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Monahan E, McCrae JS, Arbour M. Participation in Pediatric Primary Care Innovation, DULCE, Increases Caregiver Agency and Resilience and Decreases Impact of Stress. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:685-698. [PMID: 37917335 DOI: 10.1007/s11121-023-01608-z] [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] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
The purpose of the present study was to explore outcomes and heterogeneous effects of an evidence-based, cross-sector pediatric healthcare intervention for families with infants, Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is tailored to allow families' needs and desires to drive DULCE intensity. This is a longitudinal study following families involved with pediatric primary care clinics from infant's birth to 15 months. Multi-level longitudinal modeling was used to compare the program's influence on resilience, parent agency, and the impact of stress on parent functioning among program recipients (n = 172) and non-recipients (n = 170). Study participants were recruited from four health care clinics in California and Florida, and participants completed in-person survey interviews at baseline (infant age 0-6 months) and final (infant age 12-15 months) timepoints, with a minimum of 6 months between baseline and final interview required. Assignment of families to intervention (participated in DULCE) or comparison group (received clinic care as usual) varied by clinic. The cross-sector pediatric primary care intervention screened families at high rates (70-90%), along with referring and connecting families to resources. DULCE participation was associated with increases in parents' agency and resilience. DULCE's positive influence on parent agency and impact of stress was observed with low dosage, and higher-risk families saw additional improvements in resilience at high dosage (high and low risk defined with Latent Profile Analysis). Findings reinforce the importance of examining heterogeneous effects of evidence-based interventions. DULCE's influence on parent agency and impact of stress was observed with low dosage; strengthened resilience among higher-risk families was found at high dosage. These findings document the value of a universal approach to prevention services in pediatric settings with tailoring that allows families to drive their engagement with the intervention.
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Affiliation(s)
- Emma Monahan
- Chapin Hall, University of Chicago, Chicago, IL, USA.
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2
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Williams V, Franco-Rowe C, Lopez C, Allison MA, Olds DL, Tung GJ. Coordination of family's care in an evidence-based nurse home visiting program. J Interprof Care 2024; 38:234-244. [PMID: 37855719 DOI: 10.1080/13561820.2023.2266452] [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: 07/16/2021] [Accepted: 09/27/2023] [Indexed: 10/20/2023]
Abstract
Interprofessional care coordination within evidence-based prevention programs like Nurse-Family Partnership® (NFP) is necessary to meet family needs and maximize program impact. This study aimed to describe the coordination of families' care in the NFP home visiting context. We used an adapted grounded theory approach and purposively sampled seven NFP sites. We conducted telephone interviews with 95 participants: 51 NFP staff (54%), 39 healthcare providers (41%), and 5 social service providers (5%). All interviews were recorded, transcribed, validated, and analyzed in NVivo11. Many community providers in all sites described their knowledge of the characteristics of the NFP intervention, including the strength of its evidence to achieve outcomes. Care coordination was dynamic and changed over time based on client needs and staff willingness to work together. Effective care coordination in the NFP context from the provider perspective is driven by shared knowledge, integrated systems, mission alignment, and individual champions who value the program.
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Affiliation(s)
- Venice Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carol Franco-Rowe
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Connie Lopez
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mandy A Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Jackson Tung
- Colorado School of Public Health, Department of Health Systems, Management & Policy, Aurora, CO, USA
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3
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Williams VN, Marshall J, Richey M, Allison M. Engaging Community in Prioritizing Outcomes to Improve Family Health in Evidence-Based Nurse Home Visiting: Using a Modified e-Delphi Method. Matern Child Health J 2024; 28:333-343. [PMID: 37989933 DOI: 10.1007/s10995-023-03839-6] [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] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Evidence-based home visiting programs are designed to improve maternal child health. Nurse-Family Partnership (NFP) is a model evidence-based home visiting program, shown to improve pregnancy outcomes, child development, and economic self-sufficiency for first-time mothers and their families experiencing social and economic adversities, enrolling them early in pregnancy. Recently, NFP has expanded its services to multiparous women (previous live births) and enrolling women past 28 weeks gestation (late registrants) in selected agencies in Florida since 2021. OBJECTIVE To study the process and impacts of expanding NFP to expanded populations (multiparous and/or late registrants), we convened a diverse Advisory Committee to guide the NFP expansion evaluation in Florida. METHODS This study employed a modified e-Delphi method with three rounds of data collection, to engage diverse partners to identify process and impact outcomes for the NFP expansion evaluation. RESULTS Child maltreatment was identified as the highest priority outcome. Process outcomes included program reach, client enrollment, and client engagement, while impact outcomes included maternal physical health, maternal mental health and substance use, birth outcomes, and breastfeeding practices. The Advisory Committee further identified potential data sources to measure these outcomes. CONCLUSIONS FOR PRACTICE Identifying and selecting key process and impact outcomes using a community-engaged process is necessary to ensure equal buy-in from all partners and to inform rigorous program evaluation. This study showed that using methods such as e-Delphi is feasible and effective for achieving thoughtful and rigorous decision-making, even in times of uncertainty like the COVID-19 pandemic.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Jennifer Marshall
- University of South Florida, College of Public Health, Tampa, FL, 33612, USA
| | - Mirine Richey
- Center for Prevention & Early Intervention Policy, Florida State University, Tallahassee, FL, 32301, USA
| | - Mandy Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Children's Hospital Colorado, Aurora, CO, USA
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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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Massi L, Hickey S, Maidment SJ, Roe Y, Kildea S, Kruske S. "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. Women Birth 2023; 36:e613-e622. [PMID: 37302902 DOI: 10.1016/j.wombi.2023.05.010] [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: 02/10/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Luciana Massi
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia
| | - Sarah-Jade Maidment
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, Faculty of Health, Charles Darwin University, Australia.
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Harpin SB, Artmann ALA, Neal M, Robertson G, Barton AJ. Program implementation and outcomes from three cohorts of the nurse-family partnership nurse residency program. Public Health Nurs 2022; 39:1000-1008. [PMID: 35512237 DOI: 10.1111/phn.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this paper is to describe a Nurse-Family Partnership (NFP) Nurse Residency Program (NRP) and program outcomes. METHODS Dual methods were used to evaluate the first three cohorts of the NFP NRP. Participants were new NFP nurses, most working in Colorado. Pre-(n = 42) and post-program (n = 26) surveys were completed using the Individual Workplace Perception Scale (IWPS) and endorsement of program objectives; key informant interviews were done with the initial cohort. Descriptive statistics and unpaired t-tests (for the IWPS) were used to explain program effectiveness and efficacy. RESULTS Forty-two NFP nurses participated in the program at the onset. There was consistent attendance (92% or more) among those who finished and modest individual attrition during the length of the program. Participants reported high levels of satisfaction with the content and meeting program objectives; there were no significant differences on pre- and post-program IWPS scores. CONCLUSIONS The program was well-received by program participants and has the potential to contribute to the professional development of new NFP nurses.
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Affiliation(s)
- Scott B Harpin
- University of Colorado College of Nursing, Aurora, Colorado
| | | | | | | | - Amy J Barton
- University of Colorado College of Nursing, Aurora, Colorado
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Jack SM, Duku E, Whitty H, Van Lieshout RJ, Niccols A, Georgiades K, Lipman EL. Young mothers' use of and experiences with mental health care services in Ontario, Canada: a qualitative descriptive study. BMC Womens Health 2022; 22:214. [PMID: 35672725 PMCID: PMC9172978 DOI: 10.1186/s12905-022-01804-z] [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: 07/25/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite the high prevalence of mental health issues among young mothers, their subsequent needs for mental health care support does not correlate with their access and use of services. The purpose of this study, grounded in the experiences of young mothers living in Ontario, Canada, was to describe their experiences of using mental health services during the perinatal period, and to identify the attributes of services and professionals that influenced their decision to engage with mental health services.
Methods As the qualitative component of a sequential explanatory mixed methods study, the principles of qualitative description informed sampling, data collection, and analysis decisions. In-depth, semi-structured interviews were conducted with a purposeful sample of 29 young mothers (≤ 21 years) who met diagnostic criteria for at least one psychiatric disorder, and who were ≥ 2 months postpartum. Interview data were triangulated with data from ecomaps and a sub-set of demographic data for this purposeful sample from the survey conducted in the quantitative study component. Qualitative data were analyzed using both conventional content analysis and reflexive thematic analysis; the subset of survey data extracted for these 29 participants were analyzed using descriptive statistics. Results Young mothers identified the need to have at least one individual, either an informal social support or formal service provider who they could talk to about their mental health. Among participants deciding to seek professional mental health support, their hesitancy to access services was grounded in past negative experiences or fears of being judged, being medicated, not being seen as an active partner in care decisions or experiencing increased child protection involvement. Participants identified organizational and provider attributes of those delivering mental health care that they perceived influenced their use of or engagement with services. Conclusion Organizations or health/social care professionals providing mental health services to young pregnant or parenting mothers are recommended to implement trauma-and violence-informed care. This approach prioritizes the emotional and physical safety of individuals within the care environment. Applying this lens in service delivery also aligns with the needs of young mothers, including that they are actively listened to, treated with respect, and genuinely engaged as active partners in making decisions about their care and treatment.
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Affiliation(s)
- Susan M Jack
- School of Nursing, McMaster University, HSC 3H48B, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Heather Whitty
- Institute for Innovation and Implementation, School of Social Work, University of Maryland Baltimore, Baltimore, USA
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Alison Niccols
- Ron Joyce Children's Health Centre, Hamilton, ON, Canada
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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8
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Willis DW, Condon MC, Moe V, Munson L, Smith L, Eddy JM. The context and development of the early relational health screen. Infant Ment Health J 2022; 43:493-506. [PMID: 35537064 DOI: 10.1002/imhj.21986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022]
Abstract
Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.
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Affiliation(s)
- David W Willis
- Center for the Study of Social Policy, Washington, District of Columbia, USA
| | | | - Vibeke Moe
- Department of Psychology, University of Oslo, and the Regional Centre for Child and Adolescent Mental Health for Eastern & Southern Norway, Oslo, Norway
| | - Leslie Munson
- Department of Special Education, Portland State University, Portland, Oregon, USA
| | - Lars Smith
- Department of Psychology, University of Oslo, and the Regional Centre for Child and Adolescent Mental Health for Eastern & Southern Norway, Oslo, Norway
| | - J Mark Eddy
- Family Translational Research Group, College of Dentistry, New York University, New York City, New York, USA.,Texas Center for Equity Promotion, College of Education, University of Texas at Austin, Austin, Texas, USA
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Kitsaras G, Pretty IA, Allan J. Bedtime Routines Intervention for Children (BRIC) project: results from a non-randomised feasibility, proof-of concept study. Pilot Feasibility Stud 2022; 8:79. [PMID: 35387669 PMCID: PMC8984069 DOI: 10.1186/s40814-022-01039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bedtime routines are highly recurrent family activities with implications for children's wellbeing, development and health. AIMS The objective of this study is to co-develop and test in a feasibility, proof-of-concept study a bedtime routines intervention using text messages aimed at first-time parents with young children. METHODS Fifty first-time parents with children aged 1-3 years were recruited for this study. Parents received a text message-based intervention for 7-consecutive nights which provided support and information on achieving optimal bedtime routines. Parents completed pre- and post-intervention questionnaires focusing on children's sleep, bedtime routines and parental mood disturbance. Feedback was provided at the end of the study. RESULTS Recruitment target and high retention with 98%, or 49 out of 50 participants completing the study were achieved. Pre- and post-intervention, there were improvements in total children's sleep with children sleeping longer and having less disrupted sleep overall (MD = - 7.77 (SD = 17.91), t(48) = - 3.03, p = .004, CI (- 12.91, - 2.63) and in overall quality of bedtime routines (MD = - 5.00, SD = 7.01, t(48) = - 4.98, p < .001, CI (- 7.01, - 2.98). Parental mood disturbance decreased pre- to post-intervention (MD = 5.87, SD = 15.43, t(48) = 2.66), p = .010, CI (1.44, 10.30). Parents provided positive feedback about the intervention and valued the support that was provided to them. CONCLUSIONS Bedtime routines were successfully altered with short-term benefits for children's sleep and parental mood. Future research will need to utilize a more robust, longitudinal approach for a definite exploration of sustained changes in bedtime routines and their long-term implications for children and parents.
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Affiliation(s)
- George Kitsaras
- Dental Health Unit, The University of Manchester, Manchester, UK.
| | - Iain A Pretty
- Dental Health Unit, The University of Manchester, Manchester, UK
| | - Julia Allan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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10
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Massi L, Hickey S, Maidment SJ, Roe Y, Kildea S, Nelson C, Kruske S. Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study. Int J Equity Health 2021; 20:212. [PMID: 34563171 PMCID: PMC8465693 DOI: 10.1186/s12939-021-01519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations’ and other babies in Australia. The program is based on the United States’ Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting. Methods A qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate ‘yarning’ method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis. Results Seventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over ‘ownership’ of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums. Conclusion Effective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context.
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Affiliation(s)
- Luciana Massi
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia.
| | - Sarah-Jade Maidment
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Carmel Nelson
- Institute of Urban Indigenous Health, Brisbane, QLD, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
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11
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Runyan DK. Child Maltreatment and Medical Fragility: Fatalities in the First Year of Life. Pediatrics 2021; 148:peds.2021-051829. [PMID: 34426535 DOI: 10.1542/peds.2021-051829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Desmond K Runyan
- Department of Pediatrics and the Kempe Center, The University of Colorado, Aurora, Colorado and the Departments of Social Medicine and Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Jack SM, Kimber M, Davidov D, Ford-Gilboe M, Wathen CN, McKee C, Tanaka M, Boyle M, Johnston C, Coben J, Gasbarro M, McNaughton D, O'Brien R, Olds DL, Scribano P, MacMillan HL. Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation. J Adv Nurs 2021; 77:3894-3910. [PMID: 34288040 DOI: 10.1111/jan.14979] [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: 12/08/2020] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice. DESIGN An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme. METHODS Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis. RESULTS Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence. CONCLUSION Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity. IMPACT These evaluation findings underscore that improvement in nurses' self-reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence.
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Affiliation(s)
- Susan M Jack
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Melissa Kimber
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Danielle Davidov
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA.,School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Faculty of Information and Media Studies, Western University, London, ON, Canada
| | - Christine McKee
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Masako Tanaka
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Michael Boyle
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Carolyn Johnston
- Nurse-Family Partnership National Service Office, Denver, CO, USA
| | - Jeffrey Coben
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Mariarosa Gasbarro
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Diane McNaughton
- Department of Community Systems and Mental Health Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Ruth O'Brien
- College of Nursing, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - David L Olds
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Philip Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harriet L MacMillan
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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A Qualitative Study of Mothers' Perspectives on Enrolling and Engaging in an Evidence-Based Nurse Home Visiting Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:845-855. [PMID: 34117977 DOI: 10.1007/s11121-021-01260-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
Prevention programs like Nurse-Family Partnership® (NFP) must enroll and retain clients of the intended population to maximize program impact. NFP is an evidence-based nurse home visitation program shown in randomized trials to improve maternal and child health and life course outcomes for first-time parents experiencing economic adversity, particularly for mothers with limited psychological resources. The purpose of this study was to understand enrollment and engagement experiences of mothers with previous live births referred to NFP in a formative study of the program for this population, but did not enroll or dropped out before program graduation. We used a grounded theory approach and purposively selected three NFP sites with variation in enrollment rates. We conducted telephone interviews with 23 mothers who were either referred to NFP and declined enrollment or former clients who dropped out before graduation. All interviews were conducted in English, recorded, transcribed, and validated. We developed an iterative codebook with multiple coders to analyze our data in NVivo11 and wrote thematic memos to synthesize data across study sites. Mothers described experiencing overlapping risk factors including physical and behavioral health conditions, child welfare involvement, and housing insecurity. Mothers from all sites discussed how they were referred to the NFP program, their experience of the enrollment process, reasons for enrolling or not enrolling, and reasons for dropping out after initial enrollment. Key themes that influenced mothers' decision-making were: perceptions of program value, not needing the program, their living situation or being too busy as a deterrence, and past experiences including a distrust of health care. Reasons for attrition were related to no longer needing the service, being assigned a new nurse, being too tired postpartum, and moving out of the service area. One way to support home visiting nurses in family enrollment and engagement is to build their professional capacity to implement trauma-informed strategies given mothers' life experiences.
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Williams VN, Brooks-Russell A, McManus BM, Yost E, Olds DL, Tung GJ. National survey of nurse home visitor collaboration with health care and social services. Public Health Nurs 2021; 38:825-836. [PMID: 33749013 DOI: 10.1111/phn.12897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity. DESIGN A descriptive, cross-sectional survey measured collaborative practices between nurse home visitors, health care, and social service providers. A census of 263 nursing supervisors completed a web-based survey. MEASUREMENTS The survey included the validated 7-item Relational Coordination Scale, adapted items from the Interagency Collaboration Activities Scale on shared resources, and items related to collaboration attitudes and beliefs. Data were analyzed with descriptive statistics. RESULTS Relational coordination scores, which are relative measures, ranged from 1 to 5; highest with supplemental nutrition for Women, Infants & Children (M = 3.77) and early intervention (M = 3.44); and lowest with housing (M = 2.55). The greatest sharing of resources was with supplemental nutrition (sum = 12.95) and mental health providers (sum = 11.81), and least with housing (sum = 7.26); with a range of 1-30 where higher scores indicated greater resource-sharing. CONCLUSION Home visiting nurses collaborate with interprofessional providers with variation in the degree of collaboration between agencies and by provider type within an agency. Collaboration was a function of two interrelated domains: interpersonal relationships supported by organizational and contextual factors at the systems-level.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Ashley Brooks-Russell
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Beth M McManus
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Elly Yost
- Nurse-Family Partnership National Service Office, Denver, CO, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory J Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
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15
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Healthy Places for Children: The Critical Role of Engagement, Common Vision, and Collaboration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249277. [PMID: 33322469 PMCID: PMC7764690 DOI: 10.3390/ijerph17249277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023]
Abstract
Planning plays a critical role in promoting healthy communities for children. We conducted a national survey of United States (US) cities and counties in 2019 and found only half of the 1312 responding communities report they give attention to the needs of children in their community plans. Those that do, provide more services and have more child-friendly zoning codes. We use a human ecological framework to build structural equation models of child-friendly zoning and services. We find communities with more engagement of families with children and youth and a common vision across generational, race, and ethnic lines report higher levels of child-friendly zoning and services. Collaboration between health providers and schools builds trust and leads to more services. However, child-friendly zoning is lower in communities with higher child poverty, and in suburbs and rural areas. Our results support a dynamic human ecological model where the processes of collaboration, inclusion, and engagement are key to creating healthy places for children. These processes may be especially important in addressing the unique challenges of suburban and rural communities.
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16
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Tung GJ, Williams VN, Ayele R, Shimasaki S, Olds D. Characteristics of effective collaboration: A study of Nurse-Family Partnership and child welfare. CHILD ABUSE & NEGLECT 2019; 95:104028. [PMID: 31229764 DOI: 10.1016/j.chiabu.2019.104028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND In February 2018, President Trump signed into law the Family First Prevention Act, legislation in the United States aimed at providing prevention services for families at risk of entering the child welfare system. The effectiveness of these prevention efforts is dependent on the formation of collaborative relationships between prevention-programs and child welfare. OBJECTIVE To identify factors that influence the ability of the Nurse-Family Partnership (NFP) and Child Protective Services (CPS) to collaborate in serving high-risk mothers and their children. PARTICIPANTS 123 NFP, CPS workers, and community partners. SETTING Seven sites in the U.S. state of Colorado selected to include an array of community sizes, geographies, apparent levels of collaboration, and variations in internal structures and practices. METHODS Using an adapted grounded theory approach, we conducted semi-structured interviews with frontline NFP and CPS workers and supervisors. Interviews were recorded, transcribed, validated, and coded in NVivo 10. RESULTS Alignment of core organizational mission and methods was key in determining collaboration levels between NFP and CPS. Only when workers perceived there to be alignment in organizational mission, did other factors such as program eligibility, communication channels, and risk and safety assessment practices influence the perceived benefits and efforts undertaken to enhance collaboration. CONCLUSIONS High-risk families frequently require services that go beyond the scope of any one organization. As programs that serve high-risk families refine their efforts to serve them effectively, collaborative efforts should focus on examining opportunities and challenges involved in creating greater mission alignment.
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Affiliation(s)
- Gregory J Tung
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States; Prevention Research Center for Family and Child Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States.
| | - Venice N Williams
- Prevention Research Center for Family and Child Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States
| | - Roman Ayele
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States; Denver-Seattle Center of Innovation for Veteran-Centered & Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO, United States
| | - Suzuho Shimasaki
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States
| | - David Olds
- Prevention Research Center for Family and Child Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States
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Trent M, Perin J, Gaydos CA, Anders J, Chung SE, Tabacco Saeed L, Rowell J, Huettner S, Rothman R, Butz A. Efficacy of a Technology-Enhanced Community Health Nursing Intervention vs Standard of Care for Female Adolescents and Young Adults With Pelvic Inflammatory Disease: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e198652. [PMID: 31390037 PMCID: PMC6686980 DOI: 10.1001/jamanetworkopen.2019.8652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
Importance Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects female adolescents and young adults. Despite data indicating poor adherence and adverse outcomes among those who experience subsequent Neisseria gonorrhoeae and Chlamydia trachomatis infection, few trials have been designed to address this public health need. Objective To examine the efficacy of a technology-enhanced community health nursing (TECH-N) intervention vs standard of care for improving PID self-management behaviors and 90-day longitudinal prevalence of N gonorrhoeae and C trachomatis infection. Design, Setting, and Participants This randomized clinical trial of the TECH-N intervention was conducted among female patients 13 to 25 years of age diagnosed with mild to moderate PID who were being discharged to outpatient treatment from September 6, 2012, to December 8, 2016, at a large academic medical center. The final analysis of data was completed in November 2018. This study compared the efficacy of the intervention with that of the standard of care using an intention-to-treat analysis. Interventions Enrolled participants completed an audio computer-assisted self-interview, provided specimens for N gonorrhoeae and C trachomatis testing, and were randomized to standard treatment (n = 137) or the TECH-N intervention (n = 149). Intervention participants received text-messaging support and a community health nurse visit within 5 days of diagnosis. Change in the prevalence of N gonorrhoeae and C trachomatis infection was estimated with logistic regression. The N gonorrhoeae and C trachomatis positivity rate over time was evaluated using generalized estimating equations. Main Outcomes and Measures The primary outcome was the prevalence of N gonorrhoeae and C trachomatis infection at 90-day follow-up. The secondary outcome was adherence to the Centers for Disease Control and Prevention recommendations for self-care. Results A total of 286 patients (mean [SD] age, 18.8 [2.5] years; 268 [93.7%] African American) participated in the study. Although the study groups were demographically similar, the intervention group had a higher baseline rate of C trachomatis infection (45 of 139 [32.4%] vs 25 of 132 [18.9%], P = .01). Although N gonorrhoeae and C trachomatis positivity was not statistically different between groups at 90-day follow-up (6 of 135 [4.4%] vs 13 of 125 [10.4%], P = .07), the differential rate of decrease was significantly higher in the intervention group (48 of 140 [34.4%] to 6 of 135 [4.4%] compared with 34 of 133 [25.6%] to 13 of 112 [10.4%], P = .02). Intervention participants were more likely to receive the Centers for Disease Control and Prevention-recommended short-term follow-up visit compared with the control group (131 of 139 [94.2%] vs 20 of 123 [16.3%], P < .001). Conclusions and Relevance Adolescent and young adults with PID in the TECH-N intervention were more likely to experience decreases in N gonorrhoeae and C trachomatis positivity compared with the control group and to receive short-term clinical assessment. These findings suggest that the TECH-N intervention should be considered as a potential enhancement of standard of care approaches for management of female adolescents and young adults with mild to moderate PID in urban communities facing significant sexually transmitted infection disparities. Trial Registration ClinicalTrials.gov identifier: NCT01640379.
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Affiliation(s)
- Maria Trent
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charlotte A. Gaydos
- Johns Hopkins International STD Laboratory, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer Anders
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shang-en Chung
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Tabacco Saeed
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Rowell
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Huettner
- Section on Adolescent/Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Rothman
- Department of Adult Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arlene Butz
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Supplee LH, Duggan A. Innovative Research Methods to Advance Precision in Home Visiting for More Efficient and Effective Programs. CHILD DEVELOPMENT PERSPECTIVES 2019; 13:173-179. [PMID: 31598130 PMCID: PMC6774294 DOI: 10.1111/cdep.12334] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Home visiting during early childhood can improve a range of outcomes for children and families. As evidence-based models are implemented across the nation, two questions have emerged. First, can home visiting improve outcomes more efficiently? Second, can overall effects be strengthened for specific subgroups of families? For the past several decades, research focused on testing the average effects of home visiting models on short- to long-term outcomes has found small impacts. These effects are not the same for all families. The field needs new evidence produced in new ways to overcome these challenges. In this article, we provide an overview of the evidence in this field, including what works and for whom. Next, we explain precision approaches to various fields and how this approach could be used in home visiting programs. Research on precision home visiting focuses on the ingredients of home visiting models, collaborating with practitioners to identify the ingredients and testing them on near-term outcomes, and using innovative study designs to learn more quickly what works best for which families. We conclude by proposing four pillars of research that will help achieve precision home visiting services.
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Hardy K, Hooker L, Ridgway L, Edvardsson K. Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study. J Clin Nurs 2019; 28:3610-3617. [PMID: 31162886 DOI: 10.1111/jocn.14956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/04/2019] [Accepted: 05/29/2019] [Indexed: 01/11/2023]
Abstract
AIMS AND OBJECTIVES To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse. BACKGROUND Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking. METHOD Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour. RESULTS In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem. CONCLUSION The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse. RELEVANCE TO CLINICAL PRACTICE Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.
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Affiliation(s)
- Kelly Hardy
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Leesa Hooker
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bundoora, Victoria, Australia
| | - Lael Ridgway
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Flaherty E, Legano L, Idzerda S, Sirotnak AP, Budzak AE, Gavril AR, Haney SB, Laskey A“T, Messner SA, Moles RL, Palsuci VJ. Ongoing Pediatric Health Care for the Child Who Has Been Maltreated. Pediatrics 2019; 143:peds.2019-0284. [PMID: 30886109 DOI: 10.1542/peds.2019-0284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.
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Affiliation(s)
- Emalee Flaherty
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Lori Legano
- Department of Pediatrics, School of Medicine, New York University, New York, New York; and
| | - Sheila Idzerda
- Billings Clinic Bozeman Acorn Pediatrics, Bozeman, Montana
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21
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Timpe Z, Winokur M. Integrating Retention Rates into Economic Analyses of Prevention Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 20:566-574. [PMID: 30488333 DOI: 10.1007/s11121-018-0958-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evidence-based prevention interventions hold great promise for enhancing the well-being of individuals, families, and society. As these interventions are implemented in new contexts and at wider scales, policymakers and private sector organizations are increasingly interested in understanding the economic returns that programs produce through reductions of burden on public service systems, such as criminal justice and human services. Thus, it is important to ensure that economic models account for factors, such as retention, which are important when interventions are implemented in real-world contexts with selective populations and voluntary participation. Yet the field of prevention has provided little guidance to help researchers and policymakers analyze the economics of interventions so that estimates reflect the impact of implementation factors on intervention cost-effectiveness. This paper discusses the role retention plays in the economic efficiency of interventions when the prevention of child maltreatment is the primary motivation for funding these programs. We present a conceptual model to serve as a guide for explicit inclusion of retention rates when calculating cost estimates to be used in cost-effectiveness analysis. A case study is presented, demonstrating the variability in estimates dependent on the definition of retention and the estimated retention rate. The results underscore the importance of improving our understanding of factors underlying and related to retention, such as engagement, which may improve the precision of cost and cost-effectiveness analysis in applied settings.
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Affiliation(s)
- Zach Timpe
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, 80523, USA.
| | - Marc Winokur
- School of Social Work, Colorado State University, Fort Collins, CO, USA
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Zarnowiecki D, Nguyen H, Catherine Hampton, Boffa J, Segal L. The Australian Nurse-Family Partnership Program for aboriginal mothers and babies: Describing client complexity and implications for program delivery. Midwifery 2018; 65:72-81. [DOI: 10.1016/j.midw.2018.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/13/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
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Fracolli LA, Reticena KDO, Abreu FCPD, Chiesa AM. The implementation of a home visits program focused on parenting: an experience report. Rev Esc Enferm USP 2018; 52:e03361. [PMID: 30156655 DOI: 10.1590/s1980-220x2017044003361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of implementing Home Visits as part of the Young Mothers Caregiver Program. METHOD The program focuses on the mother-child relationship as an object of care for developing parenting using the attachment theory, the self-efficacy theory and the bioecological theory as references. The construction of this program was centered on materials of international visitation programs, based on the translation of the material, elaboration and validation of the theoretical content. RESULTS The home visits performed by the nurses lasted an average of 1 hour, where issues related to health care, environmental health, life project, parenting, family and social network, in addition to the adolescents' demands were discussed. It was shown that nurses encountered difficulties in implementing the program. CONCLUSION By adopting Home Visits as a care tool with a focus on parenting, the experience of implementing the program proved to be an innovative technology, with great potential and relevance for promoting adolescent care and child development.
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Affiliation(s)
- Lislaine Aparecida Fracolli
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Kesley de Oliveira Reticena
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Flávia Corrêa Porto de Abreu
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
| | - Anna Maria Chiesa
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem em Saúde Coletiva, São Paulo, SP, Brasil
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The Effects of Neighborhood Context on Exposure to Adverse Childhood Experiences (ACE) Among Adolescents Involved in the Juvenile Justice System: Latent Classes and Contextual Effects. J Youth Adolesc 2018; 47:2279-2300. [DOI: 10.1007/s10964-018-0887-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/12/2018] [Indexed: 11/25/2022]
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Clapham K, Bennett-Brook K, Hunter K. The role of Aboriginal family workers in delivering a child safety-focused home visiting program for Aboriginal families in an urban region of New South Wales. Health Promot J Austr 2018; 29:173-182. [PMID: 29742300 DOI: 10.1002/hpja.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/27/2018] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Aboriginal Australian children experience higher rates of injury than other Australian children. However, few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of New South Wales. Delivered by Aboriginal Family Workers (AFWs), the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This study reports on the qualitative interviews which explored the ways in which clients, IAMS staff and external service providers experienced the program and assessed its delivery by the AFWs. METHODS A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. RESULTS The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. CONCLUSIONS Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by AFWs to vulnerable families. Clients, IAMS staff and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT&QUEST This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children.
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Affiliation(s)
- Kathleen Clapham
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, Australia
| | - Keziah Bennett-Brook
- Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, Australia
| | - Kate Hunter
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Hiratsuka VY, Parker ME, Sanchez J, Riley R, Heath D, Chomo JC, Beltangady M, Sarche M. CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES. Infant Ment Health J 2018; 39:265-275. [PMID: 29767424 DOI: 10.1002/imhj.21708] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.
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Affiliation(s)
| | | | - Jenae Sanchez
- Pueblo of San Felipe Health and Wellness Department, Algodones, New Mexico
| | - Rebecca Riley
- Native American Professional Parent Resources, Albuquerque, New Mexico
| | | | | | - Moushumi Beltangady
- U.S. Department of Health & Human Services, Administration for Children and Families
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Gonzalez A, Catherine N, Boyle M, Jack SM, Atkinson L, Kobor M, Sheehan D, Tonmyr L, Waddell C, MacMillan HL. Healthy Foundations Study: a randomised controlled trial to evaluate biological embedding of early-life experiences. BMJ Open 2018; 8:e018915. [PMID: 29374668 PMCID: PMC5829768 DOI: 10.1136/bmjopen-2017-018915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Adverse early experiences are associated with long-lasting disruptions in physiology, development and health. These experiences may be 'biologically embedded' into molecular and genomic systems that determine later expressions of vulnerability. Most studies to date have not examined whether preventive interventions can potentially reverse biological embedding. The Nurse-Family Partnership (NFP) is an evidence-based intervention with demonstrated efficacy in improving prenatal health, parenting and child functioning. The Healthy Foundations Study is an innovative birth cohort which will evaluate the impact of the NFP on biological outcomes of mothers and their infants. METHODS AND ANALYSIS Starting in 2013, up to 400 pregnant mothers and their newborns were recruited from the British Columbia Healthy Connections Project-a randomised controlled trial of the NFP, and will be followed to child aged 2 years. Women were recruited prior to 28 weeks' gestation and then individually randomised to receive existing services (comparison group) or NFP plus existing services (intervention group). Hair samples are collected from mothers at baseline and 2 months post partum to measure physiological stress. Saliva samples are collected from infants during all visits for analyses of stress and immune function. Buccal swabs are collected from infants at 2 and 24 months to assess DNA methylation. Biological samples will be related to child outcome measures at age 2 years. ETHICS AND DISSEMINATION The study received ethical approval from seven research ethics boards. Findings from this study will be shared broadly with the research community through peer-reviewed publications, and conference presentations, as well as seminars with our policy partners and relevant healthcare providers. The outcomes of this study will provide all stakeholders with important information regarding how early adversity may lead to health and behavioural disparities and how these may be altered through early interventions. TRIAL REGISTRATION NUMBER NCT01672060; Pre-results.
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Affiliation(s)
- Andrea Gonzalez
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Catherine
- Children’s Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Michael Boyle
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Susan M Jack
- Department of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Leslie Atkinson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Michael Kobor
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Debbie Sheehan
- Children’s Health Policy Centre, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lil Tonmyr
- Family Violence Surveillance, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Charlotte Waddell
- Psychiatry Department, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Harriet L MacMillan
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Barnes J, Stuart J, Allen E, Petrou S, Sturgess J, Barlow J, Macdonald G, Spiby H, Aistrop D, Melhuish E, Kim S, Pink J, Datta J, Elbourne D. Results of the First Steps study: a randomised controlled trial and economic evaluation of the Group Family Nurse Partnership (gFNP) programme compared with usual care in improving outcomes for high-risk mothers and their children and preventing abuse. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFamily Nurse Partnership (FNP) is a home-based nurse home-visiting programme to support vulnerable parents. Group Family Nurse Partnership (gFNP) has similar aims and materials and was demonstrated to be feasible in implementation evaluations.ObjectivesTo determine whether or not gFNP, compared with usual care, could reduce risk factors for maltreatment in a vulnerable group and be cost-effective.DesignA multisite randomised controlled parallel-group trial and prospective economic evaluation, with eligible women allocated (minimised by site and maternal age group) to gFNP or usual care.SettingCommunity locations in the UK.ParticipantsExpectant mothers aged < 20 years with one or more previous live births, or expectant mothers aged 20–24 years with no previous live births and with low educational qualifications (defined as General Certificate of Education at grade C or higher in neither mathematics nor English language or, if they had both, no more than four General Certificates of Education at grade C or higher).InterventionForty-four sessions of gFNP (14 during pregnancy and 30 in the first 12 months after birth) were offered to groups of between 8 and 12 women with similar expected delivery dates (the difference between the earliest and latest expected delivery date ranged from 8 to 10 weeks depending on the group) by two family nurses (FNs), one of whom had notified her intention to practise as a midwife.Main outcome measuresParenting was assessed by a self-report measure of parenting opinions, the Adult Adolescent Parenting Inventory Version 2 (AAPI-2), and an objective measure of maternal sensitivity, the CARE-Index. Cost-effectiveness was primarily expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained.Data sourcesInterviews with participants at baseline and when infants were aged 2, 6 and 12 months. Cost information from nurse weekly logs and other service delivery data.ResultsIn total, 166 women were enrolled (99 to the intervention group and 67 to the control group). Adjusting for site and maternal age group, the intention-to-treat analysis found no effect of gFNP on either of the primary outcomes. AAPI-2 total was 7.5/10 [standard error (SE) 0.1] in both arms [difference also adjusted for baseline 0.08, 95% confidence interval (CI) –0.15 to 0.28;p = 0.50]. CARE-Index maternal sensitivity mean: intervention 4.0 (SE 0.3); control 4.7 (SE 0.4) (difference –0.76, 95% CI –1.67 to 0.13;p = 0.21). The sensitivity analyses supported the primary analyses. The probability that the gFNP intervention was cost-effective based on the QALY measure did not exceed 3%. However, in terms ofchangein AAPI-2 score (baseline to 12 months), the probability that gFNP was cost-effective reached 25.1%. A separate discrete choice experiment highlighted the value placed by both pregnant women and members of the general population on non-health outcomes that were not included in the QALY metric.LimitationsSlow recruitment resulted in smaller than ideal group sizes. In some cases, few or no sessions took place owing to low initial group size, and small groups may have contributed to attrition from the intervention. Exposure to gFNP sessions was below maximum for most group members, with only 58 of the 97 intervention participants receiving any sessions; FNs were experienced with FNP but were mainly new to delivering gFNP.ConclusionsThe trial does not support the delivery of gFNP as a means of reducing the risk of child abuse or neglect in this population.Future workA randomised controlled trial with modified eligibility to enable first-time mothers aged < 20 years to be included, and a modified recruitment strategy to enable faster identification of potential participants from antenatal medical records.Trial registrationCurrent Controlled Trials ISRCTN78814904.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Jane Stuart
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Sturgess
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Barlow
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Helen Spiby
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Dipti Aistrop
- Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Edward Melhuish
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Sungwook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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den Bosch SO, Duch H. The role of cognitive stimulation at home in low-income preschoolers' nutrition, physical activity and body mass index. BMC Pediatr 2017; 17:178. [PMID: 28764675 PMCID: PMC5539881 DOI: 10.1186/s12887-017-0918-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood obesity disproportionately affects children of low socioeconomic status. Children attending Head Start are reported to have an obesity rate of 17.9%.This longitudinal study aimed to understand the relationship between cognitive stimulation at home and intake of junk food, physical activity and body size, for a nationally representative sample of 3- and 4-year old children entering Head Start. METHODS We used The Family and Child Experiences Survey 2006. Cognitive stimulation at home was measured for 1905 children at preschool entry using items from the Home Observation Measurement of the Environment Short Form. Junk food consumption and physical activity were obtained from parent interviews at kindergarten entry. BMI z scores were based on CDC national standards. We analyzed the association between early cognitive stimulation and junk food consumption, physical activity and BMI, using multinomial and binary logistic regression on a weighted sample. RESULTS Children who received moderate levels of cognitive stimulation at home had a 1.5 increase in the likelihood of consuming low amounts of junk food compared to children from low cognitive stimulation environments. Children who received moderate and high levels of cognitive stimulation were two and three times, respectively, more likely to be physically active than those in low cognitive stimulation homes. No direct relationship was identified between cognitive stimulation and BMI. CONCLUSION Prevention and treatment efforts to address early childhood obesity may consider strategies that support parents in providing cognitively stimulating home environments. Existing evidence-based programs can guide intervention in pediatric primary care.
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Affiliation(s)
| | - Helena Duch
- Mailman School of Public Health, Columbia University, New York, NY USA
- Mailman School of Public Health, Department of Population and Family Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032 USA
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McCoy KP. The Science, and Art, of Program Dissemination: Strategies, Successes, and Challenges. New Dir Child Adolesc Dev 2016; 2015:1-10. [PMID: 26375187 DOI: 10.1002/cad.20109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The purpose of this special issue is to provide readers with a greater awareness of the processes involved in dissemination, as well as existing supports that help disseminate and sustain evidence-based interventions. Although dissemination research is limited in most disciplines, it is particularly lacking in the social science field. Many interventions aimed to help children and adolescents are found to be efficacious every year, but program developers are often not equipped to understand how to scale up a program or sustain it after the initial funding. Consumers (e.g., service providers, who are consumers of interventions), on the other hand, often do not understand all that goes into implementing and scaling up an intervention. This special issue will: (a) introduce readers to the problem; (b) discuss some of the challenges with disseminating programs; and (c) present various existing supports that can help scale up and sustain interventions.
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Hegarty K, Tarzia L, Hooker L, Taft A. Interventions to support recovery after domestic and sexual violence in primary care. Int Rev Psychiatry 2016; 28:519-532. [PMID: 27686012 DOI: 10.1080/09540261.2016.1210103] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013-2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother-child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother-child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.
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Affiliation(s)
| | - Laura Tarzia
- a The University of Melbourne , Melbourne , Australia
| | | | - Angela Taft
- b La Trobe University , Bundoora , Australia
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Miller TR, Hendrie D. Nurse Family Partnership: Comparing Costs per Family in Randomized Trials Versus Scale-Up. J Prim Prev 2016; 36:419-25. [PMID: 26507844 DOI: 10.1007/s10935-015-0406-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature that addresses cost differences between randomized trials and full-scale replications is quite sparse. This paper examines how costs differed among three randomized trials and six statewide scale-ups of nurse family partnership (NFP) intensive home visitation to low income first-time mothers. A literature review provided data on pertinent trials. At our request, six well-established programs reported their total expenditures. We adjusted the costs to national prices based on mean hourly wages for registered nurses and then inflated them to 2010 dollars. A centralized data system provided utilization. Replications had fewer home visits per family than trials (25 vs. 31, p = .05), lower costs per client ($8860 vs. $12,398, p = .01), and lower costs per visit ($354 vs. $400, p = .30). Sample size limited the significance of these differences. In this type of labor intensive program, costs probably were lower in scale-up than in randomized trials. Key cost drivers were attrition and the stable caseload size possible in an ongoing program. Our estimates reveal a wide variation in cost per visit across six state programs, which suggests that those planning replications should not expect a simple rule to guide cost estimations for scale-ups. Nevertheless, NFP replications probably achieved some economies of scale.
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Affiliation(s)
- Ted R Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD, 20705, USA.
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Delia Hendrie
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Trent M, Chung SE, Gaydos C, Frick KD, Anders J, Huettner S, Rothman R, Butz A. Recruitment of Minority Adolescents and Young Adults into Randomised Clinical Trials: Testing the Design of the Technology Enhanced Community Health Nursing (TECH-N) Pelvic Inflammatory Disease Trial. EUROPEAN MEDICAL JOURNAL. REPRODUCTIVE HEALTH 2016; 2:41-51. [PMID: 27617108 PMCID: PMC5013541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Pelvic inflammatory disease (PID) disproportionately affects adolescent and young adult (AYA) women and can negatively influence reproductive health trajectories. Few randomized controlled trials (RCTs) have focused on strategies to improve outpatient adherence or to reduce reproductive morbidity in this population. This paper describes the research methods and preliminary effectiveness of recruitment, retention, and intervention strategies employed in a novel RCT designed to test a technology-enhanced community-health nursing (TECH-N) intervention among urban AYA with PID. METHODS AYA women aged 13-25 years were recruited during acute PID visits in outpatient clinics and emergency departments (ED) to participate in this IRB-approved trial. Participants completed an audio-computerized self-interview (ACASI), provided vaginal specimens, and were randomized to standard treatment or the intervention. Intervention participants received text-messaging support for 30 days and a community health nurse (CHN) interventionist performed a home visit with clinical assessment within 5 days after enrollment. All patients received a full course of medications and completed research visits at 14-days (adherence), 30 days and 90 days with by an outreach worker. STI testing performed at the 30-and 90-day visits. Exploratory analyses using descriptive statistics were conducted to examine recruitment, retention, and follow-up data to test the overall design of the intervention. RESULTS In the first 48 months, 64% of 463 patients were eligible for the study and 81.2% of 293 eligible patients were recruited for the study (63.3%); 238 (81.2%) of eligible patients were enrolled. Most participants were African American (95.6%) with a mean age of 18.6 (2.3). Ninety-four percent of individuals assigned to the TECH-N intervention completed the nursing visits. All completed visits have been within the 5-day window and over 90% of patients in both arms have been retained over the 3-month follow-up period. Biological data suggests a shift in the biological milieu with the predominance of Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections. CONCLUSIONS Preliminary data from the TECH-N study demonstrated that urban, low-income, minority AYA with PID can effectively be recruited and retained to participate in sexual and reproductive health RCTs with sufficient investment in the design and infrastructure of the study. Community-based sexual health interventions appear to be both feasible and acceptable in this population.
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Affiliation(s)
- Maria Trent
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Shang-en Chung
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Charlotte Gaydos
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Kevin D. Frick
- Johns Hopkins University Carey School of Business, Baltimore
Maryland, USA
| | - Jennifer Anders
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Steven Huettner
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
| | - Arlene Butz
- Johns Hopkins University School of Medicine, Baltimore Maryland,
USA
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Impact of Intimate Partner Violence on Primary Health Care Use for Children: Evidences from Rio de Janeiro, Brazil. Matern Child Health J 2016; 20:2065-73. [PMID: 27324046 DOI: 10.1007/s10995-016-2036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives To assess whether severe physical intimate partner violence (PIPV) after childbirth affects the number of pediatric visits in Primary Health Care (PHC) units during this period. Methods Cross-sectional study including 927 mothers of infants under 6 months, users of 27 PHC units in Rio de Janeiro, Brazil. PIPV from childbirth to the date of interview was measured using the Revised Conflict Tactics Scales (CTS2). The number of pediatric visits in the first 6 months of life was the outcome measure of interest. Poisson and multinomial regression models were used for data analysis to control for confounders. Results Children of mothers who experienced severe PIPV had a reduced number of pediatric visits than those not reporting it. This finding was identified only among children who had health problems: relative to five or more baseline pediatric visits, the chance of 3-4 and 1-2 visits increased three- and five-fold, respectively, when severe PIPV was present. Conclusions The maternal experience of severe PIPV reduces the number of pediatric visits in PHC services among the most vulnerable children. This is a hindrance to adequate health promotion, prevention and care, required for the healthy growth and development of children. Early violence detection by pediatricians and other health professionals could be a step in the right direction.
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Czaja SJ, Valente TW, Nair SN, Villamar JA, Brown CH. Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior. Implement Sci 2016; 11:70. [PMID: 27184963 PMCID: PMC4869203 DOI: 10.1186/s13012-016-0433-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 05/04/2016] [Indexed: 01/29/2023] Open
Abstract
Background Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. Results The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Conclusions Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.
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Affiliation(s)
- Sara J Czaja
- Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami, 1694 NW 9th Ave., Miami, FL, 33136, USA.
| | - Thomas W Valente
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Sankaran N Nair
- Center for Aging, Miller School of Medicine, University of Miami, Miami, USA
| | - Juan A Villamar
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
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Eisner M, Humphreys DK, Wilson P, Gardner F. Disclosure of Financial Conflicts of Interests in Interventions to Improve Child Psychosocial Health: A Cross-Sectional Study. PLoS One 2015; 10:e0142803. [PMID: 26606667 PMCID: PMC4659631 DOI: 10.1371/journal.pone.0142803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Academic journals increasingly request a full disclosure of financial conflict of interest (CoI). The Committee for Publication Ethics provides editors with guidance about the course of action in the case of suspected non-disclosure. No prior study has examined the extent to which journal articles on psychosocial interventions disclose CoI, and how journal editors process requests to examine suspected undisclosed CoI. Four internationally disseminated psychosocial interventions were examined. 136 articles related to an intervention, co-authored by intervention developers and published in health sciences journals were retrieved as requiring a CoI statement. Two editors refused consent to be included in the study. COI disclosures and editor responses were coded for 134 articles. Overall, 92/134 (71%) of all articles were found to have absent, incomplete or partly misleading CoI disclosures. Disclosure rates for the four programs varied significantly between 11% and 73%. Journal editors were contacted about 92 published articles with no CoI disclosure or a disclosure that was considered problematic. In 65/92 (71%) of all cases the editors published an ‘erratum’ or ‘corrigendum’. In 16 of these cases the journal had mishandled a submitted disclosure. The most frequent reason for non-publication of an erratum was that the journal had no disclosure policy at the time of the publication (16 cases). Consumers of research on psychosocial interventions published in peer-reviewed journals cannot currently assume that CoI disclosures are adequate and complete. More efforts are needed to achieve transparency.
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Affiliation(s)
- Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - David K. Humphreys
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University Of Aberdeen, Centre for Health Science, Inverness, United Kingdom
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Jack SM, Catherine N, Gonzalez A, MacMillan HL, Sheehan D, Waddell D. Adapting, piloting and evaluating complex public health interventions: lessons learned from the Nurse-Family Partnership in Canadian public health settings. Health Promot Chronic Dis Prev Can 2015; 35:151-159. [PMID: 26605564 PMCID: PMC4911136 DOI: 10.24095/hpcdp.35.8/9.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The Nurse-Family Partnership (NFP) is a home-visit program for young and first-time, socially and economically disadvantaged mothers. Evidence from three United States randomized controlled trials (RCTs) on the effectiveness of this intervention at improving pregnancy outcomes, improving child health and development, and increasing maternal economic self-sufficiency is robust. However, the effectiveness of the NFP in Canada, with its different health and social care context, needs to be determined. The purpose of this article is to describe the complex process for moving the NFP from the research arena to full implementation in Canada. METHODS This process of evaluation in Canada includes (1) adapting the intervention; (2) piloting the intervention in small-scale feasibility and acceptability studies; and (3) conducting an RCT and process evaluation through a study called the British Columbia Healthy Connections Project (BCHCP). This large-scale evaluation also creates an opportunity to expand the NFP evidence base by conducting an additional study to examine potential biological mechanisms linking intervention and behavioural outcomes in children. RESULTS Adaptation of the NFP home-visit materials is a continuous process. A pilot project determined that it was feasible to enrol eligible women into the NFP. This pilot also determined that, in Canada, it was most appropriate for public health agencies to implement the NFP and for public health nurses to deliver the intervention. Finally, the pilot showed that this intensive home-visit program was acceptable to clients, their family members and health care providers. Through the BCHCP, the next steps - the RCT and process evaluation - are currently underway. The BCHCP will also set the foundation for long-term evaluation of key public health outcomes in a highly vulnerable population of families.
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Affiliation(s)
- S M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - N Catherine
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia
| | - A Gonzalez
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - H L MacMillan
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - D Sheehan
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia
| | - D Waddell
- Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia
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Miller TR. Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996-2013, USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:765-77. [PMID: 26076883 PMCID: PMC4512284 DOI: 10.1007/s11121-015-0572-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on three more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8 %, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development; increase breast-feeding; and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.
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Affiliation(s)
- Ted R Miller
- Pacific Institute for Research and Evaluation and Centre for Population Health Research, Curtin University, 11720 Beltsville Drive, Suite 900, Beltsville, MD, 20705, USA,
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Chaiyachati BH, Leventhal JM. Henry Kempe's vision: preventing child abuse then and now. Clin Child Psychol Psychiatry 2015; 20:331-6. [PMID: 24509778 DOI: 10.1177/1359104513519554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses. BMC Nurs 2015; 14:12. [PMID: 25767414 PMCID: PMC4357186 DOI: 10.1186/s12912-015-0061-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/19/2015] [Indexed: 11/29/2022] Open
Abstract
Background The Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. While the effectiveness of the NFP has been established in the United States, and is currently being evaluated in the Canadian public health care system, we have minimal understanding of how work of this nature impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels. Methods This two-phase study consisted of a qualitative secondary analysis of data from five focus groups conducted with PHNs (N = 6) who delivered the NFP intervention as part of a pilot study assessing feasibility and acceptability conducted in Hamilton, Ontario. The second phase, an interpretive description of individual interviews with the PHNs (N = 10) who have delivered the NFP in this context, further explored themes identified in the first phase. A practice, problem and needs analysis was conducted to describe and understand the phenomenon and promote sustainability of PHNs in this practice environment. Conventional content analysis was used to code and categorize data in the two datasets. Results The nurse-client relationship, the core elements and structure of the NFP program and support of NFP colleagues were described as rewarding factors, while workload and workplace factors were identified as significant contributors to stress. PHNs described transforming their nursing practice through redefining success and shifting to a philosophy where the client is the expert of her own life. PHNs described the personal impact of worry about clients and doubt about their effectiveness in addressing client concerns. High levels of satisfaction were described in relation to the depth and intensity of relationships with clients and seeing them succeed over time. Conclusions PHNs are impacted in multiple ways by their work with vulnerable, young mothers. The study findings have implications for identification of strategies to support PHNs in reducing staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improving program delivery.
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Abstract
Our aim was to examine the rates and predictors of father attendance at nurse home visits in replication sites of the Nurse-Family Partnership (NFP). Early childhood programs can facilitate father involvement in the lives of their children, but program improvements require an understanding of factors that predict father involvement. The sample consisted of 29,109 low-income, first-time mothers who received services from 694 nurses from 80 sites. We conducted mixed-model multiple regression analyses to identify population, implementation, site, and nurse influences on father attendance. Predictors of father attendance included a count of maternal visits (B = 0.12, SE = 0.01, F = 3101.77), frequent contact between parents (B = 0.61, SE = 0.02, F = 708.02), cohabitation (B = 1.41, SE = 0.07, F = 631.51), White maternal race (B = 0.77, SE = 0.06, F = 190.12), and marriage (B = 0.42, SE = 0.08, F = 30.08). Random effects for sites and nurses predicted father-visit participation (2.7 & 6.7% of the variance, respectively), even after controlling for population sociodemographic characteristics. These findings suggest that factors operating at the levels of sites and nurses influence father attendance at home visits, even after controlling for differences in populations served. Further inquiry about these influences on father visit attendance is likely to inform program-improvement efforts.
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Gonzalez A, MacMillan H, Tanaka M, Jack SM, Tonmyr L. Subtypes of exposure to intimate partner violence within a Canadian child welfare sample: associated risks and child maladjustment. CHILD ABUSE & NEGLECT 2014; 38:1934-1944. [PMID: 25455963 DOI: 10.1016/j.chiabu.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/12/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
Children exposed to intimate partner violence (IPV) are at increased risk of experiencing behavioral difficulties including externalizing and internalizing problems. While there is mounting evidence about mental health problems in children exposed to IPV, most of the research to date focuses on IPV exposure as a unitary, homogeneous construct. The purpose of this study was to examine the association between subtypes of IPV exposure on child functioning and presence of harm within a child welfare sample. Given the evidence of the "double whammy" effect, co-occurring IPV exposure was also examined. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect - 2008 (n=2,184) we examined whether specific IPV exposure subtypes or their co-occurrence resulted in a greater risk of child maladjustment. Information was obtained from child welfare workers' reports. Caregiver and household risk factors were also examined. Co-occurring IPV exposure resulted in the greatest risk for reported child maladjustment. Exposure to emotional IPV and direct physical IPV were significantly associated with increased risk of internalizing problems and presence of harm. Caregiver mental health and lack of social support emerged as significant risk factors for behavior problems. This study adds to the evidence that exposure to subtypes of IPV may be differentially related to child functioning. Given that risk factors and child functioning is part of the decision-making framework for case worker referrals, this study provides important preliminary evidence about how the child welfare system operates in practice with respect to sub-types of exposure to IPV. These findings suggest that intervening with children exposed to different types of IPV may require a tailored approach.
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Affiliation(s)
- Andrea Gonzalez
- Offord Centre for Child Studies, McMaster University, Department of Psychiatry and Behavioural Neurosciences and of Pediatrics, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Harriet MacMillan
- Offord Centre for Child Studies, McMaster University, Department of Psychiatry and Behavioural Neurosciences and of Pediatrics, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Masako Tanaka
- Offord Centre for Child Studies, McMaster University, Department of Psychiatry and Behavioural Neurosciences and of Pediatrics, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Lil Tonmyr
- Injury and Child Maltreatment Section, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, 785 Carling, AL 6807B, Ottawa, ON K1A 0K9, Canada
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Jacob-Files E, Rdesinski R, Storey M, Gipson T, Cohen DJ, Olds D, Melnick A. Should Home-Based Contraceptive Dispensing become a Routine part of Public Health Nurse Practice? Review of Nurse Perceptions. Public Health Nurs 2014; 32:702-10. [PMID: 25196399 DOI: 10.1111/phn.12150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined public health nurses' beliefs about the safety of dispensing hormonal contraceptives in the home, the extent to which they considered contraceptive dispensing within their scope of practice, and the types of support needed to effectively dispense contraceptives in the home. DESIGN AND SAMPLE We conducted focus groups in Washington State with 24 home visiting nurses participating in a Nurse Family Partnership (NFP) randomized clinical trial in which nurses dispensed hormonal contraceptives during home visits. MEASURES We assessed the feasibility of the intervention and barriers and facilitators to home dispensing of hormonal contraceptives. RESULTS Nurses were, on average 52 years old and had been working in nursing approximately 25 years, with between 5 and 18 years of experience working in a family planning setting. Overall, nurses believed that, with the right training and support, dispensing of hormonal contraceptives in the home was safe and fit within their scope of practice. Those nurses who reported resistance to the intervention cited inadequate training, lack of clear protocols, and sufficient support as important deterrents. CONCLUSIONS Home-based contraceptive dispensing by nurses is a feasible enhancement of the NFP program. To ensure that nurses are confident and able to dispense hormonal contraceptives, training, clinical protocols, consultation, and logistical support are needed.
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Affiliation(s)
- Elizabeth Jacob-Files
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Rebecca Rdesinski
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Marni Storey
- Washington County Public Health, Portland, Oregon
| | - Teresa Gipson
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
| | - David Olds
- Department of Pediatrics, University of Colorado, Denver, Colorado
| | - Alan Melnick
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon
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Holland ML, Xia Y, Kitzman HJ, Dozier AM, Olds DL. Patterns of visit attendance in the nurse-family partnership program. Am J Public Health 2014; 104:e58-65. [PMID: 25122021 DOI: 10.2105/ajph.2014.302115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined visit attendance patterns in the Memphis trial of the Nurse-Family Partnership and associations between these patterns and family characteristics, outcomes, and treatment-control differences in outcomes. METHODS We employed repeated measures latent class analysis to identify attendance patterns among the 228 mothers assigned to receive home nurse visits during pregnancy and until the child was aged 2 years, associated background characteristics, outcomes, and treatment-control differences by visit class. Home visits were conducted from June 1990 to March 1994. We collected outcome data from May 1992 to April 1994 and July 2003 to December 2006. RESULTS We identified 3 visit attendance patterns. High attenders (48%) had the most visits and good outcomes. Low attenders (33%) had the most education and the best outcomes. Increasing attenders (18%) had the fewest completed visits during pregnancy, the poorest intake characteristics, and the poorest outcomes. Treatment-control group differences varied by class, with high and low attenders having better outcomes on some measures than did their control group counterparts. CONCLUSIONS Three patterns were associated with distinct groups of mothers with different long-term outcomes. Further examination and use of patterns to classify mothers and prioritize resources may improve efficiency in the Nurse-Family Partnership.
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Affiliation(s)
- Margaret L Holland
- At the time of this study, Margaret L. Holland was with the School of Nursing, Yale University, West Haven, CT. Yinglin Xia was with the Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY. Harriet J. Kitzman was with the School of Nursing, University of Rochester. Ann M. Dozier was with the Department of Public Health Sciences, University of Rochester. David L. Olds was with the Department of Pediatrics, University of Colorado, Aurora
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Barkin JL, Bloch JR, Hawkins KC, Thomas TS. Barriers to Optimal Social Support in the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2014; 43:445-54. [DOI: 10.1111/1552-6909.12463] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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