abstract: Child abuse and neglect is a devastating yet preventable social problem. Currently, early childhood home visitation services are the primary approach to preventing maltreatment and improving child well-being in the United States. However, existing literature suggests that improvement is needed regarding how home visitation professionals identify and respond to risk factors for child abuse and neglect. Although there is substantial multidisciplinary literature that investigates the utility of standardized measures to determine future risk for maltreatment, there has been minimal inquiry into the validity of early childhood home visitation assessment instruments to accurately identify and classify children and their families by their risk for future maltreatment. In response to the dearth in the literature, the purpose of this dissertation was to examine the utility of the Healthy Families Parenting Inventory (HFPI) to predict a family’s risk for future maltreatment. Families enrolled in Healthy Families Arizona, a child abuse and neglect prevention program, were followed for 12 months after the completion of the baseline HFPI to measure if the family had received an investigation of maltreatment from the public child welfare system. Bivariate results indicated that the generated risk classifications of the HFPI and the overall total composite score were related to the occurrence of a future maltreatment investigation. Specifically, the results from the binary logistic regression models provided evidence that as a family’s score increased on the inventory, the likelihood of receiving an investigation of maltreatment decreased. Further, significant relationships were found between a family’s score on several individual items of the HFPI and the occurrence of a maltreatment investigation. This dissertation concludes with a discussion of potential avenues of research on the topic of risk assessment in prevention programs serving at-risk families. / Dissertation/Thesis / Doctoral Dissertation Social Work 2018

Thesis (Ph.D.)--Indiana University, 2010. / Title from screen (viewed on March 3, 2010). School of Social Work, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Margaret E. Adamek, Carol Hostetter, Gail M. Folaron, Angela B. McBride. Includes vitae. Includes bibliographical references (leaves 152-160).

No description available.

No description available.

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. Adolescent girls and young women who are pregnant or living in situations of social and economic disadvantage are at increased risk for poor health. Rural living may compound marginalization and create additional challenges for young mothers. In the context of a large-scale process evaluation, I posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” This thesis represents a purposeful attempt to examine the experiences of public health nurses as they deliver the Nurse-Family Partnership program across different geographical settings in British Columbia, Canada. The qualitative methodology of interpretive description guided study decisions and data were collected through focus groups and semi-structured interviews with public health nurses delivering the Nurse-Family Partnership program and their supervisors. Consisting of three studies linked by their focus of evaluating Nurse-Family Partnership in British Columbia, this thesis explores influences on program delivery across the rural-urban continuum, including issues related to nurse recruitment, retention, and turnover. Overall, the findings from these analyses suggest that the nature of clients’ place and their associated social and physical geography emphasizes that geography has a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage. In manuscript one, exploration and description of factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada are presented. Then manuscript two reflects the factors and challenges of providing the NFP program in rural communities. The final manuscript applies an intersectional lens to reveal how the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. The collective work of this thesis emphasises the importance of location as a factor affecting home visitation programs. In rural environments, public health nurses are resourceful and can provide insight into important considerations for program delivery. These may include enhanced use of technology for communicating with supervisors, nurses, or clients through cell phone/videoconferencing or experiencing rugged terrain and extreme weather conditions. Public health nurses practicing in urban areas also have geographical considerations that are location specific, including precariously housed clients whose locations are transient and providing care to clients living in unsafe conditions. Across all environments, time was a valued commodity and effective communication was essential. Supporting nurses as they deliver Nurse-Family Partnership in Canadian communities can help nurse retention in a program with many positive attributes. Working with vulnerable populations, building relationships with clients, regular reflective supervision and team meetings were among the top reasons public health nurses enjoyed being involved in Nurse-Family Partnership. Reasons leading to turnover are also discussed. / Dissertation / Doctor of Philosophy (PhD) / Living in social or economic disadvantage is associated with negative health outcomes for Canadian families. Young mothers and their children are one such group at risk for suboptimal health outcomes, creating a significant public health concern. The Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. As this program is evaluated for uptake in Canada, this thesis examines the delivery within the context of Canadian geography. Factors that influence program delivery for public health nurses in Canada are explored.

The Nurse-Family Partnership (NFP) is an evidence-based public health initiative targeted to young, pregnant, first-time mothers impacted by social and economic disadvantage. This study is part of an embedded qualitative process evaluation from a larger cluster RCT trial. The purpose of this study was to understand NFP supervisor roles, responsibilities, and experiences associated with the uptake of a new IPV intervention by nurse home visitor into existing NFP practice. / The Nurse-Family Partnership® (NFP) is a home visitation program for young pregnant and first-time mothers affected by social and economic disadvantage. In response to intimate partner violence (IPV) experienced by women and children involved in the program, a nursing intervention was developed to support nurse home visitors identify and respond to IPV. Within each participating NFP team, supervisors were accountable for facilitating the implementation process of the IPV intervention for uptake into nurse home visitor practice. To understand the functions of NFP supervisors involved with the facilitation of the implementation process for the IPV intervention, an interpretive description approach was utilized involving primary data collection from interviews with 11 supervisors and 2 managers, and triangulated with secondary data from 7 focus groups (n=35 nurses). From this analysis, an NFP supervision framework was developed that included 4 domains, 7 roles, 3 sub-roles and multiple responsibilities. Supervision was found to involve roles and sub-roles functioning in oversight of implementation and others that functioned in the direct implementation of the IPV intervention, forming levels of supervision, and creating a hierarchy. A comprehensive appreciation of NFP supervisor domains, roles, sub-roles and responsibilities enacted during the implementation process is important to help identify the best alignment of human resources, recognize how the NFP can best support supervisors, and to champion achievement of current and future innovation implementation goals. Recommendations of support for supervisors include facilitating educational opportunities, creating transparency of the implementation process, developing a quality improvement strategy, providing supervisor mentorship, improving standardization, and recognizing the competing NFP priorities for supervisors and nurse home visitors. / Thesis / Master of Science (MSc) / The Nurse-Family Partnership® (NFP) is a home visitation program targeted to young mothers, pregnant with their first child. To support nurse home visitors identify and respond to intimate partner violence (IPV) experienced by NFP mothers and children, an IPV intervention was developed. Within the NFP implementing agencies, supervisors were instrumental in ensuring the IPV intervention was delivered as intended, forming what is known as the implementation process. This qualitative interpretive descriptive study involved interviews with 11 supervisors and 2 managers, as well as a secondary analysis of 7 focus groups (n=35 nurses) to understand and describe the roles and responsibilities supervisors had within this process. From the analysis of these data, an NFP supervision framework was developed that included articulation of 4 domains, 7 roles, 7 sub-roles and multiple responsibilities affiliated with this position. This framework offers a new language for supervision which may become a first step to better understanding, communicating, and developing supervision in home visitation, and in particular, articulating the functions supervisors are required to lead when faced with the responsibility for implementing a new innovation within their program. It is important to understand NFP supervisor functions of the implementation process to enable NFP strategies that will best support supervisors, ensure responsibilities belong to the right person, and meet implementation goals when adopting evidence into NFP nurse home visiting practice.

abstract: Home visitation programs are growing in popularity for a variety of social concerns including early childhood abuse and neglect. Healthy Families Arizona (HFAz) uses the home visitation format to deliver early-childhood development and parenting skills for at-risk parents with the goal of decreasing incidents of child abuse and neglect (Daro & Harding, 1999). Some research demonstrates that the strength of the worker’s alliance with parents can be significantly predictive of home visitation program completion and decreases in depression for participating mothers, but these findings have little replication (Girvin, DePanfilis, & Daining, 2007). It is important to have a clear understanding of worker-client alliance and how it affects maternal outcomes including program retention and completion so that those working with home visitation interventions can implement programs from an evidence-based perspective, thus increasing efficiency and efficacy of programs. This study hypothesizes a significant relationship exists between Working Alliance Inventory (WAI) scores and Healthy Families Parenting Inventory scores, and that WAI scores predict maternal outcomes from the HFPI. Bivariate correlation analysis determined a significant positive relationship exists between WAI scores and home visitation completion rates (r=0.320, p= .042), and found no other significant relationships. Regression analysis found WAI scores are predictive home visitation completion. / Dissertation/Thesis / Masters Thesis Social Work 2015

Indiana University-Purdue University Indianapolis (IUPUI) / Child abuse remains a serious health problem in the U.S. Yet, there are preventative programs that can significantly improve the parenting experienced by very young children and result in lower incidence of maltreatment. Home visitation is the most prevalent and successful form of primary prevention. These programs are staffed by home visitors who empower parents and are the lynchpin of home visitation programs. What makes some home visitors excel at this work is the focus of this research. A small, non-random, purposive sample of excellent home visitors and their administrators was used to learn about the personal characteristics of outstanding home visitors. The mixed methods design of this research included qualitative interviews, home visiting situational vignettes, and quantitative tests of personality attributes. The results indicated that this group of outstanding home visitors possessed important similarities. First, the home visitors were effective at forming and maintaining empathic relationships. The variables that facilitate the formation of the therapeutic relationships between home visitor and client include: (a) “good enough empathy” (need not be extraordinarily empathic but at least averagely so), (b) positive regard (showing respect to the families and recognizing that the parent is the expert on their child), and (c) congruence. Secondly, the home visitors possessed self-awareness allowing for reflective practice and forming and maintaining better client relationships. Thirdly, the excellent home visitors possessed an attitude of lifelong learning. Fourthly, the home visitors strongly believed in the ability of their clients to change. This was accomplished by focusing on client strengths. Finally, in order for the home visitors to assist parents in therapeutic change, they had a belief in and understanding of systems theory and the impact that the environment can or has had on those clients. Without an ecological approach, home visitors are likely to blame the families with which they work for their unfortunate situations such as poverty. Each of the five characteristics can be taught and improved, but entrenched beliefs are less easily manipulated. The five characteristics are ordered with the first (effective at forming relationships) the most amenable to change and the last (an ecological approach) the least.

The intent of this thesis was to study, in depth, the experiences of four adolescent mothers who underwent a home intervention program. I studied two mothers who did well with teaching their 12-month old children during play, and two mothers who did not do as well. All four mothers received weekly intervention from the time of their child's birth through 12-months of age. I studied the following variables: 1) how much time the home visitors spent on selected child development and parenting topics; 2) the mother's perceived social support; 3) how many community resources the mother used; and 4) if the infant was healthy and within normal developmental range. All of the mothers struggled in their lives, yet varied in the quality and time of most of the variables. It was striking how different each one was from the other. The implications of the study are important for child development specialists who can use the qualitative data within this document to better understand first time adolescent mothers in order to improve the outcomes of the home visitation services that they provide to mothers and infants. After spending time studying these four adolescent mothers, I would recommend that adolescent women not get pregnant. Adolescence is a time that is meant for experiences and self-discovery and should be spent free from a dependent child who critically needs them. Future research and funding should be spent on preventing adolescent pregnancy and ensuring that flexible curriculum be utilized by the home visitors in order to meet the varying needs of adolescent mothers.

The pastoral visitation practice of Continuing Witness Training (CWT) is theoretically intended to cooperate with God to lead individuals to Christian conversion, but reconciles fewer individuals to God than anticipated. This empirical theological study of Praxis 1 analyzed the visited individuals' (1) perception of care-concern by the visitors, (2) post-visit positive mood, (3) satisfaction with the visit, (4) sense of God's presence in the visit, and (5) decision to pray to establish a relationship with Jesus Christ. in association with (a) the amount of the CWT presentation given, (b) the length of the visit, and (c) prior religious involvement. Greater amounts of the CWT presentation given resulted in greater satisfaction and greater conversion prayer. Longer pastoral visits resulted in greater satisfaction among females and males, in greater conversion prayer in females, and in higher post-visit positive mood in males. Lower prior religious involvement resulted in greater amounts of the CWT model presentation being given to females, and in greater conversion prayer in males. Although 60% of Individuals visited reported no or minimal religious involvement, the complete CWT presentation was given to only 19%, and a substantial portion of CWT was given to an additional 17%. Among this 36% of those visited who received the CWT presentation, 55% decided to pray to establish a personal relationship with Jesus Christ. This situational analysis identified four praxis problems: ( 1) inconsistent application of the CWT model with unchurched individuals, (2) dissatisfaction among 25% of individuals visited, (3) lack of sense of God's presence in the visit reported by 23% of individuals visited, and (4) 31% of those visited being outside the stated unchurched target population for CWT visits. These praxis problems and related findings in the descriplive theological research were addressed by formulating a revised practical theology upon which to base Praxis 2. This revised theology of evangelism incorporated a multi-modal model of pastoral role-fulfillment (inYolving ketygma, didache, and paraklesis) as an agogic situation of primary initiation of a person into the kingdom of God, by proposing multiple contacts within a pastoral theology of care and counseling. / Practical Theology / Th. D. (Practical Theology)