Home visiting services have become an important and common component of early intervention for children with developmental delays. Currently, this group of children is the most frequent target of home visiting programs throughout the nation, although research evaluating the effectiveness of these programs is less pervasive. For this reason, a comprehensive analysis of studies within the home visiting literature that specifically focused on children with developmental delays and their families has been conducted. This effort has been accomplished through the process of meta-analysis. In addition to the computation of standardized mean difference effect sizes, emphasis was also placed on identifying the salient sample, intervention, and outcome characteristics of this group of studies. Results are discussed in terms of ecological validity or how well the findings of the study generalize to the world of practice, policy, additional research, and training in the field of home visiting. Overall, much of what we are observing in the research is applicable to current practice, specifically in regard to the home visiting procedure. However, discrepancies between research and practice have been found in regard to the target of the intervention and the training of the home visitor.

Leaders in the field of home visiting and family support research have indicated that the inclusion of home visiting in comprehensive services for low-income families with young children can play a key role in improving a wide variety of outcomes for at-risk children and their families. These recommendations have been based in part on selected empirical findings from the home visiting literature. However, synthesis of empirical findings has proven difficult, due to the heterogeneity of this population and the diverse applications of home visiting as a service delivery strategy. The present meta-analysis examined a representative sample of the peer-reviewed literature to provide a comprehensive, quantified description of the features and findings of this literature. The four research questions addressed by the meta-analysis provide a framework for this description. The first research question concerned a description of research designs and methodological features found in the literature. The second and third research questions concerned, respectively, descriptions of the samples and interventions employed in primary studies. The final research question concerned the examination of those domains in which primary studies measured outcomes, and the quantification of outcomes in terms of standardized mean difference effect sizes. Summarization of primary studies' methodological features illustrated specific issues that may be addressed in the design of future home visiting research, and laid a basis for the examination of meta-analysis findings. The composition of primary studies' samples reflected the heterogeneity expected from a population defined by a parameter as broad as "low-income," yet included lacunae that may represent subgroups among the poor that are not being studied. Data providing an assessment of several types of intervention features have implications for questions of treatment efficacy, and for future home visiting research. Mean effect sizes in several domains were found to have a magnitude of practical significance for child and family outcomes. Findings of this project provide a structure for continued meta-analysis of this body of literature, and highlight potential areas for further primary research. Meta-analysis data lend support to previous recommendations, as well as point out gaps in our knowledge.

Burgeoning numbers of child abuse and neglect reports throughout the developed world has prompted calls for preventive and early intervention measures to support and prepare families for parenting. Nurse home visiting is one form of service delivery gaining acceptance as an appropriate strategy. Although home visiting is not a new concept in service delivery, enthusiasm for home-visitation programmes has re-emerged not only in Australia in recent years, but in many other developed countries with initiatives being launched or recommended at state, national and international levels. This thesis presents a review of the tenets of home visiting and examines a home visiting intervention programme targeting children born into families with child abuse or neglect risk factors. A randomised controlled trial using a cohort of 181 families was undertaken to evaluate the impact of this home visiting programme. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting programme or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. This procedure was shown to have utility in the context of recruitment to a research trial, in that respondents were willing to disclose sensitive personal issues using this form of screening as the basis for targeted intervention. The home visiting programme examined by this study was also shown to have social validity, with mothers willing to accept this form of intervention from the immediate postnatal period. High retention and satisfaction rates strengthened this conclusion. The ability of this study to evaluate the effectiveness of the home visiting intervention programme may have been compromised by a range of contextual factors influencing programme outcomes detailed in this thesis. Nonetheless, the study found that, for a group of families reporting risk factors for child abuse and neglect potential, provision of an intensive home visiting intervention using nurses, social workers, and parent aides was not effective in producing more favourable adjustment to the parenting role over time compared with nonintervention or clinic based service provision. The intervention programme group participants gained knowledge of child development and child management skills during the early postnatal weeks while the comparison group participants developed knowledge and skills later in the first year of their infant's lift. Early adaptation to the parenting role, parenting knowledge, and skill acquisition bodes well for parent-infant attachment and the children's long-term health and developmental outcomes. However, a 12-month assessment of maternal, family, and child development variables did not demonstrate maintenance of a positive intervention impact on parenting stress, parenting competence, or quality of the home environment. Finally, predictive analysis of fictors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. These results not only demonstrate that there is a relationship between maternal, family and enviromnental factors identified in the immediate postnatal period, and adjustment to the parenting role, but also challenge demographic targeting for child abuse and neglect risk. Findings are discussed and placed within the context of previous research and reference is made to implications for future child health practice, development, and research. Recommendations arising from this discussion relate to both future research and community child health practice.

Sometimes when a home visit is over, practitioners and families feel it was great and sometimes they feel it was not. This presentation explores strengthen-based strategies developed from a capacity-building model that deepens the families' home visit experiences so families with serious challenges feel they can help their children learn.

In the United States, intimate partner violence (IPV) is the most common cause of non-fatal injury for women. The Nurse-Family Partnership (NFP) is an evidence-based maternal and early childhood health program where nurse home visitors seek to develop therapeutic relationships and provide health promotion interventions with low-income, young pregnant women and first time mothers and their children, from early in pregnancy until the child’s second birthday. In this program, nurses have a responsibility to identify women exposed to abuse and provide supportive interventions. The purpose of this study is to understand the impact of this work on nurse home visitors’ professional and personal selves. A secondary qualitative content analysis was conducted using a sample comprised of 27 nurses, 18 community partners, and 4 nurse supervisors from an original case study by Jack et al. (2012) for the development of a nurse home visitation IPV intervention. Conventional content analysis and constant comparative techniques were used to code 8 nurse focus group transcripts and 43 transcripts from face-to-face, semi-structured interviews with the community partners and supervisors. Nurses identify that clients are exposed to multiple types of violence. These experiences increase the complexity of delivering the NFP home visitation program. Nurses also experience high levels of uncertainty related to how to respond to disclosures, and how to address IPV. The presence of IPV also significantly impacts many facets of the nurse-client relationship. At times nurses struggle with wanting to “fix” the client’s relationship with her partner; yet understand this is not a healthy response. Setting boundaries and clearly defining one’s role in this work is complex, and many nurses experience high levels of anxiety, worry and fear for their clients. Supervisors and community members confirm nurses’ experiences but also provide strategies for reflective supervision and community level support. Nurse home visitors are in a unique position to provide care for women exposed to IPV and recommendations are provided for nursing education, practice and research in this field. / Thesis / Master of Science (MSc)

Purpose: The purpose of this study is to examine the social determinants of CHIP (Child Health Investment Partnership) of Roanoke Valley children who participated in the preventive oral health program compared to those who did not. Methods: This is a retrospective cohort study of children (n=2,425) enrolled in CHIP of Roanoke Valley from September 2008-September 2014. Bivariate analysis and multivariable logistic regression models were used to compare age, gender, race, locality, parents’ education level, age at enrollment, and length of enrollment for oral health program participants versus those who did not participate. Results: Children who were Hispanic as well as children who enrolled in CHIP at an earlier age were more likely to enroll in the oral health program. Conclusions: By focusing on enrolling children at earlier ages, there is the potential to increase the use of dental care to match the recommended periodicity of dental care for young children.

La dépression postnatale (DPN) est un facteur de risque de trouble des interactions précoces mère-enfant et de troubles de santé mentale de l’enfant. Si les programmes de visites à domicile (VAD) en périnatalité ciblent souvent la prévention de la DPN, les résultats sont peu probants.CAPEDP est la première étude contrôlée randomisée de VAD destinée à des familles multirisques d’une telle ampleur menée en France. Ce travail en décrit les résultats sur la DPN. 440 femmes sont recrutées et randomisées en deux groupes : primipares, âgées de moins de 26 ans, et au moins un facteur de risque parmi : un faible niveau d’éducation, des revenus faibles et/ou être isolées. Le groupe intervention bénéficie de VAD menées par des psychologues du troisième trimestre de grossesse aux deux ans de l’enfant. La symptomatologie de la DPN est évaluée à l’inclusion et 3 mois après la naissance avec l’Edinburgh Postnatal Depression Scale (EPDS). A 3 mois post-partum, les scores moyens à l’EPDS sont respectivement de 9.4 (5.4) pour le groupe contrôle et de 8.6 (5.4) pour le groupe intervention (p = 0.18). Pour certains sous-groupes de femmes ayant bénéficié de l’intervention les scores EPDS sont plus faibles que le groupe contrôle : celles avec peu de symptômes dépressifs en prénatal (EPDS<8), celles qui pensent être avec le père pour élever leur enfant, et celles avec un niveau d’éducation supérieur au BEPC. CAPEDP n’a pas démontré d’efficacité pour prévenir la DPN. Les analyses post hoc montrent que l’intervention peut être efficace pour des femmes sans certains facteurs de risque. Il serait utile de développer des recherches plus intégrées dans le dispositif de droit commun. / Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. CAPEDP is the first French randomized controlled trial for multi-risk families evaluating the impact on PND symptomatology of a home-visiting intervention using psychologists in a sample of women presenting risk factors.440 women were recruited at their seventh month of pregnancy. All were first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. Participants were randomized into either the intervention or the control group. The intervention consisted of intensive multifocal home visits through to the child’s second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS).At three months postpartum, mean EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The intervention group had significantly lower EPDS scores than controls in certain subgroups of women: with few depressive symptoms at inclusion (EPDS<8), who were planning to raise the child with the child’s father, with a higher educational level.CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology may require more tailored interventions.

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<p>This study examined the effect of the Kindergarten Home Visit Project, a novel universal intervention program designed to enhance the transition to kindergarten for children and families by providing teachers with the training and support they need to conduct a home visit for each of their students at the beginning of the school year. Forty-four kindergarten teachers from 19 schools and 928 children and their families participated in the project. Teachers were blocked within schools and randomly assigned to intervention or control conditions. Intervention teachers successfully completed home visits for 98% of their students. After controlling for child and teacher demographic factors, multilevel modeling with children nested within classrooms and schools revealed that random assignment to receive a home visit had a significant positive impact on classroom work habits by students and teacher-child relationship warmth at the end of kindergarten. Assignment to home visiting was also associated with positive child outcomes for girls, specifically including: higher academic achievement, academic motivation, work habits, social skills, and better conduct. Impact on boys was non-significant. The effect of home visiting on child outcomes was mediated by an intervening effect on academic motivation for girls during the fall. Positive effects of assignment to intervention were also demonstrated for children from non-English speaking homes. These children demonstrated higher academic motivation and better work habits. In addition, both non-English speaking parents and their teachers reported reduced adverse effects of language barriers on home-school collaboration. The intervention was also found to have a positive effect on teacher attitudes and beliefs. Teachers who conducted home visits reported an increased understanding of the diverse needs and cultural differences of families, a greater willingness to reach out to parents, and a more positive connection to students and their families. These findings suggest that home visiting is beneficial to teachers, students and families and should be continued and expanded as a kindergarten transition practice in the schools.</p> / Dissertation