public health nurses, there is a dearth of research about their experiences delivering these programs to culturally and linguistically diverse (CALD) families with limited English proficiency (LEP). AIM This study aimed to explore the experiences of public health nurses in providing services to CALD families with LEP. METHOD Two focus groups were conducted with 13 public health nurses in two major local health districts in Sydney. The focus groups were audio recorded for transcription purposes, and thematically analyzed. A socioecological framework was applied during the analysis process. RESULT Five major themes were identified: (1) program issues; (2) service system issues in understanding and responding to diverse women; (3) issues working with interpreters; (4) trusting relationships; and (5) mother-related facilitators. DISCUSSION To achieve better access and engagement for CALD families, it is crucial that public health nurses increase their knowledge and awareness about potential challenges, such as female interpreter availability, and facilitators, such as engaging the broader family, in order to effectively deliver healthcare services to diverse populations.
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Affiliation(s)
- Mehrnoush Bonakdar Tehrani
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Lynn Kemp
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Kelly Baird
- Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Sheppard-LeMoine D, Aston M, Goldberg L, MacDonald J, Tamlyn D. Empowering Public Health Nurses and Community Home Visitors through Effective Communication Relationships. NURSING REPORTS 2021; 11:652-665. [PMID: 34968340 PMCID: PMC8608065 DOI: 10.3390/nursrep11030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022] Open
Abstract
Home visiting programs for marginalized families have included both Public Health Nurses (PHNs) and Community Home Visitors (CHV). Support for families requires health care providers to implement effective communication and collaboration practices; however, few studies have examined how this is carried out. The purpose of this qualitative research study was to explore how an Enhanced Home Visiting (EHV) program in Nova Scotia Canada was organized, delivered through the experiences of PHNs and CHVs. Feminist post-structuralism informed by discourse analysis was used to understand how their experiences were socially and institutionally constructed. Individual semi-structured interviews were conducted with 6 PHNs and 8 CHVs and one focus group was held with 10 of the participants. A social discourse on mothering layered within a social discourse of working with a vulnerable population added a deeper understanding of how communication was constructed through the everyday practices of PHNs and CHVs. Findings may be used to inform reporting and communication practices between health care providers who work with marginalized families.
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Affiliation(s)
| | - Megan Aston
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.G.); (J.M.); (D.T.)
- Correspondence:
| | - Lisa Goldberg
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.G.); (J.M.); (D.T.)
| | - Judy MacDonald
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.G.); (J.M.); (D.T.)
| | - Deb Tamlyn
- School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada; (L.G.); (J.M.); (D.T.)
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Beatson R, Molloy C, Perini N, Harrop C, Goldfeld S. Systematic review: An exploration of core componentry characterizing effective sustained nurse home visiting programs. J Adv Nurs 2021; 77:2581-2594. [PMID: 33481301 DOI: 10.1111/jan.14755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
AIMS To identify the core components or potential 'active ingredients' of sustained nurse home visiting (SNHV) programs that have demonstrated positive effects on maternal or child health, psychosocial development, or self-sufficiency outcomes among disadvantaged families in high-income countries. DESIGN Systematic review with narrative summary. DATA SOURCES Programs were identified from searches of several reputable evidence clearing houses and the following bibliographic databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Cochrane Central Register of Controlled Trials. Year of publication was originally restricted from 2008 -2018, with additional searches conducted up to 2019. REVIEW METHODS This review of SNHV program componentry builds on a previous evaluation of program effectiveness. Programs were selected for inclusion if they had been tested in a randomized or cluster-randomized controlled trial (RCT/CRCT). Componentry characteristics related to program delivery, nurse provider, and outcome-specific intervention content were then extracted. RESULTS Comparison of the seven eligible programs showed seven common core components: antenatal commencement, support to child age 2 years, at least 19 scheduled visits and experienced or highly qualified nurses with program-specific training, caseloads of approximately 25 families, regular supervision, and multidisciplinary supports. Outcome-specific program content was generally not well reported. CONCLUSION The findings from this review have utility in guiding the development of minimum standard benchmarks and best-practice recommendations for SNHV programs and call for more detailed publication of core content componentry in the SNHV literature. IMPACT Identification of the core componentry underpinning program effectiveness should inform policy decisions on program selection, adaptation for specific populations, and quality control. Such evidence-based decision-making should in turn lead to better maternal and child outcomes among disadvantaged families in high-income countries, reducing societal and economic burdens of inequity.
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Affiliation(s)
- Ruth Beatson
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Carly Molloy
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Sharon Goldfeld
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia
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