Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature

Changing praxis from within - an in-depth qualitative exploration of how home visits affected statutory service at a Child Health Clinic

PURPOSE

This study aims to define critical domains of salutogenic home visits conducted by public health nurses, and how thevisits can supplement a universal Child Health Clinic.

DESIGN AND METHOD

A qualitative grounded theory study was conducted among three public health nurses in Stovner district, Oslo, Norway. The nurses were followed for 26 months offering home visits to all first-time parents. Data from focus group discussions, monthly reflection notes and bi-weekly meeting minutes were analysed using qualitative content analysis.

RESULTS

Three critical themes emerged: building trust, prenatal visits and maintaining a salutogenic, strength-based approach. Extended public health nurse autonomy facilitated tailored support based on individual family needs. This promoted proportionate universalism to naturally be the gradient of the home visit intensity and kept actions at a universal level.

CONCLUSIONS

The key component of family access and utilizing support was building and maintaining trust. Conducting prenatal visits was an important part of the nurse-family relationship, positively affecting later Child Health Clinic follow-up and continued care.

PRACTICE IMPLICATIONS

Critical domains and benefits of practicing home visits emerged in this study and disclosed important aspects necessary for family access and utilizing support. By changing the point of entry from postnatal to prenatal, public health nurses-family relationship gets an important head start, positively affecting later follow-up and continued care. A tailored support to new families without using a predefined agenda and a salutogenic, strength-based philosophy can fit the public health nurses' professional beliefs and extend their autonomy.

Qualitative description of outreach and engagement in perinatal substance treatment in Finland

BACKGROUND

Women with perinatal substance problems experience a multitude of barriers to care. They have specific early intervention needs, they endure societal stigma, and both substances and mental health issues influence the way they navigate within support and treatment systems. Early interventions for women with perinatal substance problems are underresearched contexts. The aim of the study is to describe building relationships and engagement within an outreach and low threshold service encounter tailored for pregnant women with SUD (substance use disorder).

METHODS

The data consist of online written narratives from 11 workers involved in the program and feedback from 504 families in the recovery process comprising 228 open-ended answers. The data were analyzed with a thematic analysis.

RESULTS

The programs are characterized by flexibility and the implementation of inclusive ways to approach families. The themes for enhancing relationships and engagement within outreach and low threshold programs are Acceptance and attitude: a sensitive approach of approval; flexibility within strictness to allow for diversity and individuality; availability and space to ensure a trustful atmosphere; negotiating via doing to build connections; and everyday life changes: imagining recovery. The themes represent the need of being available, focusing on the worker's attitudes and building connections by doing together, and visioning recovery together.

CONCLUSIONS

The study results can add to the understanding of SUD outreach and low threshold work during pregnancy. The elements described in this study need further theoretical development, research and critical assessment. Building relationships during pregnancy were characterized by connecting within everyday life situations and supporting the development of an attachment relationship between the baby and the parents. To promote recovery, a comprehensive approach in which substance-related issues and mental health conditions are interconnected can be favored. Engaging early on during pregnancy might enhance success during future rehabilitation.